Order KEDRAB Now
Interested in ordering KEDRAB? Learn how.
Enroll for Rabies Updates
If you are interested in receiving the most current information about KEDRAB HRIG, proper rabies PEP, and RABV, as well as educational rabies resources, enroll now.
Formulary Monograph
Download the KEDRAB Formulary Monograph for detailed information about RABV, the efficacy and safety of KEDRAB, and why an HRIG, such as KEDRAB, is a crucial component of PEP.
RABIES VIRUS (RABV): STILL DEADLY AFTER 5000 YEARS2
Every year, about 40,000 people in the US receive rabies prevention, called post-exposure prophylaxis (PEP), because they had contact with a potentially rabid animal3
The Capacity of Rabies to Kill 99.9% of the People Infected4 Makes it One of the Deadliest Diseases in the World5
Death is inevitable following the onset of clinical symptoms,6 but 100% preventable if the rabies virus is treated promptly and properly.7
- Once rabies enters the central nervous system, it is almost 100% fatal4
- Globally, an estimated 59,000 people die every year of rabies, which is a staggering 160 people a day6
- The rabies disease costs global economies $8.6 billion annually6
Treating Patients Exposed to RABV: a Limited Window of Opportunity After Exposure
There is a variable incubation period between exposure to RABV and the appearance of symptoms. This interval typically lasts 1 to 3 months. However, it may vary from 5 days to >2 years.8 KEDRAB should be given as soon as possible after exposure, but no later than seven days after the first dose of vaccine.1
Once symptoms appear, death is all but certain.6 Prompt and proper delivery of PEP can save the life of the person exposed to rabies.
WHAT CONSTITUTES PROPER POST-EXPOSURE PROPHYLAXIS (PEP)?
PEP Is Crucial in Preventing Rabies
The following 3 components of PEP are highly effective in preventing human rabies in exposed patients who have not been previously vaccinated against the virus.8
Proper PEP consists of the following:
WOUND CLEANSING
All PEP should begin with immediate and thorough cleansing of all bite wounds with soap and water, including a virucidal agent.1
ADMINISTRATION OF HRIG
An HRIG, such as KEDRAB, is administered to previously unvaccinated persons to provide immediate rabies virus-neutralizing antibodies (passive immunization) until the patient responds to the vaccine.9 KEDRAB should be given as soon as possible after exposure, but no later than seven days after the first dose of vaccine. Do not administer into the same anatomical site(s) as rabies vaccine.1
VACCINATION AGAINST THE RABIES VIRUS
Rabies vaccine stimulates the patient’s immune system to produce virus-neutralizing antibodies (active immunization), which occurs approximately 7-10 days after initiation of the vaccine series.8
HOW KEDRAB HRIG WORKS IMMEDIATELY TO STOP RABV FROM SPREADING1
Adapted from Health and Disease Blog 2013.10
RABV Is Too Powerful for the Human Immune System to Fight11
Administration of KEDRAB HRIG, a biologic, thwarts the advance of RABV into the bite victim’s central nervous system long enough for the vaccine to boost the victim’s own natural immune response. The combination of HRIG and rabies vaccine is highly effective.8 In a 2016 animal study, 100% of animals exposed to rabies survived after administration of both HRIG and rabies vaccines. In this same study, 80% of animals survived when HRIG alone was administered, whereas 20% of the animals survived with vaccine alone.12
Because the incubation period for rabies in a given person cannot be readily predicted,13 delivering antiviral antibodies with an HRIG, such as KEDRAB, as soon as possible after exposure is recommended, as delays are potentially lethal.1
MANUFACTURING AND SAFETY
KEDRAB is a sterile, non-pyrogenic aqueous solution with a nominal potency of 150 IU/mL of anti-rabies immune globulin (human).1 It is prepared from human plasma from a pool of plasma collected from selected adult human donors who have been hyperimmunized with rabies vaccine and have developed high titers of anti-rabies antibody.1,14
Three Proprietary Viral Inactivation and Removal Steps
Three specific viral inactivation/removal steps are employed in the manufacture of KEDRAB:
1) Treatment with solvent/detergent (S/D) for inactivation of enveloped viral agents1
2) Heat treatment (pasteurization) for inactivation of both enveloped and non-enveloped viruses1
3) Nanofiltration using Planova™ 20N filters for the size-exclusion of both lipid-enveloped and non-enveloped viruses1,14
KEDRAB is derived from human plasma; therefore, the potential exists that KEDRAB administration may transmit infectious agents such as viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent.1
Additional Purification Steps
Additional steps to the purification process for KEDRAB include euglobulin precipitation and ion exchange chromatography.14
References: 1. KEDRAB [package insert]. Fort Lee, NJ: Kedrion Biopharma Inc.; 2017. 2. Lackay SN, Kuang Y, Fu ZF. Rabies in small animals. Vet Clin North Am Small Anim Pract. 2008;38(4):851-861. 3. Centers for Disease Control and Prevention. The burden of rabies. https://www.cdc.gov/Features/dsRabies/index.html. Updated September 26, 2016. Accessed June 30, 2017. 4. Rupprecht C, Kuzmin I, Meslin F. Lyssaviruses and rabies: current conundrums, concerns, contradictions and controversies. F1000Research. 2017;6(F1000 Faculty Rev):184. doi:10.12688/f1000research.10416.1. 5. Fooks AR, Banyard AC, Horton DL, Johnson N, McElhinney LM, Jackson AC. Current status of rabies and prospects for elimination. Lancet. 2014;384:1389-1399. 6. Hampson K, Coudeville L, Lembo T, et al. Global Alliance for Rabies Control Partners for Rabies Prevention. Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis. 2015;9(4):e0003709. 7. Abela-Ridder B. Rabies: 100 percent fatal, 100 percent preventable. Vet Rec. 2015;177(6):148-149. 8. Centers for Disease Control and Prevention. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2010;59(2):1-9. 9. Centers for Disease Control and Prevention. Human Rabies Prevention–United States, 2008 Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2008;57(RR-3):1-28. 10. Health and Disease Blog. Rabies virus: properties, mode of transmission, pathogenesis, types, prevention, vaccination, lab diagnosis. http://www.healthdiseaseblog.com/2013/02/rabies-virus-properties-disease-transmission-pathogenesis-neurotrophicvirus-types-of-rabies-virus-street-virus-fixed-virus-vaccine-lab-diagnosis.html. Accessed June 12, 2017. 11. Scott TP, Nel LH. Subversion of the immune response by rabies virus. Viruses. 2016;8(8):E231. 12. Zhang Y, Zhang S, Li L, et al. Ineffectiveness of rabies vaccination alone for postexposure protection against rabies infection in animal models. Antiviral Res. 2016;135:56-61. 13. Dimaano EM, Scholand SJ, Alera MTP, Belandres DB. Clinical and epidemiological features of human rabies cases in the Philippines: a review from 1987 to 2006. Int J Infect Dis. 2011;15(7):e495-e499. 14. Data on file. Kamada Ltd.
Enroll for Rabies Updates
If you are interested in receiving the most current information about KEDRAB HRIG, proper PEP, and the rabies virus (RABV), as well as educational rabies resources, enroll now.