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Treatment and prevention

I have a high anti-rabies antibody titre after pre-exposure vaccination - am I protected against rabies?

No. If you are exposed to the virus through a bite or a scratch you will still need to have a post-exposure prophylaxis booster (two doses of vaccine, but no need for immunoglobulin). However, whilst your antibody titre remains above 0.5 IU/ml you do not need to boost your pre-exposure vaccination.

I was bitten by an unvaccinated puppy - do I need vaccinations?

Most puppies that bite are exploring the world using their mouths and will interact with people in a playful way, which includes nipping and biting, and do not have rabies. However, all bites from unvaccinated animals living in regions where rabies is endemic should be investigated by a medical expert.

If the puppy has been restricted indoors, walked only on a leash outdoors, and the owner is confident that the puppy has not interacted with any wildlife or other dogs, then it is extremely unlikely that the puppy is infected with the rabies virus. A person bitten by an unvaccinated puppy that has been roaming outdoors or exposed to other animals may be at risk for the rabies virus and should seek medical advice. Even puppies that have been contained in a fenced-in backyard, may still have been exposed to high risk wildlife such as skunks, coyotes, fox, raccoons and bats, and a bite from an unvaccinated puppy is a considered a risk for contracting the disease if the puppy has not been in a restricted environment.

Should anyone not receive vaccination after an exposure?

Regardless of allergies and medical conditions, including pregnancy, anyone who has been exposed to the rabies virus should seek medical attention about getting the vaccine. Anyone who has had a life-threatening allergic reaction to a previous dose of the rabies vaccine, or who has a weakened immune system from HIV/AIDS, steroid use, or cancer drugs may need specialized treatment, but should still receive vaccination.

Can I have sex while I am undergoing PEP?

Unprotected sexual intercourse does not present a risk to the partners of those undergoing PEP after an exposure to the rabies virus. The vaccine treatment will prevent you from developing rabies, and no exposure to rabies will result after intimate contact with a person receiving prophylaxis.

Can an animal or person undergoing PEP transmit rabies?

The rabies vaccine cannot cause rabies infection, so exposure to a person or an animal undergoing post-exposure prophylaxis does not constitute an exposure.

I missed one of my PEP rabies vaccinations - do I need to start again?

No, you will not need to start over again if you deviate from the vaccine dosage schedule, but you should contact your doctor if a PEP injection is missed. The next dose will be given as soon as possible. Tell your doctor if you know in advance that you will miss one or more doses of PEP. In order to be protected against the disease, the full series of vaccines needs to be administered, and all doses, particularly at the start of the course, should be given at the recommended intervals wherever possible.

I think that I was exposed some months/years ago, and I never did anything. Can I get rabies?

Yes. It is possible, though very rare, to develop clinical rabies after an incubation period of several years. Typically, the incubation period for the rabies virus is between one and three months; however, the length of the time to onset of disease symptoms can be as short as a few days to as long as several years. As long as there are no symptoms of rabies after an exposure, PEP can still prevent clinical rabies from developing. If there is a suspicion of exposure, even as long as several years ago, victims can still benefit from PEP, and should immediately consult a medical expert to determine if it is necessary.

If there is potential that there was exposure to the rabies virus, then PEP is recommended.

I have been vaccinated against rabies, but then got exposed, do I still need treatment?

Yes, you will need a booster series of rabies vaccinations, to make sure that your immune system is prepared to fight off the virus. You do not need to have rabies immunoglobulin (RIG) if you have been pre-vaccinated.

If you suffered a rabies exposure but have received a complete series of rabies vaccinations within the last three months, you do not need vaccine or RIG. Thorough wound cleansing is still recommended.

How often are routine boosters needed after pre-exposure immunization?

Routine boosters are only recommended for workers at high risk of rabies exposure, such as lab workers and veterinarians. No booster doses following a primary series of pre-exposure vaccinations or post-exposure treatment are required for indiĀ­viduals living in, or travelling to, high-risk areas.

The recommended booster schedule depends upon the potential risk of exposure.People at high risk of exposure should have a blood test to evaluate the presence of rabies neutralizing antibodies. The time interval between blood tests is determined by the degree of risk. Directors of rabies laboratories should have specific requirements in place to monitor the presence of rabies neutralizing antibodies in the workers. In the event that the serological titre of someone working in a rabies laboratory falls below 0.5 IU/mL, they should receive one routine booster injection.

Do traditional remedies work to prevent rabies?

No. None of the remedies used in traditional medicine, such as jackfruit gum and chilli powder, stop rabies from developing.

Rabies specific vaccines are the only way to stop the onset of clinical symptoms and to prevent death.

Can a baby be given rabies vaccinations?

Yes. Both the rabies vaccine and the rabies immunoglobulin (RIG) should be administered for a suspected rabies exposure, and are considered safe for pediatric use. The recommended site of injection is the thigh for very young children and in the deltoid of older children. Rabies vaccines are used extensively worldwide in children, who constitute the largest population of exposed individuals.

Are there any side effects of the vaccination?

With WHO-approved vaccine, side effects are mild. There may be some pain at the site of injection, swollen glands, headache, aching muscles, malaise, and shivering. In rare cases, allergic reactions such as rash, wheezing and hives, swelling of the upper respiratory tract, and itching can also occur. Serious complications are very rare.

The risks for death from rabies after exposure are far higher than any potential pain or side effects after vaccination.

In a few countries, locally-produced vaccines that are not WHO-approved are still used. Whilst some are safe and effective, there are cases where ineffective and old technology vaccines have been administered and have resulted in rare, but severe, side effects.

Can vaccination itself cause rabies?

No. The World Health Organization approves human rabies vaccines, and these modern vaccines are very safe, effective and do not contain live rabies virus. No cases of rabies have been documented after administration of WHO-approved rabies vaccines.

Does the vaccination hurt?

Vaccination against rabies used to involve many painful injections to the stomach. Modern vaccines are given into the muscle or under the skin of the upper arm and are not any more painful than other vaccines.

What is post-exposure prophylaxis (PEP) and should I have it?

Immediately after any exposure to the virus, medical attention should be sought. It is critical to remember that the bite wound must be cleaned with soap and water for 15 minutes, and anti-rabies vaccine will be needed and, often, anti-rabies immunoglobulins too. Once the clinical onset of rabies is evident, there is no cure available and death is inevitable. It is therefore extremely important to get prompt medical treatment.

Full PEP consists of thorough washing of the wound, followed by immunoglobulin injections (antibodies against the rabies virus) into the wound and a series of rabies vaccinations that are administered after an exposure occurs, to prevent disease progression. If the bite victim has never been immunized for rabies, they should always receive the vaccination and the immunoglobulin treatment. For victims who were vaccinated with a modern rabies vaccine prior to exposure, you will still need booster doses of vaccine. You will not need immunoglobulin injections.

What is PrEP and should I have it?

PrEP is a preventative series of rabies vaccinations, before anyone is exposed to rabies. They are usually given to people considered to be at a high risk of exposure. People who are likely to come into contact with rabid animals or the rabies virus should consider rabies pre-exposure vaccinations. Veterinarians, those who work with rabies in laboratory settings, animal control workers and wildlife officers should consider pre-exposure rabies vaccination.

If you are travelling to a country where rabies is widespread, and you are likely to interact with animals far from medical help if you were bitten, you should consult your doctor about receiving pre-exposure vaccination against rabies.

If you have PrEP and are exposed to rabies you still need post-exposure prophylaxis (PEP). But, in this case, the PEP number of doses is reduced.

What can be done to reduce the risk of rabies exposure?

  • Travelers and residents of areas of high rabies incidence can be vaccinated against rabies prior to exposure.
  • In areas where rabies is known to occur, people are advised to reduce their exposure to wild animals and dogs.
  • To prevent potential transmission to humans, household pets such as dogs, cats and ferrets should be vaccinated against rabies and have their vaccinations updated regularly.
  • Abnormally-behaving wildlife may be infected with the rabies virus and should be avoided. Efforts should be made to keep bats out of residences and public buildings due to the potential for unseen transmission.

I've been bitten by an animal that might be rabid. What should I do

Apply first aid, as below. Then you MUST seek medical advice about post exposure prophylaxis as soon as possible.

If you are bitten or scratched by a potentially rabid animal, you must

  1. Wash the wound thoroughly with soap and water for at least 15 minutes.
  2. Apply ethanol or a similar antiseptic to prevent secondary infection.
  3. Seek urgent medical attention. You need to start post-exposure prophylaxis as soon as possible.

If you have already had pre-exposure prophylaxis, you still need further treatment.

Modern vaccines are the only way to prevent the onset of rabies after exposure. Traditional remedies, such as jackfruit gum and chilli powder do not stop the rabies virus.

Please treat any potential exposure to rabies seriously. Once clinical symptoms appear, death is almost inevitable.

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