Rabies Preparedness: Plasma-derived Hyperimmune, Immunoglobulin & Vaccine Solutions | FFF Enterprises

Days are getting longer, and temperatures are becoming more hospitable for outdoor fun. Summertime conjures feelings of excitement as many start to plan for more outdoor activities, hobbies, and trips.

However, this time of year also can bring with it increased risks for both humans and their pets, including the potential to contract rabies — a viral disease transmitted through a bite or scratch that can result in death if treatment is not received before symptoms appear, according to the US Centers for Disease Control and Prevention (CDC). The CDC states 60,000 Americans receive rabies post-exposure treatment every year.

Animal Bites and Rabies Risk

Summer is considered peak rabies season since more people are interacting with the great outdoors, which can lead to additional encounters with wild and stray animals that could potentially be carrying rabies. Camping at a favorite lake, enjoying a barbeque in a local park or simply gardening in the backyard could include an interaction with a rabid animal.

It's important for healthcare facilities to be proactively prepared for patients concerned about bites they receive this summer. Emergency rooms and clinics should be stocked with at least the first administrations of immunoglobulin and rabies vaccine for multiple people on any given day during the high-risk season. Follow-up vaccine doses can be ordered based on the number of people affected on any given day.

The two essential components of rabies post-exposure prophylaxis (PEP) include rabies immune globulin (RIG) and rabies vaccines.

Rabies Risk & Seasonal Trends: Why Summer Matters

While in some places increasing temperatures means more time indoors in air-conditioning, summertime in a lot of areas around the US equates with more time outside enjoying rivers, lakes, local forests and parks.

Jacqueline David, RN — senior territory manager for FFF Enterprises and formerly employed by Bayer Biologicals, makers of rabies immune globulin products — is a resident of Palm Beach Gardens in Florida. The 30-year RN is an animal lover with two dogs of her own.

"Something connected, and that was it for me," David said regarding her love for animals. She is a believer in rescue, especially when it comes to senior dogs.

David understands that living with wildlife in an urban area is a unique balance: "We are in their homes," said David, who also is involved with the nearby Busch Wildlife Sanctuary in Jupiter, FL, helping to report or to transfer ill or injured wildlife in the community.

As a registered nurse, David knows how to take the necessary precautions to reduce rabies risk for herself and her dogs. Living in a state with a lot of wildlife as well as ongoing new development and population growth brings challenges regarding how best to deal with wildlife as it becomes displaced.

David always makes sure to:

• vaccinate her dogs according to county guidelines (*and per local veterinarians).
• scan outdoor areas for snakes and/or other wildlife before letting her dogs go outside.
• never put her hand in ponds or lakes, especially in Florida where there are extra concerns about snakes and alligators.
• follow leash laws.
• only pet other dogs with the permission of the owner and never near its face or head, since the dog's temperament is unknown.
• always have extra towels, gloves and leashes in the car in case you choose to handle an injured animal.
• call the police non-emergency line, Animal Care and Control, or your local wildlife center if you see an injured or stray animal.
• stay away from animals acting erratically, walking alone (especially when they typically roam in packs), walking staggered or foaming at the mouth.
• remember that if raccoons are seen in the daytime, it doesn't necessarily mean they have rabies. Often, they are reacting to being displaced from their homes due to building development.

According to the CDC, rabies symptoms in animals include:

• Abnormal behavior
• Fever
• Weakness
• Self-mutilation
• Paralysis
• Seizures
• Excessive salivation
• Aggression

Wildlife that commonly carries rabies include:

• Bats (*The CDC says infected bats are the leading cause of human rabies deaths in the US. At least 7 out of 10 US rabies deaths were due to infected bats.)
• Raccoons
• Skunks
• Foxes

David said it's important to keep in mind that rabies isn't in every animal. Additionally, the CDC says rabid dogs in the US are uncommon, though precautions should always be taken with any unknown dog. Over 90 percent of reported rabies cases in animals occur in wildlife in the US, according to the CDC.

However, if someone does get bitten by a dog or you find a random bite mark from an unknown source, David recommends going to the emergency room immediately.

Rabies symptoms typically show up quickly, David said, so it's important to get to a hospital for medical care before they show up after potential exposure.

"If you are bitten by any type of animal, go to the ER," she said. "Better to be safe than sorry."

Said David:

"[If left untreated], there's no cure for it. … It's fatal. You need to go to the emergency room if you're bitten."

The Two-Part Protocol: Immune Globulin + Vaccine

As emphasized by David, it is important to go to the emergency room immediately to receive medical treatment following a bite from an animal, whether it's a dog or wildlife.

According to the CDC, treatment for previously unvaccinated individuals includes receiving rabies post-exposure prophylaxis (PEP), which will include wound washing as well as a dose of human rabies immune globulin (HRIG) and the first dose of a four-dose series of rabies vaccines. *The CDC states wound cleaning with water or a dilute water povidone-iodine solution is especially important in rabies cases. Animal studies have shown that wound cleaning alone without PEP helps to "markedly reduce the likelihood of rabies."

It is considered Day 0 when you receive your first rabies immune globulin and first rabies vaccine dose. Follow-up vaccines will be administered on days 3, 7 and 14. Note: A fifth does on day 21 will be necessary for those with a suspected or confirmed immune disorder or are immunocompromised. The CDC says they will also need serological confirmation that they responded adequately to vaccination.

It is important to receive this first day treatment before symptoms begin showing. Symptoms begin once the virus has traveled to the brain. The incubation period can last weeks to months depending on severity of exposure, age of the individual, location of the bite (i.e., how far away from the brain), and if the person every received a rabies vaccine prior to the bite, according to the CDC. The first symptoms are called prodrome and will be flu-like.

Rabies symptoms in humans include:

• Weakness
• Discomfort
• Fever
• Headache
• Itching/prickling/discomfort in the bite wound

Severe disease appears within two weeks of the first symptoms, the CDC states. It can then cause brain dysfunction and involve anxiety, delirium, confusion, agitation, insomnia, hallucinations, hypersalivation, seizures and hydrophobia (fear of water).

Rabies is almost always fatal once symptoms occur. The CDC says fewer than 20 cases of human survival from clinical rabies have been recorded.

It is essential for healthcare facilities to have access to both rabies immune globulin and rabies vaccine for optimal patient outcome and for protocol compliance.

Plasma-Derived Rabies Immune Globulin Products

Human rabies immune globulin (HRIG) is administered only once and at the beginning of PEP. It is only given to previously unvaccinated individuals. Immune globulin provides immediate immunity by supplying antibodies to fight the rabies virus. The vaccine, administered afterwards, will help the body to produce its own antibodies to fight off the virus in due time. This process is safe for all age groups.

HRIG is derived from the pooled plasma of human donors who have been hyperimmunized with rabies vaccine. Plasma donation remains highly important to continue producing products like HRIG.

Examples of HRIG that are ready and available to ship through FFF include:

• HyperRAB^® (Grifols), available through FFF on BioSupply^®

HyperRAB^® by Grifols is a high-potency human rabies immune globulin that allows for the delivery of more of the total dose per mL at the wound site, regardless of the bite size or patient's weight, according to their website. It is available in 1 mL, 3 mL, and 5 mL vial sizes. It has a 3-year shelf life.

• KEDRAB^® (Kedrion Biopharma), available through FFF on BioSupply^®

KEDRAB^® is derived from human plasma collected from donors who are hyper-immunized with rabies vaccine. It is a sterile, non-pyrogenic aqueous solution of anti-rabies immunoglobulin. Each package of KEDRAB contains a single-dose vial containing 2 mL or 10 mL of ready-to-use solution. The 2-mL vial contains a total of 300 IU, which is sufficient for a child that weighs 33 pounds. It is preservative-free, latex-free, pyrogen-free and sterile.

Rabies Vaccines for Long-Term Protection

Rabies vaccine helps the body to produce its own antibodies to thus build active immunity over time. It must be administered alongside a rabies immune globulin in previously unvaccinated individuals on Day 0 for optimal coverage.

Examples of rabies vaccine include:

• RabAvert^® (Bavarian Nordic), available through FFF on BioSupply^®

RabAvert^® is a sterile, freeze-dried vaccine obtained by growing the fixed-virus strain Flury Low Egg Passage (LEP) in primary cultures of chicken fibroblast. It is available in a pre-filled syringe.

• IMOVAX^® Rabies (Sanofi Pasteur), available through FFF on BioSupply^®

IMOVAX Rabies is a human diploid cell vaccine.

Clinical Preparedness: Stocking for Rabies Season

Sadie Cox-Hogue — PharmD, MHA, MS, and assistant vice president of strategic accounts for FFF Enterprises — is a former Director of Pharmacy for 14 years at Bonheur Children's Hospital in Memphis, Tenn. She is the owner of three dogs.

Cox-Hogue encourages everyone to use their best judgment when it comes to stray animals and wildlife this summer.

"If you find yourself outdoors, it is best to watch wildlife from afar," she said.

As a former director of pharmacy for a large hospital, Cox-Hogue recommends that healthcare facilities make sure they always have rabies immune globulin and vaccine on hand.

"It's sort of trial and error. Rabies immune globulin and vaccine are good examples of how you really can't predict how much to have on hand, but it's better to have some than none at all," she said.

Working with reliable, longtime distributors like FFF Enterprises ensures uninterrupted access to rabies immune globulin and rabies vaccines.

Protecting Patients Starts with Being Prepared

It's important to keep the potential for summer rabies exposure in mind.

"People don't think that it can happen," David said regarding the possibility of contracting rabies from wildlife or stray animals.

Yet the risks increase with more time spent outdoors. It's extremely important to go to the emergency room if an animal bite occurs. Receiving post-exposure prophylaxis (PEP) before the virus moves into the brain is critical.

Healthcare facilities should have multiple doses of immune globulin and rabies vaccine on hand.

FFF Enterprises remains a reliable partner for hospitals, clinics and all healthcare professionals, providing ready-to-ship, plasma-derived rabies immune globulin and rabies vaccines.

Contact Wow! Customer Care today to order or to learn more about how we can help provide essential rabies post-exposure treatment. Call (800) 843-7477 for 24/7 ordering support. Together, we are Helping Healthcare Care^®.

Available Now through FFF Enterprises