2023 Latest Edition of Rabies Vaccination Guidelines

As long as skin breaks, bleeding, open wounds/mucosal membranes are licked by animals, flush the wound with running water and soap for 15 minutes as soon as possible, and then vaccinate the rabies vaccine as soon as possible. There is no saying that "it is useless after 24 hours". The vaccination can be effective as long as the disease has not yet occurred. The safety of the currently approved rabies vaccine in China is guaranteed, and special groups such as pregnant women and infants can also be vaccinated. The fatality rate of rabies is 100%. Never bet on luck.

I worked in a community dog ​​injury clinic for half a year last year, and I saw too many people who struggled because they couldn't understand the rules. Last week, a little girl in school uniform got a light red mark scratched by the blue cat at home. She cried at home all afternoon, saying that it had been 30 hours and the beating was in vain. When she came in, her eyes were swollen like peaches. In fact, the so-called "24-hour golden period" is just a suggestion that the earlier you get vaccinated, the faster the production of antibodies will be. It is not a threshold of validity at all. In the cases I have come across, there are many people who were bitten by dogs for a week before coming for vaccination. As long as symptoms such as fear of water and fear of wind have not appeared, the vaccine will work, so there is no need to scare yourself.

Speaking of which, the controversial point that everyone is most concerned about must be the ten-day observation method. There are quite a lot of differences between the two sides of this thing: WHO's specifications clearly state that if the injured animal is a regular domestic, is regularly vaccinated against rabies every year, and is completely healthy during the 10-day observation period, the injections that have been given can be stopped, and there is no need for further vaccinations.； However, the mainstream recommendations for disease control in China are more conservative. Especially if stray animals cause injuries or the animals have not been vaccinated at all, don't just wait and observe. Give the first shot first and observe the animal's status simultaneously. To be honest, there is nothing wrong with both statements. The key is to adapt to different environments. After all, the current coverage rate of rabies vaccine for domestic animals in China is less than 20%, and the health status of stray animals is even more uncertain. It is indeed too risky to wait 10 days to find something wrong with the animal before re-vacculating. A while ago, there was a young man who was scratched by a stray kitten he had just brought home. He thought there was nothing wrong with the kitten, so he held it and observed it. On the seventh day, the cat suddenly convulsed and died. He rushed to get immunoglobulin at two o'clock in the morning, and his face was as white as paper. Fortunately, nothing happened in the end, but there is really no need to suffer this crime.

It's actually easy to judge whether you need to be vaccinated at home. Use alcohol to rub the area where you were bitten or scratched. If there is a stinging sensation, it means the skin is broken. It is at least a level II exposure and requires vaccination.； If you don't feel anything at all when you apply it, your skin is intact and you just need to wash it off. Many people rushed to the hospital, but neglected to wash the most important wound. The last time I picked up a high school student, he was chased by a wild dog and bit his calf. He ran for 20 minutes to the outpatient clinic with his arms folded. The wound was covered with blood and scab, and he had to wash it away and wash it again. This was the second time he suffered. In fact, for rinsing, just use ordinary alkaline soap at home, turn on the faucet with medium water pressure, and don't rub the wound desperately. Rinse for 15 minutes. If it takes too long, you can watch half a short video to stop the time. This step can wash away more than 90% of the virus, which is better than vaccination.

As for the side effects that everyone is afraid of, they are really not as scary as the rumors say. 90% of people will have a sore arm for a day or two after the vaccination. A few people will have a low fever, which does not exceed 38.5 degrees and will go away after drinking plenty of water and sleeping. The most serious reaction I have seen is a hard knot at the vaccination site, which disappeared after applying potato slices for a week. A pregnant mother who was 3 months pregnant had her ankle scratched by a dog in the community. Her mother-in-law stopped her from giving the vaccine, saying it would cause teratogenesis. In fact, the vaccines currently used in China are Vero cell-inactivated vaccines, which do not contain live viruses at all. There have been follow-up data on hundreds of thousands of pregnant women vaccinated in China. It will not affect fetal development at all. Compared with the risk of disease, this discomfort is really not worth mentioning.

Oh, by the way, some people ask whether having been vaccinated before will mean that you don’t need to take the vaccine for life. There is no unified answer to this: WHO says that if you are exposed within 3 months after the full vaccination, you do not need to take a follow-up shot. Domestic guidelines recommend that you don’t need to take a take-up shot within half a year, more than half a year but less than 1 year, 2 take-up shots, 1-3 years, 3 take-up shots, and more than 3 years, re-take the full course. When I was scratching a stray cat last year, less than 2 months after the vaccination, I still took the initiative to ask for a refill. It was not that I didn't believe in the regulations, but the cat looked wrong, drooled and was afraid of light, so I just paid for it to be safe. There are no necessary standards for this kind of thing. If the risk is high, add an extra layer of insurance. If the risk is low (for example, if the cat is scratched by a cat that has been raised at home for several years and has been vaccinated every year), even after 5 months, it is okay to observe it first.

Some people also asked whether they should be beaten if bitten by rabbits or hamsters. In fact, the WHO has long made it clear that rodents basically do not carry rabies virus, and domestic guidelines do not require vaccination for such exposure. If your hamster really bites you, just rinse it off and apply some iodophor, so there is no need to make a wasted trip. As for immunoglobulin, only level III exposure (bleeding, penetrating injuries, wounds close to nerves on the head and face) requires vaccination. Many people think it is painful and expensive and are unwilling to take it. To be honest, the deeper the bite and the closer to the head, the less money you can save. It directly injects antibodies into you, and it will take effect immediately after injection. Unlike the vaccine, which has to wait 10-14 days to produce sufficient protection. If you are infected with the virus, the ten-day window period is a life-or-death situation.

In fact, in the final analysis, all guides are just references, and there is never an absolute standard answer. If you are really not sure, go directly to the dog injury clinic near your home and ask the doctor. It is much more useful than searching on Baidu for a long time and thinking blindly. Don't ignore it and don't be frightened by the rumors on the Internet. The core principle is one: compared with the 100% fatality rate, whether it costs a few hundred yuan or hurts for two days, it is worth it.