Should Favipiravir be Used as an Additional Drug in Case of Severe Animal Bites on the Face Especially into the Eyes/ Lips or Aerosol Exposure to Rabies Virus to Prevent Rabies PEP Failures?
Abstract
Rabies is a zoonotic viral disease that affects the central nervous system leading to respiratory or cardiac failure. Dogs are a major source of rabies infection in human beings. Rabies is 100% fatal but largely preventable if proper and timely Post-Exposure Prophylaxis (PEP) is availed in the form of immediate wound wash with soap and water and injections of vaccine and rabies immunoglobulins, the first week being the most important. Here we describe four cases of PEP failure despite complete prophylaxis with vaccine and Rabies Immunoglobulins (RIG) over the past year in Himachal Pradesh. All failures were due to suspected rabid dog bites on the face, especially on cheeks, lips, or eyes where complete infiltration of RIG may not have been possible leading to PEP failure. We, after extensive research and discussion, are of the opinion that in such situations, we may add another viricidal oral drug favipiravir along with rabies PEP that could help prevent PEP failures in situations where complete RIG infiltration into wounds is difficult to achieve.
DOI: https://doi.org/10.24321/2349.7181.202211
How to cite this article:
Bharti OK, Bansal A, Mehta U. Should Favipiravir be Used as an Additional Drug in Case of Severe Animal Bites on the Face Especially into the Eyes/ Lips or Aerosol Exposure to Rabies Virus to Prevent Rabies PEP Failures? J Adv Res Med. 2022;9(2):27-30.
References
Bharti OK. Rabies. In: Choudhury J, editor. Textbook of pediatric infectious diseases (IAP) [Internet]. 3rd ed. Jaypee Brothers Medical Publishers; 2022 [2022 Aug 25]. Available from: https://www.meripustak.com/Textbook-Of-Pediatric-Infectious-Diseases-IAP3rd-Edition-388995
Whitehouse ER, Mandra A, Bonwitt J, Beasley EA, Taliano J, Rao AK. Human rabies despite post-exposure prophylaxis: a systematic review of fatal breakthrough infections after zoonotic exposures. Lancet Infect Dis. 2022 Dec;S1473-3099(22)00641-7. [PubMed] [Google Scholar]
Scholand SJ, Quiambao BP, Rupprecht CE. Time to revise the WHO categories for severe rabies virus exposures-category IV? Viruses. 2022;14(5):1111. [PubMed] [Google Scholar]
Bharti OK, Madhusudana SN, Wilde H. Injecting rabies immunoglobulin (RIG) into wounds only: a significant saving of lives and costly RIG. Hum Vaccin Immunother. 2017;13(4):762-5. [PubMed] [Google Scholar]
Bharti OK, Madhusudana SN, Gaunta PL, Belludi AY. Local infiltration of rabies immunoglobulins without systemic intramuscular administration: an alternative cost effective approach for passive immunization against rabies. Hum Vaccin Immunother. 2016;12(3):837-42. [PubMed] [Google Scholar]
Bharti OK, Tekta D, Shandil A, Sharma K, Kapila P. Failure of postexposure prophylaxis in a girl child attacked by rabid dog severing her facial nerve causing possible direct entry of rabies virus into the facial nerve. Hum Vaccin Immunother. 2019;15(11):2612-4. [PubMed] [Google Scholar]
Shewale A, Nale T, Daptardar M, Tiwari S. A case for pre-exposure prophylaxis of high-risk groups against rabies in India. J Commun Dis. 2021;53(1):110-6. [Google Scholar]
Sujatha P. Cost analysis of rabies prophylaxis in India. Int J Community Med Public Health. 2020 Sep;7(9):3403-8.
Royal A, John D, Bharti O, Tanwar R, Bhagat DK, Padmawati RS, Chaudhary V, Umapathi R, Bhadola P, Utarini A. A cost-effectiveness analysis of pre-exposure prophylaxis to avert rabies deaths in school-aged children in India. Vaccines (Basel). 2022;11(1):88. [PubMed] [Google Scholar]
Joshi S, Parkar J, Ansari A, Vora A, Talwar D, Tiwaskar M, Patil S, Barkate H. Role of favipiravir in the treatment of COVID-19. Int J Infect Dis. 2021;102:501-8. [PubMed] [Google Scholar]
Kimitsuki K, Khan S, Kaimori R, Yahiro T, Saito N, Yamada K, Nakajima N, Komeno T, Furuta Y, Quiambao BP, Virojanapirom P, Hemachudha T, Nishizono A. Implications of the antiviral drug favipiravir on rabies immunoglobulin for post-exposure prophylaxis of rabies in mice model with category III-like exposures. Antiviral Res. 2022;209:105489. [PubMed] [Google Scholar]
Adis Insight [Internet]. Favipiravir - FUJIFILM Toyama Chemical; [2022 Aug 25]. Available from: https://adisinsight.springer.com/drugs/800014667
Tejaswi P, Devashish K, Prasad RR. Pharmacological effects of favipiravir on coronavirus: an update. Biomed Pharmacol J. 2021;14(2). [Google Scholar]
Guzman FD, Iwamoto Y, Saito N, Salva EP, Dimaano EM, Nishizono A, Suzuki M, Oloko O, Ariyoshi K, Smith C, Parry CM, Solante RM. Clinical, epidemiological, and spatial features of human rabies cases in Metro Manila, the Philippines from 2006 to 2015. PLoS Negl Trop Dis. 2022;16(7):e0010595. [PubMed] [Google Scholar]
Bharti O, Thakur B, Rao R. Wound-only injection of rabies immunoglobulin (RIG) saves lives and costs less than a dollar per patient by “pooling strategyâ€. Vaccine. 2019;37 Suppl 1:A128-31. [PubMed] [Google Scholar]
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