Rabies and immunoglobulin

[HerbyJFlash]

I got bit a few days ago in Udon by a dog . 
 

I immediately went and got rabies vaccine and have since had the second jab. 
 

However the internet says I also need a shot of immunoglobulin but I can’t find any mention of this in relation to Thailand . 
 

Does anyone know what the protocol is here and if there is anywhere I can get a shot of it ? Will travel to bangkok if necessary .  

[bignok]

Ask a doctor or pharmacist

 

Why would you ask us?

[Morch]

28 minutes ago, HerbyJFlash said:

I got bit a few days ago in Udon by a dog . 
 

I immediately went and got rabies vaccine and have since had the second jab. 
 

However the internet says I also need a shot of immunoglobulin but I can’t find any mention of this in relation to Thailand . 
 

Does anyone know what the protocol is here and if there is anywhere I can get a shot of it ? Will travel to bangkok if necessary .  

 

I got rabies vaccine shots in India ages ago (BIG syringe...). Don't recall there was something else administered (though self-medicated with the good stuff to make sure). As this is quite common in Thailand, guess if it was the done thing your doctor would administer or advise it. Probably better to consult him/her.

[LS24]

Were the shots Virorab? 

[FritsSikkink]

Ask the doctor while you are there.

[scubascuba3]

Available at any hospital in Pattaya so shouldn't be difficult to find it

[HerbyJFlash]

They were shots of speeda . I’m also worried that I won’t be able to get the fourth dose in the U.K. on the 28th day because they use a different treatment there . Hence why they didn’t use immunoglobulin.
 

im thinking I will either have to stay here or go home and return which will be expensive . 

 

[Lorry]

8 hours ago, HerbyJFlash said:

I got bit a few days ago in Udon by a dog . 
 

I immediately went and got rabies vaccine and have since had the second jab. 
 

However the internet says I also need a shot of immunoglobulin but I can’t find any mention of this in relation to Thailand . 
 

Does anyone know what the protocol is here and if there is anywhere I can get a shot of it ? Will travel to bangkok if necessary .  

I understand  you were not previously vaccinated against rabies.

In this case, the WHO recommends rabies immunoglobulin.

It is very expensive - up to 1000 USD and more - that's why it's not routinely given here. Even so, there are few rabies deaths in Thailand.

Bangkok Hospital in  Udon probably has it. The big private hospitals in Bangkok have it.

 

You can continue your vaccination, started with Speeda, in the UK.

UK uses Rabipur, which is compatible with Speeda.

https://immunisationhandbook.health.gov.au/recommendations/people-with-potential-rabies-exposure-who-started-post-exposure-prophylaxis-overseas-are-recommended-to-complete-the-rabies-vaccine-course-in-australia

 

 

 

 

[Nick Carter icp]

1 hour ago, HerbyJFlash said:

They were shots of speeda . I’m also worried that I won’t be able to get the fourth dose in the U.K. on the 28th day because they use a different treatment there . Hence why they didn’t use immunoglobulin.
 

im thinking I will either have to stay here or go home and return which will be expensive . 

 

 

 

   You can get the Speeda vaccine in the U.K , ask the NHS and they can give you a shot 

[Nick Carter icp]

9 hours ago, HerbyJFlash said:

However the internet says I also need a shot of immunoglobulin but I can’t find any mention of this in relation to Thailand . 

 

  You need to go to a hospital to find out which vaccine you need as some people have allergies to certain vaccines .

   The gamma globim shot does directly into the wound and its a one off shot , the other four shots go in your arm

[Gaccha]

11 hours ago, HerbyJFlash said:

I got bit a few days ago

 

It should only be given on day zero (perhaps day one or day two) because it actually interferes with the injection vaccinations. It is only intended to prevent the virus reaching your nerve system before the vaccines can kick in.

 

If you were outside a major city they probably took a judgment call taking into consideration the risk vs benefit.

 

Current best practice in Thailand (if no pre-exposure vaccines) appears to be: [Source]

 

Giving Rabies immunoglobulin (RIG)

 

· Indication of injection RIG include:

 

1. Level wound category III

 

2.Wounds around the head, neck, and hands

 

3. Patients with severe immunodeficiency disease (severe immunodeficiency) In case of disease patients HIV With low immunity levels Or do not receive antiretroviral drugs RIGBoth in the wound category II and III

 

4. People who are bitten in areas where patients are infected with rabies.

 

5. People who were bitten by bats Or touch the disease from bats

 

 

(N.b. wound category 3 is any wound with bleeding)

 

I am assuming you failed to obtain vaccines pre-exposure. If you did get vaccines pre-exposure then it is very very unlikely that you will need the immunoglobin.

 

In any event, consult with the doctor.

 

Edited November 28, 2023 by Gaccha

[Sheryl]

2 hours ago, Gaccha said:

 

It should only be given on day zero (perhaps day one or day two) because it actually interferes with the injection vaccinations. It is only intended to prevent the virus reaching your nerve system before the vaccines can kick in.

 

If you were outside a major city they probably took a judgment call taking into consideration the risk vs benefit.

 

Current best practice in Thailand (if no pre-exposure vaccines) appears to be: [Source]

 

Giving Rabies immunoglobulin (RIG)

 

· Indication of injection RIG include:

 

1. Level wound category III

 

2.Wounds around the head, neck, and hands

 

3. Patients with severe immunodeficiency disease (severe immunodeficiency) In case of disease patients HIV With low immunity levels Or do not receive antiretroviral drugs RIGBoth in the wound category II and III

 

4. People who are bitten in areas where patients are infected with rabies.

 

5. People who were bitten by bats Or touch the disease from bats

 

 

(N.b. wound category 3 is any wound with bleeding)

 

I am assuming you failed to obtain vaccines pre-exposure. If you did get vaccines pre-exposure then it is very very unlikely that you will need the immunoglobin.

 

In any event, consult with the doctor.

 

As above

 

Also, if immune globulin is to be given it needs to be done immediately, on day of the bite

 

I think you can proceed with the postexposure regimen the  hospital recommended.

[soisanuk]

I was bitten by a cat and went to Jomtien Hospital in Pattaya 5 days later (puncture wounds were not healing).  They injected Berirab P inj. (300 Iu/2 ml) (Hrig)..Dose 20 IU/Kg direct into the wound area. The price was 3,978 baht - this was on 5 September this year.

 

They also injected the first dose of SPEEDA  which was followed later by the required dosage at specified intervals.

 

 

 

[Fairynuff]

21 hours ago, bignok said:

Ask a doctor or pharmacist

 

Why would you ask us?

Because some of us have knowledge which I realise from your other responses to peoples posts is kinda hard for you to grasp.

[Fairynuff]

21 hours ago, HerbyJFlash said:

I got bit a few days ago in Udon by a dog . 
 

I immediately went and got rabies vaccine and have since had the second jab. 
 

However the internet says I also need a shot of immunoglobulin but I can’t find any mention of this in relation to Thailand . 
 

Does anyone know what the protocol is here and if there is anywhere I can get a shot of it ? Will travel to bangkok if necessary .  

My friend was accidentally nipped while feeding a Soi dog we know well and the tooth went into the nail cuticle. He went to the Red Cross in BKK the next day and was given immunoglobulin plus the first of 5 injections over a period of about a month.

I decided to get vaccinated too because it’s just 2 injections a few weeks apart and it covers you for life. Should you get bitten it’s just a single booster shot. 
The Red Cross are amazing and very inexpensive.

[Searunner]

I was bitten by a cat a few months ago. I had not been previously vaccinated against rabies. I was advised by a private hospital doctor I needed a series of 5 vaccination shots (administered in the shoulder as with most vaccines) and an HRIG shot administered around the site of the bite. HRIG is Human Rabies Immunoglobin vaccine made from human blood. There is also ERIG which is Equine Rabies Immunoglobin vaccine made from horses blood. HRIG is supposed to be better than ERIG but both will do the trick. The private hospital wanted to charge me 35,000 baht for the HRIG but the nurses very kindly whispered to me that it was available at any government hospital and that I had time. I  declined the HRIG at the private hospital and went to a government hospital the next day where it cost me 1,800 THB for ERIG. It must have worked because I'm still here today!

 

I think that even if you have been previously vaccinated it is recommended to have the HRIG/ERIG

[Sheryl]

1 hour ago, Searunner said:

I was bitten by a cat a few months ago. I had not been previously vaccinated against rabies. I was advised by a private hospital doctor I needed a series of 5 vaccination shots (administered in the shoulder as with most vaccines) and an HRIG shot administered around the site of the bite. HRIG is Human Rabies Immunoglobin vaccine made from human blood. There is also ERIG which is Equine Rabies Immunoglobin vaccine made from horses blood. HRIG is supposed to be better than ERIG but both will do the trick. The private hospital wanted to charge me 35,000 baht for the HRIG but the nurses very kindly whispered to me that it was available at any government hospital and that I had time. I  declined the HRIG at the private hospital and went to a government hospital the next day where it cost me 1,800 THB for ERIG. It must have worked because I'm still here today!

 

I think that even if you have been previously vaccinated it is recommended to have the HRIG/ERIG

IG is not recommended if previously immunized.

 

Only for those never before immunized with a category 3 wound (which any catr bite would easily be, cat bites are very deep).

[Lorry]

On 11/28/2023 at 8:21 AM, Nick Carter icp said:

 

 

   You can get the Speeda vaccine in the U.K , ask the NHS and they can give you a shot 

According to the NHS website, only Rabipur is available in the UK.

But websites sometimes are not up to date or even plain wrong 

[Lorry]

On 11/28/2023 at 12:48 PM, Sheryl said:

Also, if immune globulin is to be given it needs to be done immediately, on day of the bite

WHO recommends it even many days later.

That's my personal experience,  too.

And that's what is done in Thailand,  see the posts of Soisanuk, Fairynuff and Searunner

[Nick Carter icp]

30 minutes ago, Lorry said:

According to the NHS website, only Rabipur is available in the UK.

But websites sometimes are not up to date or even plain wrong 

 

   That is the NHS vaccine that is used by them .

 If you have had a course of the Speeda Thai vaccine and you need some more , the NHS will provide it . 

  I had the Speeda vaccine in Thailand and went back to the UK and had the last shot there , after permission from the Home office .

    Speeda isnt used by the NHS , but you can get it if you've already started the course (Abroad)

Edited November 30, 2023 by Nick Carter icp