Rabies Vaccination Guidelines

If you are scratched and bitten by an animal that may carry rabies virus, as long as skin damage or bleeding occurs (i.e., level 2 and above exposure), immediately rinse with running soapy water for more than 15 minutes and then disinfect with iodophor, promptly and standardly vaccinate the rabies vaccine, and add rabies immunoglobulin if necessary. With proper treatment, the probability of rabies incidence can be reduced to almost 0. The protection period after the full and standardized vaccination is at least 6 months, and there is no need to be vaccinated repeatedly after a slight scratch or bite.

Last week, when I was working the night shift for community disease control, I met a little girl who was crying while clutching the finger that had been bitten by the family’s blue cat with small blood spots, asking whether she would die. In fact, there is really no need to panic - most of the time, as long as the treatment is timely, there is no risk at all.

Many people are not sure what kind of situation should be treated and what kind of situation should not be used. In fact, to put it bluntly, it depends on the degree of exposure: if the intact skin is licked by a cat or a stray dog on the roadside is touched, this is a first-level exposure, so you don’t need to worry about it at all, just wash your hands; if you are caught and get a red mark If there is bleeding, no bleeding, or if the skin is bitten and the skin is not broken, this is a second-level exposure, and routine vaccination is enough; if there is bleeding, the open wound is licked by an animal, or even scratched and bitten by a bat, then it is a third-level exposure, and immune globulin is required in addition to the vaccine. There is also a consensus in the industry that if the level 2 exposure is on the head, face, or neck, or if the person bitten is a child or a person with AIDS or a person with poor immunity who has been taking hormones for a long time, some disease control colleagues will recommend directly treating it as level 3 exposure and adding immune globulin. After all, the head and face are close to the brain and the virus has a short incubation period. It is better to be safe than to gamble.

Many people like to use the ten-day observation method as an argument, saying that as long as the animal that bites you remains alive for ten days, you don’t need to beat it. This is either true or not. In Europe and the United States, the rabies vaccination rate for domestic animals can reach over 90%, so they will recommend that those who meet the requirements can be vaccinated and observed at the same time. However, the vaccination rate for stray animals in our country is less than 10%. If you are caught by a stray cat on the roadside, you can't just sit there and guard it for ten days, right? If it really gets sick ten days later, it will be too late for you to get vaccinated. Therefore, our general clinical advice is that no matter what the situation is, you should first get the injection according to the regulations. If you can be sure that the one biting you is a domesticated dog and you get a rabies vaccine every year, you can observe it while injecting it. After ten days, it will be alive and kicking, and the subsequent injections are not necessary.

As for the number of injections, there are two commonly used methods now, the 5-injection method (one injection each on the day of the bite, 3, 7, 14, and 28 days) and the 2-1-1 procedure (one injection each in the left and right arms on the same day, and one injection each on the 7th and 21st days). There are also people who want to take imported vaccines as soon as they come out, saying that they are effective. The monitoring data I have come across in recent years is that the potency of domestically produced vero cell vaccines has fully met the standard, and the adverse reaction rate is even lower than some imported vaccines. There is really no need to spend hundreds of extra dollars.

After the injection, there are always people asking if there are any dietary restrictions, whether you can eat hot pot or drink alcohol. To be honest, these dietary restrictions are not mentioned at all in the latest rabies prevention and control guidelines. They are all the opinions passed down by the elders in the past. As long as you don’t feel uncomfortable after eating, you can eat whatever you want. At most, don’t let the needle touch the water on the day after the injection to avoid infection. If you have a low-grade fever and your arms are red, swollen and painful, don’t panic. It usually subsides in a day or two. If you feel really uncomfortable, go to the hospital.

There are also people who have been vaccinated before and were bitten, and they don’t need to be vaccinated all the time. If the injection has just been completed within half a year, even if you are bitten again, you only need to wash it off and disinfect it, and there is no need to inject it again; two injections will be given every six months to one year, three injections will be given every one to three years, and the whole process will be repeated after three years. Of course, some experts in the field of virology believe that as long as you have been fully vaccinated before, even if it has been three years, as long as it is not a particularly serious large-scale exposure, two supplementary injections are enough, instead of five injections. This depends on your own choice and the judgment of the treating doctor.

Oh, by the way, if you are a veterinarian, often rescue stray animals, or have several cats and dogs at home who always get scratched, you can actually get the pre-exposure vaccine in advance, just three injections. If you are bitten later, you only need two more injections. There is no need to take immune globulin, which saves a lot of trouble.

In a word, don't be careless and don't panic. According to the regulations, nothing will happen. If you are really unsure, go to the local disease control center and ask. Don't scare yourself by searching online for a long time.