Rabies vaccination problem

[s_jess]

I wanted to get vaccinated against rabies before coming to Thailand so I made some enquiries in a neighbouring country and was given a 4-dose schedule (days 0, 3, 7 and 14).

 

I got the shots on day 0 and day 3 but when I went on day 7 they said the original schedule wad wrong. It turns out it should have been either a 2-dose schedule (days 0 and 7) or a 3-dose (0, 7 and 21-28), depending on risk of exposure. So I shouldn't have had a shot on day 3.

 

They didn't give me the shot on day 7 because I'd had one on day 3, but they weren't sure what I should do to complete the course or what level of protection I currently have.

 

The US CDC guidines talk about getting  a booster dose if the "titer" is below a certain level, so it seems like the way to go is to find out the "titer" and then get another shot if necessary - but does anyone know 1) if I can get this done in Thailand and how I would explain what I need, and 2) if I need to leave it a certain time before testing?

[AnotherOneHere]

Why not getting vaccinated after getting bite? I did it 3 times while here and there was no problem with that, 5000 baht for all 5 doses at private hospital.

 

Also each region has a different strain of rabies, getting vaccinated in other country means you're not getting the most effective vaccine.

[PPMMUU]

Getting a rabies vaccination before being bitten is a good idea especially when planning to come to Thailand because there are many free-roaming unaccounted dogs virtually everywhere. If you were previously vaccinated when you got bitten you only need a booster regimen, not a full regimen, and the passive immunity (the serum antibody) is not needed.

 

I think you should get another dose on day 7 so that you undeniably have completed the pre-bite regimen.

[proton]

Just keep well away from dogs especially, never touch the filthy things in the sois, or feed these vermin. 

[proton]

36 minutes ago, AnotherOneHere said:

Why not getting vaccinated after getting bite? I did it 3 times while here and there was no problem with that, 5000 baht for all 5 doses at private hospital.

 

Also each region has a different strain of rabies, getting vaccinated in other country means you're not getting the most effective vaccine.

 

Bitten by dogs three times, how did you manage that?

[AnotherOneHere]

27 minutes ago, proton said:

 

Bitten by dogs three times, how did you manage that?

 

Sounds crazy, but not much about it:

 

1. My German shepherd tore my arms to shreds as a puppy, then an unvaccinated stray dog I recently took home licked my wounds (rabies transfer from saliva to wound ...).
2. While driving my dogs on a motorcycle sidecar, other dogs chased us (a daily occurrence), and one bit my leg for no reason at all.
3. I took another stray dog home, and about a week later, while still unvaccinated, he accidentally snagged me while we were playing.

[s_jess]

1 hour ago, PPMMUU said:

I think you should get another dose on day 7 so that you undeniably have completed the pre-bite regimen.

 

tbh that's what I thought but they refused to give it to me and I'm now well past day 7.  It was out of the fridge and reconstituted so can't be used at all now.

[scubascuba3]

i wouldn't have bothered, you can get vaccinated here after a bite. Dengue is a much bigger risk, did you get that?

 

Although it happens it would be extremely unlikely you get bitten

[Robert Paulson]

I would never get rabies vaccine no matter what myself but as I have been informed the vaccine is really for people who expect to be way out in the boondocks… which basically nobody does so that rules that out

[proton]

11 hours ago, AnotherOneHere said:

 

Sounds crazy, but not much about it:

 

1. My German shepherd tore my arms to shreds as a puppy, then an unvaccinated stray dog I recently took home licked my wounds (rabies transfer from saliva to wound ...).
2. While driving my dogs on a motorcycle sidecar, other dogs chased us (a daily occurrence), and one bit my leg for no reason at all.
3. I took another stray dog home, and about a week later, while still unvaccinated, he accidentally snagged me while we were playing.

 

Best kept away from, nothing but pests 

[FritsSikkink]

13 hours ago, PPMMUU said:

Getting a rabies vaccination before being bitten is a good idea especially when planning to come to Thailand because there are many free-roaming unaccounted dogs virtually everywhere.

Never been bitten in over 40 years here.

[FritsSikkink]

13 hours ago, PPMMUU said:

I think you should get another dose on day 7 so that you undeniably have completed the pre-bite regimen.

Are you a doctor?

[PPMMUU]

When you work in a hospital you get to see several people get bitten by unvaccinated dogs every day.

[PPMMUU]

It is unwise to believe or disbelieve something someone says on the internet based solely on their claim of being a professional or not.

[Sheryl]

As you know ,the pre-exposure regimen is 2 doses, day 0 and day 7.

 

Obviously the place you went was initially confused and started to follow the protocol for post-exposure.

 

The day 3  dose you mistakenly received will nto suffice as the second dose as given too soon.

 

Best option IMO would be to treat the day 3 dose like it was the first and give repeat dose 7 days later (i.e. day 10 but we consider as day 7, disregarding the first dose).

 

But what I o=r anyone else think, is nto going to persuade "them".

 

Getting a rabies titer here will be a bit challenging. Where in Thailand will you be?

[s_jess]

On 7/9/2024 at 7:32 AM, Sheryl said:

Best option IMO would be to treat the day 3 dose like it was the first and give repeat dose 7 days later (i.e. day 10 but we consider as day 7, disregarding the first dose).

 

Thanks a lot for that suggestion and sorry for the slow reply.  I think I was on day 12 when I originally posted so even if the hospital was cooperative there's no way to get a 7-day gap.

 

On 7/9/2024 at 7:32 AM, Sheryl said:

Getting a rabies titer here will be a bit challenging. Where in Thailand will you be?

 

I will be in Hat Yai and then Udon Thani, so if getting a titer is challenging in general it's probably not going to happen unless I make a special trip.

 

So I suppose the question is whether I can be sure I'm protected if I get a single dose in say a month's time, or whether I'd have to start over. Or looking at it the other way round, whether there's any harm in just starting over and getting 2 more doses, 7 days apart. I don't see how there can be, seeing that the post-exposure regimen is 4 doses in a shorter timeframe, but then I'm not a doctor...

[LosLobo]

1 hour ago, s_jess said:

 

Thanks a lot for that suggestion and sorry for the slow reply.  I think I was on day 12 when I originally posted so even if the hospital was cooperative there's no way to get a 7-day gap.

 

 

I will be in Hat Yai and then Udon Thani, so if getting a titer is challenging in general it's probably not going to happen unless I make a special trip.

 

So I suppose the question is whether I can be sure I'm protected if I get a single dose in say a month's time, or whether I'd have to start over. Or looking at it the other way round, whether there's any harm in just starting over and getting 2 more doses, 7 days apart. I don't see how there can be, seeing that the post-exposure regimen is 4 doses in a shorter timeframe, but then I'm not a doctor...

 

I would suggest that beside a four-dose post-exposure regimen, there is also a four-dose pre-exposure regime for rabies.

Seems the two-dose schedule while economical does not provide extended protection.

The advantage of the pre-exposure vaccination is that you don't need immunoglobulin HRIG or ERIG which is expensive, difficult to obtain and is a blood product with inherent issues.

I suggest you need advice from a professional travel clinic.

Seems you can consult on-line here.

Thai Travel Clinic.com - The Special clinic for traveler's health in Thailand

[Will B Good]

Chances of being bitten are slim......just get the jabs afterwards if you are that unlucky.

[LosLobo]

59 minutes ago, LosLobo said:

 

I would suggest that beside a four-dose post-exposure regimen, there is also a four-dose pre-exposure regime for rabies.

Seems the two-dose schedule while economical does not provide extended protection.

The advantage of the pre-exposure vaccination is that you don't need immunoglobulin HRIG or ERIG which is expensive, difficult to obtain and is a blood product with inherent issues.

I suggest you need advice from a professional travel clinic.

Seems you can consult on-line here.

Thai Travel Clinic.com - The Special clinic for traveler's health in Thailand

Correction Seems on-line consult is only for those with Thai ID, possibly try sending an email.