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This is me getting my rabies vaccine, dose 2, day 7. I got the first dose last week. One more in 3 weeks.
Soon I'll no longer have the urge to bite the postman.
In some parts of the world, rabies is a problem, and South Africa's Kwazulu Natal region has reported an increase among dogs. Port Shepstone has the highest concentration in KZN, says the Pretoria News of 3 Jan 2007. Countrywide, there were 28 cases of human rabies infection reported in 2006, according to the National Institute for Communicable Diseases, the NICD.
People who may be exposed to rabies, such as lab workers, veterinary surgeons, etc., should be vaccinated with three doses, on day 0, day 7, and day 28, with one intramuscular dose each time, if they are immunocompitent. A booster at least every 5 years is required.
Post-exposure prophlyaxis is the prevention of rabies in people who have been bitten, or otherwise significantly exposed to, an animal with rabies.
For those who have up-to-date pre-exposure prophylaxis, a booster on day 0 and day 3 is required, with no antibodies given, as they may interfere with an adequate response of the body's own immune system which has memory for rabies antigen.
The majority of people will not have been vaccinated prior to exposure.
The wound should be washed thoroughly - 5-10 minutes of flushing with water, with 5% chlorhexidine in the water if possible. Cat bites are deep with small pucture wounds, and a syringe can be used to flush them. 70% alcohol or iodine-based disinfectants should then be used, as they inactivate rabies viruses. Don't forget tetanus toxoid and antibiotics.
Further sharp trauma to the wound should be avoided, as this may enhance rabies virus infection of nerve or muscle tissue. This includes stitching the wound and repeated needle trauma during local anaesthetic or immunoglobulin administration.
There should be NO delay in giving antibody and vaccine - some authorities recommend waiting to see if the animal develops illness (NEJM 16 Dec 2004, which gives otherwise excellent advice) but this is incorrect. This gives up to 10 days without prevention, during which the virus has plenty of time to infect and start multiplying. Vaccination can be stopped if the animal ends up being considered rabies-free, but the time spent determining whether or not that is the case is not to interfere with treatment.
They should get rabies immunoglobulin on the day they report for medical care. The usual dose is 20 IU/kg if the immunoglobulin used is of human origin, and 40 IU/kg if it comes from horses. As much as possible should be given into the wounds, and if necessary, diluted up to 50% in saline. The maximum dose of immunoglobulin should not be exceeded, as it will interfere with the vaccine. Any remaining immunoglobulin should be given into the deltoid muscle at the shoulder - preferably not the buttock, as absorption may be poor.
The vaccine should be given into the deltoid muscle, preferably into the opposite muscle to any bites on the arm, which have been injected with rabies antibody, and definitely not into the same muscle as any remaining antibody. Never into the buttock, where it will not be as effective in producing an adequate immune response.
The vaccine is given on day 0 (the day the patient presents for medical care), day 3, day 7, day 14, and day 28. The commonly used vaccine is Verorab.
A double dose of vaccine on day 0 should be given if the patient is immunocompromised, e.g. taking steroids, takes chloroquine for malaria prophylaxis, if antibody was given before vaccine was obtained, or if day 0 was more than 48 hours after exposure.
If no antibody is immediately available, vaccine can be given, and the antibody given within 7 days.
If no vaccine is available, and will become available soon, antibody and vaccine should be given together.
Official rabies guidelines should be consulted - never base treatment on a website, even if it is a virologist's website!
The best guidelines I've seen have been compiled by a team of experts from the Departments of Health and Agriculture, and are relevant for both human and animal medical personnel. [PDF, 1.1 MB]
Soon I'll no longer have the urge to bite the postman.
In some parts of the world, rabies is a problem, and South Africa's Kwazulu Natal region has reported an increase among dogs. Port Shepstone has the highest concentration in KZN, says the Pretoria News of 3 Jan 2007. Countrywide, there were 28 cases of human rabies infection reported in 2006, according to the National Institute for Communicable Diseases, the NICD.
People who may be exposed to rabies, such as lab workers, veterinary surgeons, etc., should be vaccinated with three doses, on day 0, day 7, and day 28, with one intramuscular dose each time, if they are immunocompitent. A booster at least every 5 years is required.
Post-exposure prophlyaxis is the prevention of rabies in people who have been bitten, or otherwise significantly exposed to, an animal with rabies.
For those who have up-to-date pre-exposure prophylaxis, a booster on day 0 and day 3 is required, with no antibodies given, as they may interfere with an adequate response of the body's own immune system which has memory for rabies antigen.
The majority of people will not have been vaccinated prior to exposure.
The wound should be washed thoroughly - 5-10 minutes of flushing with water, with 5% chlorhexidine in the water if possible. Cat bites are deep with small pucture wounds, and a syringe can be used to flush them. 70% alcohol or iodine-based disinfectants should then be used, as they inactivate rabies viruses. Don't forget tetanus toxoid and antibiotics.
Further sharp trauma to the wound should be avoided, as this may enhance rabies virus infection of nerve or muscle tissue. This includes stitching the wound and repeated needle trauma during local anaesthetic or immunoglobulin administration.
There should be NO delay in giving antibody and vaccine - some authorities recommend waiting to see if the animal develops illness (NEJM 16 Dec 2004, which gives otherwise excellent advice) but this is incorrect. This gives up to 10 days without prevention, during which the virus has plenty of time to infect and start multiplying. Vaccination can be stopped if the animal ends up being considered rabies-free, but the time spent determining whether or not that is the case is not to interfere with treatment.
They should get rabies immunoglobulin on the day they report for medical care. The usual dose is 20 IU/kg if the immunoglobulin used is of human origin, and 40 IU/kg if it comes from horses. As much as possible should be given into the wounds, and if necessary, diluted up to 50% in saline. The maximum dose of immunoglobulin should not be exceeded, as it will interfere with the vaccine. Any remaining immunoglobulin should be given into the deltoid muscle at the shoulder - preferably not the buttock, as absorption may be poor.
The vaccine should be given into the deltoid muscle, preferably into the opposite muscle to any bites on the arm, which have been injected with rabies antibody, and definitely not into the same muscle as any remaining antibody. Never into the buttock, where it will not be as effective in producing an adequate immune response.
The vaccine is given on day 0 (the day the patient presents for medical care), day 3, day 7, day 14, and day 28. The commonly used vaccine is Verorab.
A double dose of vaccine on day 0 should be given if the patient is immunocompromised, e.g. taking steroids, takes chloroquine for malaria prophylaxis, if antibody was given before vaccine was obtained, or if day 0 was more than 48 hours after exposure.
If no antibody is immediately available, vaccine can be given, and the antibody given within 7 days.
If no vaccine is available, and will become available soon, antibody and vaccine should be given together.
Official rabies guidelines should be consulted - never base treatment on a website, even if it is a virologist's website!
The best guidelines I've seen have been compiled by a team of experts from the Departments of Health and Agriculture, and are relevant for both human and animal medical personnel. [PDF, 1.1 MB]
on April 18, 2007, 10:59 pm
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on April 18, 2007, 11:31 pm
http://amedeo.com/lit.php?id=8840614
"This report describes two unusual human rabies patients, a 41 year old woman and a 5 year old boy. The only known source of exposure for both patients was to family members who died of rabies. The clinical histories of these two patients suggest the possibility of naturally occurring human-to-human transmission of rabies."
This is a report of a possible case of rabies transmitted by kissing. It has not been proved. The only documented cases of human-to-human transmission are organ transplants. But since rabies is shed in the saliva, there is a possible risk.
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on April 18, 2007, 11:36 pm
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