Rabies Vaccination Guidelines 2019

As long as standard wound treatment and vaccination/immune globulin vaccination corresponding to the exposure level are completed before the onset of rabies, the onset of rabies can be 100% avoided. There is no such thing as the so-called "incubation period of decades" and "vaccination is useless".

I have been working in a community dog ​​injury clinic for almost 5 years. When this version of the guideline first came out, our whole department trained for almost two weeks. It was true that it was down-to-earth. It changed many old rules that had been in use for more than ten years and clarified all the rumors that had been spread on the Internet. Last week, I met a junior high school student who was scratched by the family cat on the back of his hand. His grandmother held him at the door and refused to enter, saying that in the past, if he was bitten by a dog, he would need 10 injections.

Let me first tell you the most practical judgment criteria. There is no need to compare blindly with the online grading chart: if your cat or dog gets rabies vaccination on time every year, and has never been out of the house, and is scratched by it, rub it with 75% alcohol and it will not sting at all, indicating that the dermis is not broken. You don’t need to bother with disinfection, let alone vaccination. If rubbing alcohol causes a stinging sensation, it means there is skin damage that is invisible to the naked eye. Regardless of whether there is bleeding or not, you must get vaccinated as required. If the wound is bloody, or the bite is on a nerve-intensive place such as the head, face, neck, or fingers, don’t worry about the immunoglobulin money. You must get it. This is emphasized in bold in the 2019 edition. In the past, many people thought that just getting a vaccine would be enough. In fact, if the head and face are exposed, the virus will run to the central nervous system faster than the vaccine can produce antibodies. Immune globulin will kill the virus directly around the wound. It is equivalent to buying you an "expedited insurance", which is really not worth saving.

There are currently two vaccination plans. No one is better than the other. Just choose the one that suits you. The older 5-injection method is the familiar one on the 0th, 3rd, 7th, 14th, and 28th days. The single injection dose is small and the side effects are mild. It is suitable for the elderly and children with relatively sensitive constitutions. There is also a 4-injection "2-1-1" plan. One injection in the left and right arms for the first time, and then one injection on the 7th and 21st days, which saves a trip to the hospital. Most of the office workers I met choose this. The first time I go to get the injection on the weekend, the next two times can be done on the way to get off work, without having to take extra time off.

The question that many people ask the most is: “I just had a full course of treatment last year, and if I get bitten again this year, do I still have to get one? ”In fact, there is still some disagreement in the industry on this issue. The official standard given in the guide is: exposure within 3 months after full vaccination. If the wound is not serious, you only need to wash the wound with soap and water for 15 minutes, and there is no need to re-injection. ； 2 additional injections from 3 months to 1 year, 3 additional injections from 1 to 3 years, and a full re-injection after 3 years. However, in our clinic, we sometimes encounter people who are aggressively bitten by stray dogs. Even if it is just 2 months after the treatment, we will advise him to take two more booster shots. This is not to say that the guidelines are wrong, but that the infection rate of stray dogs is much higher than that of domestic animals. There is no harm in taking two more shots. Please rest assured. Some clinicians think that as long as the antibody concentration in the body is sufficient, there is no need to take injections. Some veteran disease control experts think that as long as the injury is caused by an unknown animal, it is safer to give a few more injections no matter how long it takes. There is no absolute right or wrong. It all depends on the level of risk you can accept.

There is also a misunderstanding that has been circulating for more than ten years: "Rabies vaccination is required only if a dog bites you." The 2019 edition has specially listed a list of susceptible animals. Warm-blooded animals such as cats, bats, foxes, weasels, and raccoons are all at high risk. Anyone bitten by these animals must be dealt with according to regulations. ； Rodents and lagomorphs such as hamsters, rabbits, and chinchillas rarely carry rabies virus. There is no need to beat them if they are bitten by domestic animals. However, if they are wild hamsters and rabbits caught in the wild, they can be beaten. After all, no one knows what they have been exposed to outside. Oh, by the way, someone asked if you should hit someone if you are bitten? Unless the person biting you is a confirmed rabies patient, don't use it at all. Don't torment yourself.

By the way, let me tell you the most outrageous rumor: "Being beaten for more than 24 hours is in vain." This is pure nonsense. The 2019 version clearly stated that the incubation period of rabies is usually 1 to 3 months. As long as you have not yet developed the disease, vaccination is useful to stimulate the body to produce antibodies. Even if it has been ten days after a week, as long as there are no symptoms, it is still too late to get vaccinated. Of course, the sooner the better, don’t delay it deliberately.

In fact, if you read through this guide, you will find that its core logic has never been to "let everyone get vaccinated when everything is fine", but to minimize the risk - after all, rabies is currently the only acute infectious disease in humans with a fatality rate of 100%, so we really can't afford to bet on it. If you are not sure about your situation, go directly to the local dog injury clinic and ask. Don’t search for messy information on the Internet. It is really not worth it to be scared that you can’t sleep and then be too conceited to take it seriously.