Rabies Update

[nevcross]

A friend has just called from hospital. This morning he was bitten by a dog and has taken advice to get precautionary rabies shots, I would be grateful if anyone can advise if a series of shots are required , how many and what is usual cost?, he has been advised 2500 for first and 500x5 thereafter....is this about right, thanks for speedy help!

[Rimmer]

That is probably about right, I had the whole course of 6 injections and I see that I should have gone for one more booster back in December some time making seven in all.

They are quite expensive injections. Sounds like a reasonable price to me though.

[junkofdavid2]

Thai Red Cross, near the corner of Rama 4 and Henry Dunant Road... at the Queen Saovabha Clinic.

Non-profit, VERY low priced injections and vaccines, and they originally specialized in rabies shots. Dunno if they're open during holidays though.

Never had rabies shots there, but I have had my vaccines there and they're so much cheaper than even St. Louis Hospital which itself is supposedly a catholic non-profit. (And St. Louis itself was already so much cheaper than Bumrungrad and Samitivej).

Queen Saovabha Clinic inside Red Cross: Tel. 0-2252-0161 to 64

[jdinasia]

price depends on the hospital/clinic

I believe at government hospitals that the shots might be free

[JimmyTheMook]

I was recently bitten by a skanky soi dog and went for the course of 5 shots at 700 baht each.

Your friend should also consider a tetanus shot unless he had one within the last 10 years ( or is it 5?)

[ClaytonSeymour]

The Wife has just had her first of five shots (VERORAB IM Regimen), 740 baht a shot. We'll be back in the UK by the time her last two shots are scheduled, so I'm hoping they'll be free.

Personally, I'd avoid a government hospital - I'm not sure if it applies to them all, but, the only one I've had recent experience with (nephew undergoing treatment) are still using the older vaccine which involves numerous injections in the stomach. No thanks.

[Mosha]

price depends on the hospital/clinic

I believe at government hospitals that the shots might be free

JD a couple of years back our cat got attacked by a dog. She accidentally bit me, and as a precaution I went for the jabs, the first one was while we were away fom home and cost me 200 Baht, at a clinic in Nakhon Sri Thammerat. Back home the rest of the course cost 30 Baht a jab at the local district hospital. I do have a card for there though, so I don't know if that makes a difference. I stay away from the Moo Ban clinic though as the nurse there always charges me more, what ever I go for.

[ClaytonSeymour]

The Wife has just had her first of five shots (VERORAB IM Regimen), 740 baht a shot. We'll be back in the UK by the time her last two shots are scheduled, so I'm hoping they'll be free.

Update: The Wife has had her second injection (same hospital, Ekachon Buriram) - 420 baht. So I guess the other 320 baht was the fee for the initial cleaning & dressing of the wound & the course anti-biotics.

Edited January 1, 2009 by ClaytonSeymour

[ClaytonSeymour]

The Wife had her third injection at Hua Chiew hospital - 720 baht.

The next one is due the day after we return to the UK, so, I called her GP to advise on the situation. The receptionist was totally confused; never had to deal with this before, so, I was advised to call back the next day & discuss with the practice nurse. The nurse advised me that she would have to order the vaccine at the pharmacy next door & she'll have to collect it prior to the appointment. She couldn't tell me whether it will cost the same as a usual prescription or more, but, it certainly isn't free!

I thought about going back to Hua Chiew to see if they'd sell & provide documentation for the two remaining shots. But, seeing as that was an afterthought, I'm sure the <deleted> will charge her for the shot they've already ordered. Has anyone had to have rabies shots in the UK & how much did you pay?

[ClaytonSeymour]

The Wife had her third injection at Hua Chiew hospital - 720 baht.

The next one is due the day after we return to the UK, so, I called her GP to advise on the situation. The receptionist was totally confused; never had to deal with this before, so, I was advised to call back the next day & discuss with the practice nurse. The nurse advised me that she would have to order the vaccine at the pharmacy next door & she'll have to collect it prior to the appointment. She couldn't tell me whether it will cost the same as a usual prescription or more, but, it certainly isn't free!

I thought about going back to Hua Chiew to see if they'd sell & provide documentation for the two remaining shots. But, seeing as that was an afterthought, I'm sure the <deleted> will charge her for the shot they've already ordered. Has anyone had to have rabies shots in the UK & how much did you pay?

Update: This morning, the Wife had her fourth shot, back here in the UK. Cost? Price of a prescription - £7.10 & this also included the fifth & a final shot which is now being stored in the fridge at the GP's. Glad I didn't get those shots at Hua Chiew.

Incidentally, Verorab is unlicensed in the UK, but is available on prescription as it's commonly used in many other parts of the world. Rabipur is the vaccine they use over here.

[PeaceBlondie]

When a house dog bit me in Hua Hin, the owner's employee paid 1,900 baht to the Red Cross Clinic for the entire series of anti-rabies shots and the first aid and antibiotic. The dog did not die, so I stopped after three injections.

[kriswillems]

A dog bit me yesterday. Today I went to the hospital (government hospital).

I paid 470 Baht. Next 3 times I'll have to pay 250 Baht.

They gave me VERORAB.

I only need to get 4 shots (in stead of 5, I don't know why).

But they said it was necessary for the first time to (also) get a shot with imunoglobuline (live vaccin).

This first shot would cost 18000 baht! (the dose depends on the body weight, I am 30% more heavy than most Thai guys).

I refused to get this shot.

Is it really necessary ?

[taxout]

YES, you need the immunoglobulin. Verorab and similar vaccines don't take effect for about a week, so you're at risk until it kicks in. The immunoglobulin kicks in right away and gives immediate protection, covering you until the Verorab takes effect.

At that price, you're probably being offered imported immunoglobulin. It IS that expensive.

The Thai Red Cross in Bangkok makes its own immunoglobulin. It's still expensive -- maybe 4,000 baht or so depending on your weight -- but far less so than the imported variety. I'd get there ASAP. You're at risk until you have the shot.

It's easy to find, right on Rama IV road.

Edited January 15, 2009 by taxout

[kriswillems]

YES, you need the immunoglobulin. Verorab and similar vaccines don't take effect for about a week, so you're at risk until it kicks in. The immunoglobulin kicks in right away and gives immediate protection, covering you until the Verorab takes effect.

At that price, you're probably being offered imported immunoglobulin. It IS that expensive.

The Thai Red Cross in Bangkok makes its own immunoglobulin. It's still expensive -- maybe 4,000 baht or so depending on your weight -- but far less so than the imported variety. I'd get there ASAP. You're at risk until you have the shot.

It's easy to find, right on Rama IV road.

Thanks Taxout,

I had the immunoglobulin shot today at the red cross hospital in BKK, about 40 hours after I was bitten. I spent almost the whole day on the bus to go there and to come back. I let my wife inform about the price before I went there. First I didn't tell them that my wife called them. The price they mentioned to me was also rather high (they said 5000 to 6000 baht, I don't know if this was just because they didn't know exactly or because they tried to charge me). After that I let them know what my wife was told on the telephone. At the end I paid exactly the same amount as my wife was told. The service was great and fast and people were very kind. I paid 2600 baht for my body weight. I needed 4 bottles.

The Thai person before me got a special deal and paid even a little bit less (per bottle) after explaining them it was too expensive for him. I can understand Thai and the door was open because the airco was not on with this cold weather.

I wanted to have a look at their snake farm. It had a sign saying in Thai (written Thai, no numbers): "adults forty B". Besides that there was a sign in English (with numbers) saying: "adults 200B". I gave them forty bath because the sign in Thai didn't say this was for Thai people but they refused to let me in (even thought I live in Thailand, I pay tax here and I can read/write and speak Thai).

Edited January 16, 2009 by kriswillems

[ClaytonSeymour]

A dog bit me yesterday. Today I went to the hospital (government hospital).

I paid 470 Baht. Next 3 times I'll have to pay 250 Baht.

They gave me VERORAB.

I only need to get 4 shots (in stead of 5, I don't know why).

But they said it was necessary for the first time to (also) get a shot with imunoglobuline (live vaccin).

This first shot would cost 18000 baht! (the dose depends on the body weight, I am 30% more heavy than most Thai guys).

I refused to get this shot.

Is it really necessary ?

Depends on the nature of the contact; this is what the WHO says:

Types of contact are:

• category I – touching or feeding animals, licks on the skin
  
• category II - nibbling of uncovered skin, minor scratches or abrasions without bleeding, licks on broken skin
  
• category III – single or multiple transdermal bites or scratches, contamination of mucous membrane with saliva from licks; exposure to bat bites or scratches
  

For category I no treatment is required, whereas for category II immediate vaccination and for category III immediate vaccination and administration of rabies immune globulin are recommended in addition to immediate washing and flushing of all bite wounds and scratches.

[kriswillems]

A dog bit me yesterday. Today I went to the hospital (government hospital).

I paid 470 Baht. Next 3 times I'll have to pay 250 Baht.

They gave me VERORAB.

I only need to get 4 shots (in stead of 5, I don't know why).

But they said it was necessary for the first time to (also) get a shot with imunoglobuline (live vaccin).

This first shot would cost 18000 baht! (the dose depends on the body weight, I am 30% more heavy than most Thai guys).

I refused to get this shot.

Is it really necessary ?

Depends on the nature of the contact; this is what the WHO says:

Types of contact are:

• category I – touching or feeding animals, licks on the skin
  
• category II - nibbling of uncovered skin, minor scratches or abrasions without bleeding, licks on broken skin
  
• category III – single or multiple transdermal bites or scratches, contamination of mucous membrane with saliva from licks; exposure to bat bites or scratches
  

For category I no treatment is required, whereas for category II immediate vaccination and for category III immediate vaccination and administration of rabies immune globulin are recommended in addition to immediate washing and flushing of all bite wounds and scratches.

The dog bite didn't hurt. It took me even a while to realize I had been bitten. 2 teeth went in and left 2 small holes. Blood was coming out one of the holes, so that makes me category III. It all looks very innocent but I don't want to take any risk. I also don't know the owner of the dogs and I don't know which of the dogs bit me although all dogs were protecting an area around a shop. They attacked every motorcycle and bicycle that passed on Sukumwit highway (I was riding bicycle). Sometimes they attack me in front of the eyes of several police officers that do road checks around that area, but the police doesn't care at all. Even my wife says it the nature of the dog to bite and I shouldn't try to hurt it. The dogs looked healthy and trained to attack, as if somebody "took care" of these dogs. I didn't try to contact the shop owner and gave up my new hobby, riding bicycle, for now. The situation is more or less hopeless because on a distance of about 60 kms I get about 4 times attacked by dogs. Only farang and mad people ride bicycle around here

Thanks all for your advice, I'll give the thread back to the thread starter now

[taxout]

Given all those dogs out there, I'm sure you'll be relieved to know that if and when you're bit again, you'll just need a booster series of Verorab, not another shot of immunoglobulin.

[schmutzie]

Ok, I'm resurrecting this.

Was bit by a soi dog on the 10th at what qualifies as a cat 3, ie. blood came out from the bite (but was actually more like a scratch from the teeth).

Called the Red Cross clinic but they had already closed and advised us to seek treatment in a hospital, that is, not to wait for the next day.

We went to Lat Phrao Hospital because it's nearby. Gave me Verorab and cleaned and dressed wound and prescribed a course of antibiotics.

Total bill came to 1800THB.

Had my second shot of Verorab yesterday at a local clinic. Cost me 450THB.

But now I'm reading that I should have been given Immunoglobin (sp?). Is there any reason why the hospital would not have given me this,

other than a misinterpretation by the doctor (went to emergency and he saw me all but 5 minutes)?

Confused and a little worried. I think I'll contact the hospital and have them explain why I wasn't given this.

Edited September 14, 2010 by schmutzie

[TBWG]

That sounds about right I had 5 shots (not Painful at all) cost 2,100 baht 18 months ago, dog owner is legally obliged to pay, that if you can find owner!

From what I can recall 2nd injection after 3 days 3rd after further 5 days 4th 7 days etc

It is a no brainer must have injections alternative is death if dog was rabid.

Good luck

TBWG

PS Just noticed I was replying to 2008 post so not really relevant to latest post.

Edited September 14, 2010 by TBWG

[schmutzie]

That sounds about right I had 5 shots (not Painful at all) cost 2,100 baht 18 months ago, dog owner is legally obliged to pay, that if you can find owner!

From what I can recall 2nd injection after 3 days 3rd after further 5 days 4th 7 days etc

It is a no brainer must have injections alternative is death if dog was rabid.

Good luck

TBWG

PS Just noticed I was replying to 2008 post so not really relevant to latest post.

Were you aware or made aware that an additional immunoglobulin might be required, or did the dog not break skin?

Edited September 14, 2010 by schmutzie

[schmutzie]

I found this:

http://www.who.int/rabies/human/adminimmuno/en/

So it seems to me the hospital neglected to follow the recommended procedure. They failed to ascertain the level of exposure (cat 3)

and to perform a skin test. And subsequently failed to recommend an ERIG treatment. It mentions all this on the Verorab jab card (in Thai)

so am puzzled.

[taxout]

Because the immunoglobulin is expensive and in relatively short supply, you can only count on the largest hospitals, as well as the Red Cross, having it in stock. "Best practice" is frequently not followed.

[gotlost]

Wife just finished a series of Rabies shoots (5) and one Tetanus. Chiang Mai Ram Hospital Chiang Mai. Cost 5,000 Baht.

[Sheryl]

Yes, you should have received rabies immunoglobulin (RIG) if you have no prior vaccination for rabies.

And as long as less than 7 days have not elapsed since the start of the vaccine series, you should still get it.

Go to a larger hospital or Thai Red Cross. Be aware that there are 2 preparations, one made from human serum and one from horses, the latter is cheaper but carries a not insubstantial risk of allergic reaction. May be worth calling around to find a hospital which carries the human RIG. If you do get the equine make sure they do a skin tests first.

It is possible they did not have RIG at Lat Phrao. There is an unfortunate tendency in Thailand for doctors/hospitals not to tell patients about treatments they need that are not available. Perhaps "loss of face" thing. Also the mai pen rai philosophy does sometimes make its way into medical practice here, a context in which needless to say it loses its charm.

In your case it's irrelevant but for those who haven't yet been bitten, getting the pre-exposure vaccine will avoid the need for RIG and also shorten the number of post-bite jabs needed if/when you are bitten.

[schmutzie]

I had my ERIG shot at the Thai Red Cross today ("Snake Farm").

They did an allergic reaction test (inject you and you wait 15 minutes for observation).

Then injected me at the wound and both sides of my behind. It's quite a lot of serum, depending on weight (I'm 72kg so not massive).

Then observed me for 30 minutes to check for side effects.

Charged me 2000 for the ERIG and 20 for registration. HRIG (administered if they find an allergic reaction to ERIG) would have been +3000, so not really much more. Compare this to a quote of approx. 20000 for RIG shots at Lat Phrao General Hospital.

They would also be cheaper for the Verorab shots, charging only 350 per shot.

I wholeheartedly recommend the Thai Red Cross clinic for vaccinations for residents or travellers. They were efficient, professional and courteous. I was surprised that they actually all spoke much better English than at the private hospital.

I will definitely want to follow up with Lat Phrao General about what their MO with regards to rabies is. We visited them late last night, at about 1.30am, and were given frankly a very poor response: Basically, they claimed that RIG shots were not standard in Thailand for rabies (!) and that if I did not have any symptoms now they could not really see the point of giving the RIG. As I mentioned, they suggested the shot would cost 20000, which they used as a another excuse as to why did not think to do this, ie. that I would probably find it too expensive. They claimed to have some form in English that would describe to me their rabies policy and set up an appointment with a doctor today for further explanation.

Really very worrying behaviour for what I considered a large hospital in the capital. This is potentially life threatening. Not something to take chances with or gamble.

Edited September 15, 2010 by schmutzie

[Sheryl]

I will definitely want to follow up with Lat Phrao General about what their MO with regards to rabies is. We visited them late last night, at about 1.30am, and were given frankly a very poor response: Basically, they claimed that RIG shots were not standard in Thailand for rabies (!) and that if I did not have any symptoms now they could not really see the point of giving the RIG. As I mentioned, they suggested the shot would cost 20000, which they used as a another excuse as to why did not think to do this, ie. that I would probably find it too expensive. They claimed to have some form in English that would describe to me their rabies policy and set up an appointment with a doctor today for further explanation.

Really very worrying behaviour for what I considered a large hospital in the capital. This is potentially life threatening. Not something to take chances with or gamble.

Completely nonsensical response from the hospital, whomever you spoke with clearly had no idea what they were talking about and just made up something to try to placate you. "Symptoms" of rabies do not set in for months and when they do it is far too late for immunolobulin. RIG most definitely is part of the rabies protocol for Thailand. The doctor who treated you did not follow either accepted medical practice or his own Ministry of Public Health's recommendations, full stop.

I doubt you'll get anywhere with the hospital on this, though. Thai hospitals are not accustomed to receiving this type of inquery or complaint from customers and will respond, if at all, with evasion or defensiveness and random excuses. They most likely will not even question the doctor concerned. If you know the name of the doctor who treated you, a letter directly to him may have more effect and possibly he will be more careful in the future.

You may find this article of interest

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-476MK0N-21&_user=10&_coverDate=02%2F28%2F1989&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1462713033&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=5c2fcbb492cb9159443aaa3cca47f249&searchtype=a

On a more general note, the quality of care in smaller private hospitals in Thailand (Bangkok and elsewhere) is often substandard and they are best avoided in favor of either one of the "international" hospitals or a large (provincial level or higher) government hospital.