Why were rabies vaccines given in the abdomen?

[autumn1971]

Hi everyone,
I was talking to my wife, and I mentioned the old horrors of the rabies injections in ones abdomen. She (works in an ER) wondered why the hell you would ever inject anything into someone's abdomen. The muscle layer is relatively thin, so it's a bad choice for intra-muscular injection; there are a bunch of really important organs just under the muscle layer which would possibly be compromised if one injected a little deeper; and what about the fatties?
Was this a series of subcutaneous injections involving a large enough amount of serum to be really uncomfortable?
Why the abdomen? Why were all other sites not used?

 

[Deetee]

The old duck embryo-derived vaccine had to be given by injection into the abdominal cavity ("intra-peritoneal"). I forget the details, but that was just how it worked - more immunogenic I think with the vaccine type of the day.
They now use a human diploid cell vaccine which is given intramuscularly, so it is usually given in the arm.

 

[Aitch]

They now use a human diploid cell vaccine which is given intramuscularly, so it is usually given in the arm.

And in an episode of House broadcast in the UK in the last few weeks, they showed one of House's minions getting the abdomen injection. Don't tell me a TV programme got it wrong

 

[Deetee]

And in an episode of House broadcast in the UK in the last few weeks, they showed one of House's minions getting the abdomen injection. Don't tell me a TV programme got it wrong

I've never seen anything on "House" that has reflected medical reality, ever.

 

[Mashuna]

I've never seen anything on "House" that has reflected medical reality, ever.

If you want medical accuracy on TV, watch Scrubs.

 

[fls]

If you want medical accuracy on TV, watch Scrubs.

Seconded.

Linda

 

[Ixion]

Rabies vaccinations were given in the abdomen originally because, as DeeTee stated, it was the custom of the time from the development of the duck embryo vaccine. Intraperitoneal macrophages are in high abundance in vertebrates, and served as the first line of defense for picking up the vaccine and mounting an immune response. Now that we have a much greater understanding of immunology, we know that macrophages and dendritic cells exist in most tissues of the body, and thus intramuscular vaccines or subcutaneous injections are usually just as effective or more so than intraperitoneal injections. The thinking of the time was, if it works, then why bother changing it.

We now have a much greater understanding of immunological tissues and cells. Most people know about lymph nodes, being one of the four primary lymphoid tissues where your immune cells do their job. The other three primary immune tissues are your bone marrow, spleen and your thymus. We know that there are also three secondary lymphoid tissues, which have a larger amount of lymphoid cells that the surrounding areas, and they are called the MALT, BALT, and GALT. MALT, BALT, and GALT stand for, respectively, mucus-associated lymphoid tissue, brochial-associated lymphoid tissue, and gut-associated lymphoid tissue. The MALT includes your tonsils, the BALT are a collection of cells in your bronchi, and the GALT is a collection of cells in your small intestines called the Peyer's patch. These are not a singular point of tissue either, but are spread out between your mucosal membranes. Incidentally, the Peyer's patch would be the source of peritoneal macrophages that would be used to mount a response to a rabies vaccine. Thus, Pasteur would have been immunizing utilizing these cells in the gut, but not knowing why it worked.

I could speculate that they related the symptoms of rabies (hydrophobia) as being associated with the stomach, and immunized there because of that, but I don't really know.

 

[autumn1971]

Thanks, Ixion. All the medical sites I looked at mentioned the abdominal series, but had no information as to why. I appreciate the lesson.
Deetee, are you saying that House isn't a true refection of reality?!
I mean, are you saying that my single doctor is not going to make an initial diagnosis, perform a full forensic inspection of my apartment, take samples from me, run the lab tests and do the pathology, then return to perform my surgery?
My wife and I had a running joke when we watched House; Any time a character needed anything at all, for instance, "darn, I ripped my suit" one of us would shout "Chase, sew this man's suit, and tailor it for him", or whatever the applicable task was.

 

[Aitch]

If you want medical accuracy on TV, watch Scrubs.

I do. Only bit that grates is the appalling sentimental homily they always chuck in at the end.

 

[Ixion]

Thanks, Ixion. All the medical sites I looked at mentioned the abdominal series, but had no information as to why. I appreciate the lesson.

I am glad the information helped. I am an immunologist, so it is in my field of study. I hope I wasn't coming across as lecturing, because that wasn't my intent.

As for House, we know that they blow most of the medicine way out of proportion. However, I found a great website hosted by an M.D. that evaluates the medical aspect of the show and I have found it quite informative. House Medical Reviews

 

[Skeptic Ginger]

Hi everyone,
I was talking to my wife, and I mentioned the old horrors of the rabies injections in ones abdomen. She (works in an ER) wondered why the hell you would ever inject anything into someone's abdomen. The muscle layer is relatively thin, so it's a bad choice for intra-muscular injection; there are a bunch of really important organs just under the muscle layer which would possibly be compromised if one injected a little deeper; and what about the fatties?
Was this a series of subcutaneous injections involving a large enough amount of serum to be really uncomfortable?
Why the abdomen? Why were all other sites not used?

Well you learn something new everyday. I thought it was for 23 subq sites as well and have looked and looked with little success for information on this in the past. There was enough info in this thread to finally get closer to the correct answer from a Net source. Still, the info from our forum members here has more than I could find elsewhere. You would think there would be an abundance of info on "why aren't the shots in the stomach anymore", but on the Net there is almost nothing.

Adding to what Ixion said, I tracked down a little more information. The DEV was less effective and required more shots, regardless of the injection site so that accounted for the 23 doses. According to the following more current research, "anatomical studies suggested a role of the mammalian peritoneum in immunological processes", in particular in the "greater omentum" (aka your belly fat pad)

Intraperitoneal immunization of human subjects with tetanus toxoid induces specific antibody-secreting cells in the peritoneal cavity and in the circulation, but fails to elicit a secretory IgA response.

Milky spots in the human greater omentum were first described by Seitert in 1921.[2]...in.. animals.. consist of an accumulation of macrophages and lymphocytes ....

And as has been mentioned, it probably made little difference compared to intramuscular injections. But it looks like researchers are revisiting the hypothesis with the study I've linked to.

The technique of intraperitoneal injections is archaic enough I have yet to find any descriptions of how it was done or exactly where the shots were given. If anyone finds a source on that I would love to see it. I think the next time I see any medical texts from the 40s I'll have a look. I imagine it will be there.

This source from Chiron vaccines had a bit of info on the history of the vaccine but nothing mentioning the injection site. I wonder why injection site is so rarely addressed in these vaccine information sources? You would certainly think it was significant enough to mention.

 

[Nursefoxfire]

Well House may get a lot of things wrong, but in an odd way, it helped diagnose my brother-in-law's brain cancer.

My BIL was having seizures, staggering and experiencing phantom smells, and my sister took him to the doctor where they ran tests on him (at a rural Texas regional facility). She called me and told me they were pretty sure he was suffering from panic disorder, and that she and BIL were returning to the doctor for a follow-up visit and to get medications.

I said, "What about the phantom smells? Did the doctor check his brain? Like an MRI or something?" She said no, they only tested his blood, and ran a stress test on his heart. I told her I'd seen an episode of House where the phantom smells led them to believe it was brain-related, and I asked her to check with the doctor and make sure they at least ADDRESSED the smells (which seemed odd to me).

She called me back shortly after the doctor visit and told me that she insisted to the doctor that they do a cat-scan or MRI and check his brain, and they found a large mass growing near the thalamus. She said the doctor was stunned, and was going to write the BIL a prescription for Zoloft (or whatever they treat panic disorder with), until my sister insisted.

I know, it was all just random luck. I like to think that Hugh Laurie had something to do with it, though!

Btw, my BIL is now undergoing chemotherapy, as the tumor is too centrally located and they can't surgically excise it. He's also got a better team of specialists working on him. We're hoping for good things

 

[Immunologist12]

Rabies vaccinations were given in the abdomen originally because, as DeeTee stated, it was the custom of the time from the development of the duck embryo vaccine. Intraperitoneal macrophages are in high abundance in vertebrates, and served as the first line of defense for picking up the vaccine and mounting an immune response. Now that we have a much greater understanding of immunology, we know that macrophages and dendritic cells exist in most tissues of the body, and thus intramuscular vaccines or subcutaneous injections are usually just as effective or more so than intraperitoneal injections. The thinking of the time was, if it works, then why bother changing it.

We now have a much greater understanding of immunological tissues and cells. Most people know about lymph nodes, being one of the four primary lymphoid tissues where your immune cells do their job. The other three primary immune tissues are your bone marrow, spleen and your thymus. We know that there are also three secondary lymphoid tissues, which have a larger amount of lymphoid cells that the surrounding areas, and they are called the MALT, BALT, and GALT. MALT, BALT, and GALT stand for, respectively, mucus-associated lymphoid tissue, brochial-associated lymphoid tissue, and gut-associated lymphoid tissue. The MALT includes your tonsils, the BALT are a collection of cells in your bronchi, and the GALT is a collection of cells in your small intestines called the Peyer's patch. These are not a singular point of tissue either, but are spread out between your mucosal membranes. Incidentally, the Peyer's patch would be the source of peritoneal macrophages that would be used to mount a response to a rabies vaccine. Thus, Pasteur would have been immunizing utilizing these cells in the gut, but not knowing why it worked.

I could speculate that they related the symptoms of rabies (hydrophobia) as being associated with the stomach, and immunized there because of that, but I don't really know.

Hi,

New member just made an account to reply to this (10 year old thread!) because I had to comment. Your explanation, while elaborate, assertive and convincing, is completely false. The old rabies ("Semple") vaccine was never given introperitoneally. It was given in the subcutaneous fat of the abdomen, because children and adults received 2 and 5ml of liquid respectively, and up to 10 injections were required, so this was a large volume requiring a large area of fat across multiple doses. So the abdominal fat was the natural choice. Nothing to do with intraperitoneal macrophages, peyer's patches, the stomach, hydrophobia, or anything else.

I have an image taken from a very old textbook that I'm unable to post on this platform, which clearly shows the needle going in at a very shallow angle to go into the subcut fat. Not in the peritoneum.

 

[dann]

Welcome to the ISF, Immunologist12, and thanks for the clarification.

Does anything know what is happening in this Youtube clip?
Can you vaccinate animals orally by hiding rabies vaccine inside a piece of meat?

 

[Skeptic Ginger]

Hi,

New member just made an account to reply to this (10 year old thread!) because I had to comment. Your explanation, while elaborate, assertive and convincing, is completely false. The old rabies ("Semple") vaccine was never given introperitoneally. It was given in the subcutaneous fat of the abdomen, because children and adults received 2 and 5ml of liquid respectively, and up to 10 injections were required, so this was a large volume requiring a large area of fat across multiple doses. So the abdominal fat was the natural choice. Nothing to do with intraperitoneal macrophages, peyer's patches, the stomach, hydrophobia, or anything else.

I have an image taken from a very old textbook that I'm unable to post on this platform, which clearly shows the needle going in at a very shallow angle to go into the subcut fat. Not in the peritoneum.

Thank goodness for butting in. I hadn't read this old thread but when I read the post above yours I thought, crap, did I have it wrong all these decades? I always thought it was simply because there was space to rotate the needed number of sub q injections.

That elaborate explanation about macrophages was quite convincing. But if you think about it, how dangerous it is to try to hit the peritoneal space with a needle without puncturing intestines.

Oh my, look at my reply 8 years ago. I should have known I would have answered this. I should have trusted my knowledge back then, though I did find some information relative to the intraperitoneal claim. I would think you would need to put a catheter in like we do with peritoneal dialysis to get in the right space. I can't see health care providers giving peritoneal injections repeatedly with a needle and syringe.

 

[Skeptic Ginger]

Welcome to the ISF, Immunologist12, and thanks for the clarification.

Does anything know what is happening in this Youtube clip?
Can you vaccinate animals orally by hiding rabies vaccine inside a piece of meat?

Actually they do. It's used to vaccinate wild raccoons.

Wildlife Rabies Vaccination Project* NY State

I'll have to look up why an oral vaccine is not available for one's pets.

 

[Hellbound]

Actually they do. It's used to vaccinate wild raccoons.

Wildlife Rabies Vaccination Project* NY State

I'll have to look up why an oral vaccine is not available for one's pets.

Just as a SWAG, I'd say that it's probably less effective. Still useful for reducing the prevalence in the wild, but shots would offer better protection for pets (that are likely to have a much higher rate of contact with humans).

That's just me thinking up a rational explanation without evidence, though, so take it for what it's worth

 

[Skeptic Ginger]

It appears at the moment the issue is the oral vaccine is not yet approved for pets. Probably won't change soon where there are no serious drawbacks using the proven effective injectable vaccines. In third world countries it's a different story.

WHO oral rabies vaccine for dogs research guidelines

 

[Hellbound]

It appears at the moment the issue is the oral vaccine is not yet approved for pets. Probably won't change soon where there are no serious drawbacks using the proven effective injectable vaccines. In third world countries it's a different story.

WHO oral rabies vaccine for dogs research guidelines

Dang it! Serves me right. I should never try for a rational explanation when bureaucracy is involved!

 

[Skeptic Ginger]

Dang it! Serves me right. I should never try for a rational explanation when bureaucracy is involved!

We are cross posting. I had this edit to my post ready.

Just as a SWAG, I'd say that it's probably less effective. Still useful for reducing the prevalence in the wild, but shots would offer better protection for pets (that are likely to have a much higher rate of contact with humans).

That's just me thinking up a rational explanation without evidence, though, so take it for what it's worth

Reasonable guess. It's not hard to look up though, instead of guessing.


I don't think you should dismiss proper research as just "bureaucracy", though.