Dog Bite

[Samuinick]

Hi All

I am looking for a bit of advice for a friend of mine who has just been bitten by a dog. She was bitten previously about 2 years ago and received the immunisation injections for that bite. My question is, how long do these injections last, the pharamcy assures us she is still ok and doesn't require more

Thanks

Nick

[FBN]

If a full course of Rabies vaccine has been administered, she should be fine. The usual management in these cases where another bite happens is to have blood taken for Rabies antibodies to be sure that she has developed an effective/protective immune response.

If not, she will need a booster dose. The vaccine is usually good for 10 years.

In the case of a non-routine vaccination, as in immunisation after a bite, the first injection is usually an Immune globoline to give immediate protection(passive antibodies) followed by the vaccine; the immune globuline may interfere with the development of immunity.

If a routine vaccination is given with booster dose as recommended, this is usually not a problem.

[Samuinick]

Thanks FBN

[FBN]

Just did a bit of research and seems the American updated advice is to have a dose of Rabies vaccine on day zero and day three in cases where previous vaccination was done.

Reference: http://www.uptodate.com/patients/content/t...~MvMJgLSStBRPtz

I would advise this course of action if a test for Rabies antibodies is not available.

[londonthai]

I believe the offending dog should be taken to veterinarian and checked for rabies.

If it's an aggressive dog it might have to be put to sleep - reporting an accident to police will show if the dog was reported there before and if police can take action against the owner of the dog. Agressive dogs should be kept on a leash or enclosed.

After reporting to police your friend might claim compensation from the owner for her medical expenses

[taxout]

Yes, even if she's been vaccinated before, she still needs booster shots if she's been bit. These are not expensive -- less than 500 baht normally.

Since she's been vaccinated, she won't need shots of the very expensive HRIG.

People do die of rabies in Thailand. Protection is so simple, please take no chances whatever.

[wasabi]

If a full course of Rabies vaccine has been administered, she should be fine. The usual management in these cases where another bite happens is to have blood taken for Rabies antibodies to be sure that she has developed an effective/protective immune response.

If not, she will need a booster dose. The vaccine is usually good for 10 years.

In the case of a non-routine vaccination, as in immunisation after a bite, the first injection is usually an Immune globoline to give immediate protection(passive antibodies) followed by the vaccine; the immune globuline may interfere with the development of immunity.

If a routine vaccination is given with booster dose as recommended, this is usually not a problem.

Can you expand on the underlined portion of your quote? I had the vaccine and immunoglobuline after a monkey bite last year. Does the fact I had the immunoglobuline somehow make the vaccine less effective or mean I will need boosters more frequently?

Edited March 1, 2009 by wasabi

[FBN]

If a full course of Rabies vaccine has been administered, she should be fine. The usual management in these cases where another bite happens is to have blood taken for Rabies antibodies to be sure that she has developed an effective/protective immune response.

If not, she will need a booster dose. The vaccine is usually good for 10 years.

In the case of a non-routine vaccination, as in immunisation after a bite, the first injection is usually an Immune globoline to give immediate protection(passive antibodies) followed by the vaccine; the immune globuline may interfere with the development of immunity.

If a routine vaccination is given with booster dose as recommended, this is usually not a problem.

Can you expand on the underlined portion of your quote? I had the vaccine and immunoglobuline after a monkey bite last year. Does the fact I had the immunoglobuline somehow make the vaccine less effective or mean I will need boosters more frequently?

Immune globuline is a preparation of antibodies from an immune donor intended to "neutralise" the circulating virus before it could do harm. This also to some extent neutralises the actual virus antigen that your body needs to make antibodies from the vaccine but the effect from the immune globuline does not last more than a week or two. This is the main reason for the multiple doses of vaccine given in a post exposure scenario.

In Rabies, the manufacturer claims that the vaccination, even after immune globuline administration, will result in immunity after 2 weeks but most authorities would suggest to have booster dose/s after a year or so in these cases, especially if you have a high risk of exposure. Most international companies with expats in Thailand will recommend Rabies vaccination for long stay residents due to the relatively high risk here.

In Hep A, if immune globuline is given to exposed persons as a prophylaxis, vaccination is usually delayed for a few weeks for this reason.

[GarryP]

Speaking from personal experience, after being bitten I had a full series of shots. I believe it was five or seven injections in total. Three years later I was bitten again and just to be on the safe side went back to the hospital where I had the first set of shots. The doctor checked my records and told me I didn't need any shots as the first lot would cover me for five years. After 5 years I would need a booster, or just leave it until bitten again and go through the full course again.

[bina]

londonthai, u cant check for rabies unless the dog is dead; and for the most part that isnt neccessary unless it was an unowned dog that seemed unhealthy. a healthy, aggressive dog, means just that, it is naturally aggressive and therefore acting healthy. a dog that is usually docile but has a sudden personality change is more suspect of having a number of different diseases, one being rabies... it is better to just get the injections. and if u have had a rabies shot (if u are a vet, or zoo worker) then u just have to do a blood titre once a year to see if u need a booster or not.

anyway, there is an other thread running in the pets section recently unless it moved to here...

bina

israel

[FBN]

Bina,

There is a saliva test (rapid test) available as well: http://www.msnbc.msn.com/id/28998759/

As far as I know, this is available and has been used in Bangkok before when studies were conducted on seroprevalence of Rabies in strays.

Tests were conducted when strays were rounded up for sterilisation and vaccination.

Presentation here: http://www.oie.int/eng/rabies2007/files/Se...Kasemp_dogs.ppt

[londonthai]

I don't know the details, but when I was bitten as a kid, the owner had to go with a dog to the veterinarian. I hadn't got any blood tests, probably because it takes time to develop antibodies. Since than (a long time ago) there might be the other ways of checking the victim and the dog.

[bina]

fbn if that is the case i will check in israel since we are a rabies prevalent country and also have packs of feral dogs all over the place and foxes, a large amount of rabid foxes in our villages biting dogs every year.

; in every bite case we had in the clinic (the owner of dog checking with us for his rabies licsence), the dog was in house or dog pound quarantine for 10 days.

with every animal bite we had at the petting zoo (fortunately not to many as long as i worked there) from rabbit to goat, the animal was in 'in house' quarantine for ten days and if the bite was reported to the ministery of health by hospital or health center, the person bitten had to get the shots. if it wasnt reported, then the procedure was just quarantine for the animal.

all canines, goats and ferrets were required vaccinated. donkeys and rabbits werent, so werent vaccinated-- required rabies vaccines are cheap. voluntary vaccines are expensive and the national vet service guy doesnt like to come out and do them and he is the only one that can give them.

not once was a saliva test mentioned, especially not by the national vet school and rabies center in beit dagen. if we had an animal die mysteriously or we found a dead animal (not slaughtered by wild dogs) that we couldnt account for its death, it was taken to beit dagen as they have an emergency rabies lab 24 hrs a day. it is the only lab check that is free. any other dead mammal if it didnt seem to have neurological problems prior to death, we did the vivisection on site.

a good point, am sending off an email to one of my vets to ask if there is such a thing here. it could be there isnt because it is cost prohibitive or something.

and then there is the problem of false positives false negatives and te amount of time it takes to get results., probably just cheaper and easier for people to get the injections then the emotional tension of waiting for results. unless it was somebody's pet dog in which case the statistics of it being rabid go down quite a bit.

i would love it if somebody in the forum living in thailand would find out ALL the procedures, costs, etc and do a pinned subject either in health or in pet,vet forums (or both) since this question crops up all the time and the answers are always filled with heresay, and it is a potentially life threatening situation. anyone interested? as a mod i will pin it in the pet,vet section if someone will just do a good survey of info, and ensure it is updated and relevant.

bina

israel

read thru... sending info off to my vets ... as they said, animals can carry for along period,but apparently, grazers carry longer then canines before presenting. at least that is waht we were told at the jeruslalem zoo several years ago when a rabid fox or jackal bit several antelope type grazers... the zoo was in quarantine for 6 months!! we couldnt even get our emus from them though emus have no way of getting rabies, being birds and not mammals.

[FBN]

The safest approach would always be to get the RIG (Rabies Immune Globuline) immediately post exposure followed by the full regime of vaccinations. The closer the bite or site of exosure is to the face/head, the less time delay there is (hours). There are recorded cases of people having been bitten in the face (one boy in the eye) and still had a fatal outcome even after an appropriate post exposure management.

4 from the known 5 survivors were either previously vaccinated or had the post exposure regime. Only one 15yo girl survived rabies from a bat bite (thumb) without any vaccination.

The animal can be caught if possible and quarantined. Tested with the saliva test and kept for 10 days. If the animal dies, an analysis of brain tissue is made to identify the Negri bodies which is diagnostic. If the animal tests negative and remains alive after 10days, the Rabies post exposure regime could, theoretically, be stopped but this would not be a good idea.

Animal vaccination is many times cheaper than human vaccination which again in turn is many times cheaper than the post exposure regime.

The critical issue here is not to delay treatment after animal bites or suspected exposure incidents. The closer to the brain the bite, the more critical time becomes.

In general, it is good advice to get vaccinated when living in a high risk area.

As we speak, reports are out of 80 children in Luanda (Angola) that have died from rabies after dog bites.

[taxout]

"The safest approach would always be to get the RIG (Rabies Immune Globuline) immediately post exposure followed by the full regime of vaccinations."

No, not always. HRIG should be given when the victim hasn't been previously immunized against rabies.

But if the victim has been previously immunized, then not only is HRIG not needed, it can be counter-effective, since it can suppress production of the antibody.

See the CDC page on rabies for more detailed information.

http://www.cdc.gov/RABIES/exposure/postexposure.html

[FBN]

"The safest approach would always be to get the RIG (Rabies Immune Globuline) immediately post exposure followed by the full regime of vaccinations."

No, not always. HRIG should be given when the victim hasn't been previously immunized against rabies.

But if the victim has been previously immunized, then not only is HRIG not needed, it can be counter-effective, since it can suppress production of the antibody.

See the CDC page on rabies for more detailed information.

http://www.cdc.gov/RABIES/exposure/postexposure.html

Correct; refer post no 4 in this thread.