Human diploid cell rabies vaccine is an inactivated vaccine prepared from the rabies virus grown in human diploid cell cultures then dissolved in tributyl phosphate and inactivated a second time with b-propiolactone.
108/100000-87/100000 type III reactions
9/100000 type I reactions
In some reports, type III reactions occurred in 6% of immunized individuals boosted with the current HDC rabies vaccine.
Booster doses for type III reactions.
Type I: within minutes or hours after a dose of HDCV: bronchospasm, laryngeal edema, generalized pruritic rash, urticaria or angioedema.
Type III: occurring 2 to 21 days after a dose or doses of HDCV: generalized pruritic rash or urticaria, arthralgias, arthritis, angioedema, nausea, vomiting, fever and malaise.
Cutaneous testing: positive tests to vaccine and mock vaccine.
Specific IgE (immunofluorescence): the specificity of this method has been confirmed by solid phase binding of the vaccine to antigens (19 out of 21 cases of urticaria).
Type I hypersensitivity.
Type III hypersensitivity.
The principal antigen implicated in the IgE-mediated response is a modified protein component of the vaccine: a b-propiolactone - human serum albumin (BPL-HSA) complex formed during preparation of the vaccine.
Some individuals produce a dual reaction (IgG and IgE) against BPL-HSA and fetal calf serum.
The new HDC rabies vaccine, Lyssavac-HDC Berna is safer (no type III hypersensitivity reactions).
The vaccine should be prepared without b-propiolactone (inactivation with formalin or tributylphosphate only).
Boosters should only be administered to risk-group patients
The use of the intradermal route for both primary and booster injections may result in lower rates of reactions.