Travel Medicine / Vaccination / Immunization Expert Forum
Rabies Shots
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Questions in the Travel Medicine forum are answered by Dr. Philip D Parks, affiliated with Harvard School of Public Health. Topics covered include disease prevention, finding a doctor abroad, food and water safety, illness and injury abroad, mosquito and tick protection, resources for travelers, traveling with children or pets, traveling with special needs, vaccinations and immunizations.

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Rabies Shots

Could somebody explain when it's required to get a rabies shot? A little background: my girlfriend lives in China, and last June when playing with her dog, received a small bite, enough to break the surface of the skin. She went to the doctor, and was given a series of 5 shots, on the 1st, 3rd, 7th, 14th & 28th day after the bite.

In April of this year, again she received a bite from her new puppy, which broke the skin. This time, her doctor gave her a series of 2 shots, on the 1st and 3rd day after the bite.

Finally, yesterday, she was received another bite, and again was given another rabies shot, and was told to return again in 3 days to get a 2nd injection.

Both dogs were vaccinated against rabies, and are in normal health. Is it necessary to receive rabies shots this frequently, and are there any health risks with such a high frequency?
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Hello Vince,

Practice guidelines per CDC (Centers for Disease Control in the U.S.) do not recommend rabies treatment when a person is bitten by a pet that is confirmed or known to be immunized against the rabies virus. If the immunization status of the animal is unknown, then the decision to treat with rabies vaccination and immunoglobulin depends on the estimated risk that the animal is rabid and the nature of the bite.

Rabies is 100% fatal if a person is not treated after being exposed. This is why persons are treated aggressively if there is not certainty of the animal's immunization status.

The health risks of receiving the rabies immunoglobulin ("rabies shot")  and vaccine are: Mild local and systemic adverse reactions to these vaccines and immunoglobulin may occur but are usually treatable with supportive care, antihistamines, and anti-inflammatory medications. Local pain, erythema, headache, nausea, and abdominal pain may occur. If prophylaxis is warranted, do not postpone or discontinue treatment because of mild adverse effects. (www.cdc.gov)

The CDC recommended course of post-exposure rabies immunoglobulin is: Administer human rabies immunoglobulin (HRIG) to any person not previously vaccinated against rabies in a dose of 20 IU/kg (for adults and children). Apply as much of the dose as possible at the injury site and the remainder as a deep intramuscular injection in the gluteal area. HRIG may be administered up to the seventh day after the first dose of vaccine if it is not immediately available when the patient presents for evaluation. (www.cdc.gov)

And for the vaccine: day 0, day 3, day 7, day 14, and day 28 postexposure.

There is some variability in practice outside the U.S. (as you can see from the treatment that your girlfriend has received in China).

If both of the dogs that bit your girlfriend received proper immunization against rabies, she is very unlikely to require treatment for rabies.

However, it is very important for the dog bites to be cleaned properly to reduce the risk of local infection from bacteria that are present in dirt and saliva.

I hope that this is helpful to you.

Links:
http://www.emedicine.com/PED/topic1974.htm
http://www.cdc.gov/RABIES/
~•~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.
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