FAQ’sON RABIES

DR. APARNA JAIN and DR. SUGANDHA JAUHARIJR- II , DEPT. OF COMMUNITY MEDICINE,KGMU , LUCKNOW

Q1. What should not be done with an animal bite wound?

Avoid:

Applying irritants to the wound such as chilli powder, plant juices, acids or alkalis.

Covering the wound with dressings or bandages

Q2. Are there any contraindicated drugs or dietary restrictions during anti-rabies vaccination?

All immunosuppressive drugs are contraindicated during vaccination such as steroids, chloroquine (anti-malarial drug) and anti-cancer drugs.

If these drugs cannot be avoided and the patient is in an immunocompromised state, the IM regimen must be followed by infiltration of site of bite wound with RIG. Monitoring of antibody titration is recommended in such patients where possible.

There are no dietary restrictions during the course of vaccination

Q3. Can the rabies vaccine and immunoglobulin be given to a pregnant woman or a lactating mother?

Yes.

All modern rabies vaccines are inactivated, safe and potent and can be given to pregnant women or lactating mothers.

It has no effect on foetal development during pregnancy or

breastfed infants during lactation.

The rabies virus is not known to cross the placental barrier in women.

Q4. Is there any possibility of failure after PEP?

There are occasional human rabies cases reported despite PEP, due to various factors like :

Delayed vaccination Non-use of rabies immunoglobulin in category III exposure Incomplete course of vaccination. Immunocompromised status such as HIV/AIDS, cirrhosis or use

of chloroquine, steroids or anti-cancer drugs. Unexplained failure in cases where everything was apparently

done correctly have also been documented

Q5.If a previously immunized person is bitten by a rabid dog again, what is the RE EXPOSURE VACCINATION SCHEDULE?

PATIENT RECEIVED RABIES VACCINE IN PAST (PRE OR POST EXPOSURE)

NO YES

RE EXPOSURE SCHEDULE : Local treatment of wounds + Vaccine on days 0 & 3 (IM / ID) No RIGs

(However, a full vaccination course isrecommended for those previously vaccinated with nerve tissue vaccine.)

START POST EXPOSURE SCHEDULE DEPENDING ON CATEGORY

Q6. Can a dog without any symptoms transmit Rabies?

The dog might not show any symptoms of rabies but would transmit rabies through a scratch or a bite as 20 % of cases are of Dumb rabies without any obvious symptoms. Thus it is mandatory to start the treatment even if a dog is not visibly rabid .

Q7. Can a vaccinated dog transmit rabies?

A dog effectively vaccinated against rabies cannot suffer and transmit the disease.

But it is difficult to say with certainty that a dog immunized with a specific vaccine is immune against rabies.

Facts : 6 % of dogs found rabid have a reliable rabies vaccine history

Q8. Can rabies be transmitted from man to man ?

The saliva of a patient with hydrophobia is infectious and occasionally such transmissions have been reported.

But the well documented transmission is through corneal transplantation

Hence confirmation of cause of death particularly in neurological cases is very important before corneal transplantation

Q9. If a person is bitten by a rat does he require post exposure prophylaxis (PEP)?

Rat rabies has been reported from some Asian countries but is extremely rare.

It is not necessary to take PEP in bite cases by house rats.

However, it is prudent to take PEP, in consultation with an infectious disease physician, when bitten by wild rats/rodents.

Q10. Is PEP necessary if milk or milk products from an infected animal are consumed?

No.

There is no laboratory or epidemiological evidence that the consumption of milk or milk products from rabid animals transmits the disease.

However, it is not advisable to consume milk from rabid animals.

Q11. Can consumption of meat from an infected animal transmit rabies?

The consumption of raw meat from an infected animal requires PEP.

Cooked meat does not transmit rabies;

However, it is not advisable to consume meat from an infected animal

Q12. WHAT SHOULD BE DONE IF RIG IS INDICATED AND NOT AVAILABLE?

In case RIG is indicated and not available the next best alternative is to double the first dose of vaccine i.e. 2 doses of anti

Rabies vaccine injection to be given on day 0.However doubling of the dose of MTCV on day 0 is not a replacement to RIG but only

next best alternative.

Q13. IS IT NECESSARY TO PERFORM AN ANTIBODY TEST FOLLOWING ANTIRABIES VACCINATION IN ALL

ANIMAL BITE VICTIMS?

No, it is not required in all cases. When human rabies vaccines are given according to the approved schedule in a healthy individual it is not necessary to do antibody titre estimation. It is recommended only under special

circumstances such as for immunocompromised patients, patients receiving immunosuppressive therapy

or patients who have not taken vaccination as per recommended schedule.

Ref: National Guidelines on Rabies Prophylaxis(NATIONAL CENTRE FOR DISEASE CONTROL)

QUESTION 14

WHAT IS THE LINE OF TREATMENT FOR A PATIENT REPORTING AFTER 24

HOURS OR LATER?

If the patient presents after 48hours,it is appropriate that the first dose of vaccination

should be doubled. Since there is possibility of a prolonged incubation period so even if patient

comes after a long gap, he should be treated as if the contact occurred recently.

QUESTION 15

WHAT ARE THE PRECAUTIONS THAT NEED TO BE TAKEN BY THE TREATING

DOCTOR?

The treating doctor needs to take utmost care while washing and cleansing the wound.

He should carry on the treatment by wearing gloves.

Pre exposure immunization against rabies of nursing staff and health care personnel in hospitals should be considered.