Cooks

Cooks – the vaccine applied to prevention of rage.

Form of release and structure

Cooks are let out in the form of lyophilisate for preparation of solution for intramuscular introduction: white hydroscopic porous weight (in ampoules, on 5 ampoules in a cardboard pack complete with solvent).

Is a part of 1 dose:

• Active agent: the inactivated vaccinal rhabdovirus, a strain of Vnukovo-32 – is not less than 2,5 IU (international units);
• Auxiliary components: sucrose – 75 mg, human albumine – 5 mg, gelatin – 10 mg.

Solvent: water for injections.

Indications to use

• Preventive immunization: for immunization of persons with high risk of infection with rage, including the staff of the laboratories working with a street rhabdovirus, the foresters, veterinary workers, hunters, huntsmen, persons performing works on the contents and catching of animals, and also other professional groups;
• Treatment-and-prophylactic immunization: at contact and stings of people animal (unknown, wild, and also with the confirmed rage or at suspicion on it).

Contraindications

Carrying out preventive immunization is contraindicated in the presence of the following diseases / states:

• Chronic diseases (at an aggravation or a decompensation), acute infectious and noninfectious diseases (drug can be used not earlier than one month after remission (recovery));
• The system allergic reactions to the previous use Kokava which are shown in the form of generalized rash, a Quincke's edema, etc.;
• Pregnancy.

For treatment-and-prophylactic immunization of a contraindication are absent.

Route of administration and dosage

Before use ampoule contents Kokava need to be dissolved in 1 ml of water for injections. Dissolution time – no more than 5 minutes. The ready vaccine represents slightly opalescent or transparent liquid from light yellow to colourless. It is impossible to allow storage of the dissolved vaccine Kokava longer than 5 minutes.

The drug needs to be administered intramusculary slowly in a deltoid muscle of a shoulder, to children 5 years – in an upper part of a perednebokovy surface of a hip are younger (it is impossible to enter into a rump).

The antirabic help represents local processing of grazes, wounds, places of oslyuneniye and scratches with the subsequent introduction of a vaccine of Kokav for prevention of rage or, in cases of existence of indications, introductions with an interval to 30 minutes of immunoglobulin of antirabic (AIG) and Kokava.

And places of oslyuneniye it is desirable to begin local processing of wounds (grazes, scratches, stings) immediately or as soon as possible after damage or a sting. The wound surface is plentifully washed out for several minutes (up to 15 minutes) water with soap or other detergent or, at their absence, a water stream. Edges of a wound after that it is necessary to process 5% spirit solution of iodine or 70% alcohol.

It is necessary to avoid whenever possible suture on wounds. Suture is shown only in the following situations:

• Extensive wounds: after pretreatment of a wound put several directing skin stitches;
• Cosmetic indications (preferential, in a face);
• The bleeding vessels: for a stop of outside bleeding.

In the presence of indications to use of immunoglobulin antirabic, it needs to be used just before suture.

Carrying out treatment-and-prophylactic immunization is begun right after local processing of wounds (damages). All persons who underwent risk of infection with rage are subject to it. In the presence of indications to performing the combined treatment, at first enter AIG and then, with a break to 30 minutes, Kokav.

Before introduction of horse (heterological) AIG it is necessary to check individual sensitivity of the patient to proteins of a horse. The drug should be administered within 3 days after a sting in a dose 40 ME on 1 kg of body weight, but no more than 20 ml. It is not necessary to check sensitivity before use of human (homologous) AIG. The vaccine is entered in a dose 20 ME on 1 kg of body weight.

As it is possible the most part of the recommended dose of AIG it is necessary to infiltrirovat in fabric in the depth of a wound and around it. An unused part of a dose is entered deeply intramusculary into the place, other than introduction of an antirabic vaccine.

At absence of damage of integuments, oslyuneniye of mucous membranes and rabid integuments by animals treatment-and-prophylactic immunization is not carried out.

At an oslyuneniya of the unimpaired integuments, existence of the grazes, scratches, superficial stings of a trunk, the lower and upper extremities (except for the person, the head, brushes, a neck, toes and hands) put with domestic and farm animals in cases if for 10 days of observations the animal remains healthy, after the third injection treatment is stopped. At the laboratory proof of absence of rage at an animal, from this point therapy is cancelled. In all other cases introduction of a vaccine is continued according to the following scheme: 1 ml Kokava in the 0, 3, 7, 14, 30 and 90 day.

At any oslyuneniye of mucous membranes, stings of the person, head, neck, genitalias, brushes and toes and hands, and also at the single or multiple deep avulsive wounds given by farm or domestic animals in cases if for 10 days of observations the animal remains healthy, after the third injection treatment is stopped. At the laboratory proof of absence of rage at an animal, from this point therapy is cancelled. In all other cases appoint a combination therapy: AIG in 0 day and Kokav on 1 ml in the 0, 3, 7, 14, 30 and 90 day.

It is necessary to appoint a course of treatment-and-prophylactic immunization irrespective of circulation period of the victim for the help (even several months later after contact with an animal). For adults and children of a dose and the scheme of treatment-and-prophylactic immunization do not differ.

To persons who received a full course of preventive or treatment-and-prophylactic inoculations earlier and from the moment of its termination there passed no more than 1 year, Kokav appoint for prevention of rage 1 ml in the 0, 3 and 7 day; more than a year – conduct a full treatment-and-prophylactic course.

After the termination of a course of immunization (preventive or treatment-and-prophylactic) issue to vaccinated the reference (the certificate on preventive inoculations) with the indication of series and type of drugs, a course of inoculations and information on postvaccinal reactions.

During all course of inoculations it is necessary to avoid overcooling, overfatigue, overheating. Also throughout all course and six months after its termination it is impossible to take alcohol.

Can result immunodepressants and glucocorticosteroids in inefficiency of vaccinotherapy. Therefore when performing vaccination against the background of reception of these drugs definition of a caption of virus neutralizing antibodies is obligatory. In cases of lack of virus neutralizing antibodies conduct an additional course of introduction of a vaccine according to the scheme 0, 7 and 30 of days.

When carrying out preventive immunization of 1 ml Kokava enter intramusculary into a deltoid muscle of a shoulder in the 0, 7 and 30 day, a revaccination – 1 ml once in year and further each three years.

It is not necessary to apply Kokav at the broken integrity, markings of an ampoule, and also at change of transparency and color of lyophilisate, at the wrong storage and the expired drug period of validity. It is necessary to carry out opening of ampoules and the procedure of vaccination at strict implementation of rules of an asepsis. After the procedure vaccinated it is necessary to be under medical observation not less than 30 minutes.

Side effects

Use Kokava can be followed by development of the following side effects:

• Local reactions: increase in regional lymph nodes, a hyperemia, an itch, reddening, an insignificant swelling, morbidity in the place of an injection;
• General reactions: an indisposition, a headache, weakness, fervescence, system allergic reactions in the form of a Quincke's edema and generalized rash (performing symptomatic therapy and use of the hyposensibilizing means is recommended).

At development of neurologic symptoms of the patient it is necessary to hospitalize urgently.

After introduction of AIG from blood serum of a horse development of the following complications is possible:

• Local allergic reactions (as a rule, come for 1-2 day after administration of drug);
• Serum disease (as a rule, comes for 6-8 day after administration of drug);
• Acute anaphylaxis.

At emergence of anaphylactic reactions carrying out acute management (introduction of Norepinephrinum, Epinephrinum, ephedrine) and further observation in specialized institution is necessary.

At emergence of signs of a serum disease parenteral administration of glucocorticosteroids, drugs of calcium and blockers _{of H1-}of histamine receptors is recommended.

Special instructions

During therapy by the patient it is recommended to avoid control of motor transport and performance of other types of the works demanding high concentration of attention and bystry psychomotor reactions.

Medicinal interaction

It is possible to carry out preventive vaccination not earlier, than in 1 month after vaccination against other infectious diseases.

During performing treatment-and-prophylactic vaccination use of other vaccines is forbidden (it is possible to carry out vaccination by other drugs not earlier, than in 2 months).

Appointment during treatment-and-prophylactic immunization of such drugs as immunodepressants and corticosteroids, it is possible only according to vital indications.

Terms and storage conditions

To store in the place, unavailable to children, at a temperature of 2-8 °C.

Period of validity – 1,5 years.