Rabies is an acute infectious disease caused by rabies virus, also known as hydrophobic disease, mad dog disease, etc. Rabies virus is mainly transmitted among animals with a mortality rate of 100%.
Have you encountered the following problems in clinical practice? Is the processing standard?
1. What kinds of rabies vaccines are there? Each has its own what?
VERO cell rabies vaccine, hamster kidney cell rabies vaccine, chicken embryo kidney cell rabies vaccine and human diploid cell rabies vaccine are currently used in China, all of which are inactivated vaccines.
In addition to rabies vaccine, rabies antiserum or rabies human immunoglobulin (HRIG) need to be injected for patients with severe animal bites. These two drugs belong to passive immune preparations and are used to neutralize rabies virus to obtain rapid protection.
However, the sources of the two are different. Antiserum is derived from horse serum and belongs to heterogeneous protein. Many people have allergic reactions, so skin tests must be done first. If it is positive, desensitization therapy can only be used for a small amount of multiple injections, which takes a long time and may cause serum diseases with serious side effects.
The source of HRIG is human serum, and the incidence of allergic reactions is extremely low. Therefore, skin tests are not required. HRIG is safe and reliable, with high titer and good stability. Apart from occasional local pain and low fever, the incidence of adverse reactions is low, but the price is relatively expensive.
2. What needs to be vaccinated with rabies vaccine and antitoxic serum at the same time. What are the precautions?
Those with high exposure level should be beaten.
Rabies exposure is divided into three levels according to contact mode and exposure degree:
1. Contact or feed animals, or intact skin is licked as Grade I.
2. Bare skin is slightly bitten, or minor scratches and abrasions without bleeding are Grade II.
3. Single or multiple penetrating skin bites or scratches, or damaged skin licked, or open wounds, mucosal contamination is classified as Grade III. Exposure to bats is also classified as Grade III.
If it is confirmed as a Class II exposure person with low immune function, or if the Class II exposure is located on the head and face and the injured animal cannot be determined to be healthy, it shall be treated according to Class III exposure.
For those who are judged to be Class III exposed, in addition to timely and standardized cleaning and disinfection of wounds and rabies vaccine vaccination after exposure, if the injured person has never been vaccinated with rabies vaccine for at least 2 doses before, passive immune preparations need to be vaccinated at the same time.
On the day of injury, the vaccine was injected with anti-rabies serum (40 IU/kg body weight) or rabies immunoglobulin (20 IU/kg body weight) in the local infiltration injection of the bitten. After exposure, the vaccine immunization must be carried out in combination with antiserum.
3. Can children receiving planned immunization be vaccinated against rabies?
You can play.
Children undergoing planned immunization can be vaccinated against rabies according to normal immunization procedures. During the period of rabies vaccination, other vaccines can also be vaccinated according to normal immunization procedures. In case of conflict, rabies vaccine should be given priority.
4. Is rabies vaccine effective only after being bitten by rabies or suspected rabies within 24 hours?
Vaccination against rabies is effective at any time. Vaccination is like a race against disease, so the sooner the better.
As long as people do not suffer from the disease before the vaccine takes effect, that is, before the vaccine stimulates the body to produce sufficient immunity, the vaccine can play its role.
For those who have been exposed for several days and months but have not been vaccinated against rabies for various reasons, as long as they can get the vaccine, they should also be given supplementary injections as soon as possible as those who have just been exposed. Try to make the vaccine work before the onset of the disease.
5. If you don’t object the vaccine according to the procedure, what if you are one or severe days late? Do you want to do it again accord to the procedure?
There is no need to follow the procedure again, but the vaccination time needs to be adjusted.
Correct vaccination according to the procedure is very critical to the body’s immunity against rabies. When a certain injection is delayed for one day or several days, the subsequent injection time will be postponed according to the interval time of the delayed original immunization procedure.
6. Can rabies vaccines of different brands be mixed, and can domestic and imported rabies vaccines be mixed?
Try to use the same brand of vaccine.
According to regulations, the same brand of rabies vaccine should be used as much as possible to complete the whole vaccination.
If it cannot be realized, qualified rabies vaccines of different brands should continue to be vaccinated according to the original procedures. In principle, patients are not allowed to carry rabies vaccines to different places for injection.
However, clinical observation shows that mixing vaccines of different brands will not affect their preventive effect.
7. Injection site and precautions during vaccination?
The injection site for adults is intramuscular injection of deltoid muscle of upper arm. Infants under 2 years old can be injected into anterolateral thigh muscle.
Hip injection is prohibited. Slight reactions, such as redness or mild induration, may occur at the injection site, and fever reactions are rare.
The incidence of allergic reactions is extremely low, and people with allergic reactions can receive corresponding antiallergic treatment.
8. How to get rabies vaccine when you are bitten by animals again during vaccination?
According to the time of the bite again.
After any exposure, the wound should be treated first, timely and thoroughly. Under normal circumstances, the antibody level in the body can be maintained for at least one year after the whole process of rabies vaccination.
If the re-exposure occurs during the immunization process, the whole vaccination process will continue to be completed according to the original procedure without increasing the dose.
According to the rabies vaccine position paper updated by the World Health Organization in April 2018, those who are exposed again within 3 months after the whole immunization generally do not need to be immunized again. After the exposure occurs 3 months after the whole process of rabies vaccination, one dose of vaccine should be vaccinated on 0 and 3 days respectively.
Injection of passive immune preparation: For those who have completed the whole process of rabies vaccine (cell culture vaccine) according to the pre-exposure (post-exposure) procedures, passive immune preparation is no longer required for re-exposure.
9. Do you want rabies vaccine if you are bitten?
You don’t have to fight.
The host animals of rabies include all warm-blooded mammals, including humans.
When a person is bitten by an animal with rabies, the virus in the saliva of the animal reaches the brain center along the nervous system, causing the onset of the disease. Only after the onset of the disease will the virus disperse into glands such as the saliva of the person.
Therefore, even if a person is bitten by a dog but does not suffer from the disease, there will be no rabies virus in his glands.
Furthermore, people need to be vaccinated against rabies only if they are bitten by a sick rabies person. If you are sure that you are not bitten by a rabies person, you do not need to be vaccinated against rabies.
Although rabies vaccine may not be required for bites, there are more than 1,000 kinds of bacteria in human oral cavity. Special attention should be paid to infection when dealing with bites.
10. Can pregnant women get rabies vaccine?
Pregnant women can also play. There is no contraindication for immunization after exposure.
In theory, rabies vaccine will not affect the intellectual and physical development of embryos or fetuses. Current research shows that qualified rabies vaccine will not have adverse effects on pregnant women or fetuses.
Rabies vaccine is an inactivated virus vaccine. The inactivated virus cannot pass through the placental barrier and will not cause fetal abnormalities. At present, studies carried out at home and abroad have not found that rabies vaccine causes abortion, premature delivery or teratogenicity. However, it is suggested that immunization before exposure should avoid pregnancy.
Thank Dr. Tian Wei of Ningguo Center for Disease Control and Prevention for reviewing the manuscript. The revision was made on October 23, 2018.