Latest Rabies Vaccination Guidelines

① Only level II and above exposures require vaccination, and no treatment is required for level I exposures; ② The 5-shot method or the "2-1-1" procedure is optional for routine vaccination, and there is no difference in protective efficacy; ③ The ten-day observation method has strict application prerequisites and cannot be used alone without vaccination; ④ The entire population, including pregnant women, infants, and immunocompromised people, can be vaccinated, and there are no absolute contraindications.

Last week I was on duty at the vaccination clinic of the community health service center. Just after I got to work in the afternoon, a little girl in school uniform rushed in. She had a shallow cat scratch on the back of her hand and her eyes were red. She asked if the stray cat in the community that I had just fed was scratched. She would need more than a dozen injections to see if she would die. I comforted them for a long time and found that many people’s understanding of the rabies vaccine is still ten years ago, and many rumors are still circulating on the Internet. Today I will clarify the issues that everyone is most concerned about.

First let’s talk about the most confusing criteria for “whether to spank”, which actually depends on the level of exposure: if your cat licks your intact skin, or if you touch the fur of a stray dog and there are no wounds on your body, this is level I exposure, and you don’t even need to disinfect; if you scratch a red mark without bleeding, or if you are bitten and the skin is broken, If there is no bleeding, it is Class II, and vaccination is required; if it bleeds, or the bite is in a nerve-intensive location such as the head, face, neck, or hand, even a small puncture the size of a needle tip, it is Class III. In addition to the vaccine, immune globulin must be administered around the wound to neutralize the possible invading viruses first.

Speaking of this, someone must ask, isn’t there a ten-day observation method? If the cat or dog is not dead after 10 days, then there is no need to beat it? I have to explain this controversial point at least ten times a day in the outpatient clinic: the ten-day observation method is indeed officially recommended by the WHO, but there are three indispensable prerequisites: the animal causing the accident must be domestic, have clear records of more than two full rabies vaccinations, you have treated the wound properly as soon as possible, and the first shot of vaccine must be given first. If you really observe the animal for 10 days and see it jumping around, the subsequent shots are not necessary. Don't believe it, I met a young man before who was bitten by a stray dog. He posted on the Internet that the ten-day observation method was enough. He didn't treat the wound or give an injection. He waited at home for a week and developed symptoms of water fear. He was sent to the hospital and could not be saved. Stray animals have no vaccination records at all. You can't afford the one-in-10,000 chance.

As for the fear of having to go to the hospital many times, the latest guidelines have now opened up two procedure options. If you have enough time and don’t mind the trouble, you can choose the traditional 5-injection method, with one injection each on days 0, 3, 7, 14, and 28. The immune effect is very stable; If it is difficult for office workers or students to take leave, you can choose the "2-1-1" procedure. On the first day, take two injections, one for each arm, and then one on the 7th day and the 21st day. A total of 3 times, two less times, the effect is exactly the same as the 5-injection method. Of course, if you have an immune deficiency, such as taking hormones for a long time, have had an organ transplant, or are HIV-infected, the 5-injection method is still recommended clinically, and the antibody positive conversion rate will be higher.

The most frequently asked question is, can pregnant women be vaccinated? Will spanking a child affect his development? I made it clear that the latest guidelines have removed all contraindications for rabies vaccine, because the mortality rate of rabies is 100%. As long as there is a risk of exposure, no matter you are 3 months pregnant or breastfeeding, whether you are a 1-year-old child or an 80-year-old man, you can get it. This is an inactivated vaccine that will not cause teratogenicity at all and will not affect the growth and development of children. Last year, I encountered an expectant mother who was 6 months pregnant and was bitten by a dog at home. After the entire vaccination, the baby was very healthy. Common side effects include a little redness and swelling at the site of vaccination and a low fever, which will disappear within two days at most and no special treatment is required.

Finally, I would like to mention a key point that many people overlook: Don’t rush to the hospital immediately after being bitten. Treat the wound at home first! Wash the wound with running soapy water and clean water alternately for more than 15 minutes. While washing, squeeze out the blood near the wound, and then apply iodophor. This step is more important than getting to the hospital 10 minutes earlier. It can wash away most of the viruses first. There was an old man who was bitten by a dog and rushed to the hospital directly covering his wound. He was delayed for more than 20 minutes on the way. The virus had already invaded his body, and the gain outweighed the loss.

Oh, by the way, if you have been fully vaccinated against rabies before, it is not permanent. If you are bitten within half a year, you do not need to get vaccinated. You will need to get two injections from half a year to one year, and three injections from one to three years. If it exceeds three years, you can just get the full vaccination again. To be honest, when you are unsure, you can go directly to the nearby community vaccination department and ask. It is much more reliable than searching for various contradictory opinions on the Internet for a long time. After all, you really can’t afford to gamble on this matter.