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VERORAB can be administered to children and adults using the same posology.
Always use exactly as the doctor has instructed. Check with the doctor or pharmacist if not sure.
Pre-exposure vaccination: Three doses of 0.5 mL of VERORAB are administered at D0, D7, and D28 for primary vaccination.The dose scheduled at D28 can be administered at D21.
Booster doses and regular serological tests, to assess the subjects' seroconversion status, are recommended. The frequency of booster doses and serological tests is indicated in Table 1.
Each booster dose consists in the administration of one dose of 0.5 mL. (See Table 1.)
Click on icon to see table/diagram/imageFor immunodeficient subjects, a serological test should be performed 2 to 4 weeks after vaccination. If the test result shows antibody titers strictly below 0.5 IU/mL, an additional injection is justified.
Intradermal Route: Primary-vaccination: As according to WHO, VERORAB may be given intradermally (0.1 ml dose on day 0, D7 and D21 or D28). However, intramuscular injections are preferable if antimalarial chemoprophylaxis (e.g. chloroquine) is being used concurrently or there is a possibility of an immune-compromised state (antibody response may be impaired if the intradermal method is used).
Post-exposure vaccination: Post-exposure treatment includes local non-specific treatment of the wound, vaccination and passive immunisation with rabies immunoglobulins. The treatment should be adapted to the nature of the contact or of the wound (see Table 2), the condition of the animal (see Table 3) and the patient's rabies vaccination status.
First Aid: local treatment of the wound: Local treatment of all bites and scratches is very important and must be performed immediately.
First aid recommendations include immediate flushing out of the wound for at least 15 minutes with water and soap, detergent, povidone iodine or any other substance with a proven destructive action on the rabies virus.
If necessary, the treatment can be supplemented by the administration of a prophylactic tetanus treatment and an antibiotherapy in order to prevent the development of infections other than rabies.
Vaccination: Post-exposure vaccination must be performed under medical supervision, only in a rabies centre and as soon as possible following exposure. (See Tables 2 and 3.)
Click on icon to see table/diagram/image
Click on icon to see table/diagram/imageIntradermal Route: Intradermal schedule: This vaccine is of sufficient potency to allow its safe use in the WHO recommended intradermal post-exposure regimen in countries where relevant national authorities have approved the intradermal route for rabies post-exposure treatment.
If VERORAB is administered by the intradermal route, the following instructions and warnings must be strictly adhered to.
Vaccination of non-immunised subjects (subjects who did not receive pre-exposure vaccination): Five doses of 0.5 mL of VERORAB are administered at D0, D3, D7, D14 and D28.
Vaccination must not be discontinued unless made possible by the animal's health status (see Table 3).
Rabies immunoglobulins should be administered at D0 concomitantly with the vaccine, in case of category III exposure (WHO classification, see Table 2). The rabies immunoglobulins posology is as follows: Human rabies immunoglobulins 20 IU/kg of body weight.
Equine rabies immunoglobulins 40 IU/kg of body weight.
For more information, please see the package leaflet of the rabies immunoglobulins used.
When possible, the vaccine should be administered contra-laterally to the immunoglobulins administration sites.
For immunodeficient subjects, in the case of Category II exposure (WHO Classification, see Table 2), rabies immunoglobulins should also be administered concomitantly with the vaccine.
Vaccination of subjects already immunized (full pre-exposure vaccination confirmed): If pre-exposure vaccination was performed less than 5 years before (cell culture rabies vaccine): two booster doses are administered at D0 and D3. Rabies immunoglobulins are not necessary.
This does not apply to immunodeficient subjects.
If pre-exposure vaccination was performed more than 5 years before, if it is incomplete or in case of doubt, the subject's vaccination status is not considered as complete and a full post-exposure treatment should be started (see Vaccination of non-immunised subjects in the previous text).
If the patient is immunodeficient, a full post-exposure treatment should also be started (see Vaccination of non-immunised subjects in the previous text).
Method of Administration: The vaccine is administered by the intramuscular route, generally in the anterolateral region of the thigh muscle until the age of 12 months and inthe deltoid muscle after this age.
The intradermal (ID) injection may be used as an alternative, on upper or forearm (1) and approved by national health authorities in some countries such as Thailand. Please refer to the ID Route as follows.
VERORAB must not be injected in the buttocks region.
The vaccine must not be injected via the intravascular route.
Intradermal Route: Dosage and administration for intradermal route: One intradermal dose comprises 0.1 ml of reconstituted vaccine, i.e. 1/5 of the intramuscular dose. For Verorab, the administration schedule recommended by WHO is: Non-immunized individuals: The 2-site Intradermal regimen: 222011 known as original Thai Red Cross Regimen prescribes 1 injection of 0.1 ml at different sites on D0,D3,D7 and 1 injection at one site on D28 (or D30) and D90.
22202 known as updated Thai Red Cross regimen prescribes 1 injection of 0.1 mL at 2 sites on D0, D3, D7, and D28.
Fully immunized individuals: 2 injections on D0, D3. This schedule should not apply to immunocompromised patients.
