Archive for Sunday, March 8, 1992

VACCINE

March 8, 1992

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The number of people receiving post-exposure rabies shots at Lawrence Memorial Hospital 15 now is unusually high, according to Dr. Donald Abels, medical director of LMH's emergency department.

In a normal year, he said, the hospital averages perhaps two such patients.

He urged people who are bitten by animals suspected of being rabid to clean out their wounds "real well" with soapy water and have the wound evaluated by a physician.

Most physicians in practice today never have seen an active case of rabies, Abels added, including himself in the group. He said the recent initial rush of post-exposure shots by patients caught the hospital without enough of the rarely used vaccine on hand.

Other vaccine sources in the region were tapped to provide enough of the product to cover the need, though, he said.

PATRICK PARKER, LMH director of pharmacy and intravenous therapy, explained the intent of the vaccine is to prompt the body's own immune response.

He said there were three different regimens. One, a three-dose, pre-exposure series, is given to veterinarians and other people who are most likely to come into contact with the virus in their work.

Another is a booster regimen, given to those who have received the pre-exposure series if they are bitten.

The third is for people who are not normally exposed to the virus but who have been bitten by an animal with either confirmed or suspected rabies. This is the series most people now are receiving at LMH.

Parker said the third regimen involved two products the vaccine itself, which is given in five doses over a 28-day period, and rabies immune globulin, which is actually antibodies and which is given along with the initial vaccine shot.

THE VACCINE provides "active" immunity, Parker explained, meaning it prompts the body to make antibodies, while the rabies immune globulin provides "passive" immunity which protects until the body's "active" immunity builds to an adequate level.

The rabies immune globulin, Parker said, is "prepared from the blood of people hypersensitized to rabies," and because it is human-based, those who receive it suffer few adverse reactions.

The rabies immune globulin shots are the most unpleasant aspect of the series, though, Parker said, because of the large volume that must be given.

Two adults who recently received the shots underwent three and four of the rabies immune globulin shots, respectively, along with the vaccine shot.

Overall, though, Parker said, "the injections are not like the horror stories of the past."

PREVIOUSLY, a longer series of shots was given in the stomach.

Today, most reactions to the newer vaccine involve mild fever and soreness at the injection site.

Dr. Elliot Goldstein, director of the Division of Infections Diseases at the Kansas University Medical Center, agreed.

"The shots are very safe now," he said, noting only that people who are hypersensitive to the rabies virus should not receive the shots again.

Goldstein said that, like Abels, he had never personally seen a case of rabies in his 25 years in infectious diseases.

He added, though, that recently he was in Mexico City where they do have active rabies cases. There, he said, he learned doctors use products made from inactive nerve tissue of suckling mice to protect people against the disease rather than the more advanced human-based product because of the cost involved.

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