Equirab anti rabies equine antibody for post exposure prophylaxis

Equirab is an anti rabies equine antibody for post exposure prophylaxis. Rabies is a deadly disease and it is spread from animals to humans when infected animals bite humans.

As its name implies these antibodies are prepared from horse serum.

There is no cure for this disease. Death is almost certain when someone suffers from the rabies disease. Rabies vaccination is the only thing that can prevent Rabies disease.

The animal can be asymptomatic at the time of the bite but may be carrying a virus in the saliva. It can also spread the virus by scratch also.

In which form Equirab is available?

Equirab is available in the form of ready to inject sterile liquid for injection.

It is packed in an opaque box to protect it from light.

It is available as 300 IU/ml power of 4 ml or 5 ml packages.

In some countries it is distributed as 1000 IU package of strength 200 IU/ml.

How to store Equirab vaccine (Human IP)?

Store Equirab at temperature range 2 – 8 degree Celsius as recommended by the manufacturer.

Maintain the temperature range at all stages of transport and storage using cold chains. Strictly maintain temperature range. 

Discard if frozen accidentally.

While discarding this product all the local biomedical waste management protocols should be followed to protect the environment.

How to reconstitute Equirab?

Equirab is ready to inject vial and the required dose is sucked into the sterile syringe depending on weight of the patient.

How is the Equirab vaccine (Human IP) given?

Give Equirab anti rabies antibody by injection.

In small children, give it on the thigh anterolateral aspect.

In adolescents and adults, give it in the deltoid muscle.

The dose of 40 IU/kg body weight is given to cat 3 wound and immunocompromised patients cat 2 and cat 3 wound.

Half the calculated dose should be given into the animal bite wound and give half systemically.

Follow all the safety injection precautions while injection.

Discard the disposables per the biomedical waste management protocols.

Do not use expired vaccines and discard it as per biomedical waste management protocol to protect the environment.

What is the schedule for Equirab Anti Rabies antibodies?

For post exposure prophylaxis, give injection in the following schedule. The need of the Rabieshield vaccine together depends upon the category of bite wound.

CategoryType of contactType of exposureRecommended post exposure prophylaxis
ITouching or feeding of animalsLicks on intact skinNoneNone if reliable case history is available.
IINibbling on uncovered skinMinor scratches or abrasion without bleedingMinorWound management and antirabies vaccine.
IISingle or multiple trans-dermal bites or scratches, licks on broken skin Contamination of the mucous membrane with saliva.SevereWound management + Antirabies immunoglobulin + Antirabies vaccine
Category of animal bites

Category of dog bite wound

  • For intradermal route, Administer 4 doses, 2 injections of 0.1 ml at 2 different sites as per the updated thai red cross regimen (2-2-2-0-2) as given above.
  • In those previously immunized by complete vaccination schedule (pre or post exposure prophylaxis), give 2 doses of 0.5 ml by intramuscular route or 2 doses of 0.1 ml by intradermal route on day 0 and 3.
  • In cases of category 3 exposures and of category 2 exposure in immunodeficient patients, human rabies immunoglobulin or equine rabies immunoglobulin should be given with Equirab vaccine.
  • Do not administer immunoglobulin later than 7 days after the first vaccination since later administered would result in interference with immune response of the vaccine.
RouteDoseNumber of dosesSchedule
Intramuscular0.5 ml5Day 0, 3, 7, 14 and 28
Intradermal0.1 ml+0.1 ml4Day 0, 3, 7 and 28
Rabies vaccine schedule Post exposure

Post exposure prophylaxis

What are side effects of the Equirab anti rabies antibodies?

Equirab vaccine prevents deadly rabies disease. The side effects are usually milder and usually self resolving and can be managed at home.

  • Fever.
  • Injection site pain.
  • Irritability.
  • Headache.
  • Asthenia.
  • Shivering.
  • Dizziness.
  • Myalgia.
  • Nausea.
  • Abdominal pain.
  • Arthralgia.
  • Like every other vaccine anaphylaxis allergic reaction can occur after this vaccine though extremely rare I should be managed swiftly. The necessary skilled personnel, drugs and equipment should be available at the time of the vaccination.

What are the warnings and precautions while taking the Equirab vaccine?

  • Corticosteroids, chloroquine and other immunosuppressive treatments can interfere with the immune response of vaccines and lead to failure of the vaccination.
  • Administer Equirab anti rabies antibody at different sites than that from vaccines.
  • Do not exceed the recommended dose of Equirab.
  • Do not administer repeated doses of the Anti rabies antibody once the vaccination course has been started.
  • Higher dose of immunoglobulin could interfere with the immune response to rabies vaccine.
  • The person who is hypersensitive may get anaphylaxis reaction with these antibodies though it contains a very small amount of neomycin. The vaccine should be given with precaution in such a person as rabies is deadlier.
  • The safety of Equirab in pregnancy is not known but it is used as Rabies disease is itself lathal.

Hypersensitivity skin test

Some people may get severe hypersensitivity and anaphylactic reaction with Equirab.

Before injecting this anti rabies antibody, do a skin test.

1:100 dilution of the Equirab injection is injected intradermal to an arm 0.02 ml.

Similar control of normal saline is injected on the other arm.

The reading is taken after 15-10 minutes of injection.

If > 10 mm wheal appears at the test site, the patient is allergic to Equirab anti rabies antibodies.

What if a skin test indicates allergy to this injection?

Allergy to injection on skin test is not itself an absolute contraindication to the injection considering the grave prognosis of Rabies disease.

Patient should be given Rabishield injection or given Equirab cautiously at facility which is equipped to manage the anaphylaxis.

<span class="has-inline-color has-luminous-vivid-orange-color">Dr Yatin Bhole MBBS DCh DNB</span>
Dr Yatin Bhole MBBS DCh DNB

This article was written by Dr Yatin Bhole who is practicing Pediatrician at Bhole Children Clinic, Ravet. This post is for general information and before applying it on yourself, you should meet your doctor or meet us in person.

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