Rabies vaccination for a person after a dog bite

"40 INJECTIONS IN THE ABDOMEN"

When it comes to rabies, people generally fall into three groups.
Some people know about the disease and understand the consequences. Others have heard something like this and vaguely remember that after being bitten by a stray dog, there are 40 injections in the stomach. And there are those who know nothing about rabies and think that this is a characteristic of people with a bad character. But no one is safe from encountering a rabid animal, and your own life and that of your loved ones may depend on what exactly you know about this disease. First of all, children. They are the ones who strive to pet any cat. Or they are touched by a hedgehog that curls up so funny in the palm of their hand. They hand-feed a squirrel with nuts or chase a fox that has sneaked into their summer cottage.

However, there are also plenty of adults who become familiar with unfamiliar animals. Many people do not even suspect that you can become infected with rabies, even if a sick animal simply licked you.

WHAT IS IT?

Rabies is a fatal viral disease of warm-blooded animals, which includes humans. The symptoms are unpleasant and characteristic: hydrophobia, which is why rabies is often called hydrophobia, aerophobia, increased excitability of the patient, sometimes turning into violence.

The main source of infection is the bite of a sick animal. But even “mad” saliva that accidentally gets on damaged skin or mucous membrane is dangerous. Having penetrated the body, the virus strives to enter nerve cells, through which it begins to quickly spread towards the brain and spinal cord.

Rabies carriers are both wild animals (most often foxes, but also wolves, raccoons, badgers, bats, skunks, hedgehogs and even squirrels) and domestic animals (dogs, cats, horses, pigs, small and cattle). Stray dogs are the most dangerous for humans, especially in spring and summer.

The animal becomes “mad” and, therefore, dangerous to others even before the first signs of illness appear. It can be identified by its characteristic signs - excessive salivation and lacrimation, increased excitability and a strange unsteady gait.

Rabies virus (Neuroryctes rabid) belongs to the group of myxoviruses of the Lyssavirus genus of the Rhabdoviridae family. It is unstable in the external environment: it dies when heated to 560C in 15 minutes, when boiled - in 2 minutes. Sensitive to many disinfectants. However, it is resistant to both low temperatures and antibiotics

In all cases does a person develop rabies from the bite of a sick animal?

The main thing is that the development of the disease depends only on the location of the bite. For example, if a dog bites the neck or face, the disease occurs in 90% of victims. When the dog bit the hand – 60%; injuries received in the hip or shoulder area – 23%.

In all cases, whether a person develops rabies from the bite of a sick animal or not should be judged only after consultation with a specialist. Rabies is a disease with which it is better to play it safe, without hoping for a miracle.

NOT IN ENGLAND, BUT WE HAVE

Some countries do not have rabies at all - for example, Sweden, Norway, Finland, Great Britain, New Zealand, Australia, Ireland and Iceland. But overall, things are worse now than in the middle of the 20th century. The main reason is considered to be an unsuccessful experiment to resettle the raccoon dog in Europe. There were hopes that this predator would displace the more dangerous wolves and foxes. But in fact, it turned out that the raccoon dog is a “company” animal and coexists well with those with whom it was supposed to fight, and tolerates rabies several times better.

In Russia everything is not fun at all. Cases of the disease are recorded every year in Moscow and the Moscow region. According to Regnum news agency, the largest number of identified cases was recorded in the Lipetsk, Belgorod, Tambov, Penza regions and in the Republic of Tatarstan. The situation regarding rabies remains difficult in the Republic of Udmurtia, in the Volgograd, Bryansk and Saratov regions. This is primarily due to the cessation of anti-epidemic measures, which were successfully carried out in the USSR, when meat with a vaccine was scattered in foci of infection so that wolves and foxes, eating meat, would be automatically vaccinated. The growing number of sterilized, but, unfortunately, unvaccinated stray dogs also contributes to the widespread spread of rabies.

Island of Calm

In terms of combating rabies, the experience of the British is interesting. There is no rabies in England: sick animals were exterminated back in the 20s of the last century, and healthy ones were vaccinated. In addition, owners were prohibited from keeping dogs on chains. In such a situation, the animal is more likely to be bitten by a rabid animal, because it cannot escape. Also, a chained dog is generally more aggressive and bites more often. Since the country is surrounded by water on all sides, animals with hydrophobia cannot reach it. All animals imported into the territory undergo strict quarantine. Sometimes, however, in England bats are found with the rabies virus, so those who often “communicate” with them are vaccinated.

WHAT NEXT?

The incubation period of the disease is on average 30–50 days. The first stage of rabies begins with general malaise, headache, and a slight increase in body temperature. After a few (1–3) days, the patient enters the second stage – excitement. Restlessness, anxiety and attacks of hydrophobia characteristic of this stage appear, manifested by an unbearable aversion to a glass of water approaching the patient’s lips. At the sight of a glass, the patient experiences a reflexive, sharply painful spasm of the muscles of the larynx and pharynx. No less indicative are the symptoms of aerophobia - laryngopharyngeal spasm from a stream of cold air directed at the patient’s face. Increased salivation is almost always observed. This period usually lasts 2–3 days. Then the third stage of the disease begins, the beginning of which is characterized by calmness - fear and attacks of hydrophobia disappear. After an imaginary improvement, body temperature rises sharply to 40–42°C, paralysis of the limbs, impaired consciousness and convulsions occur. Death occurs from paralysis of the respiratory muscles or cardiac arrest. Thus, the total duration of clinical manifestations lasts from 3 to 7 days. In some cases, all this may not happen, and the disease very quickly progresses to the stage of paralysis (death occurs within 24 hours after the first manifestations).

What are the consequences of a dog bite for a person?

Regardless of whether a domestic dog has bitten a person or a stray one, you need to know what the consequences of a bite to a person are. The following are dangerous symptoms that indicate that a person has become infected with rabies.

• There is dry mouth and aggressive behavior;
• Seizures and convulsions;
• Hallucinations;
• Increases sensitivity;
• Fear of sharp sounds, light and water;
• Paresis, muscle spasm of the throat and impaired consciousness;
• Death from paralysis of the respiratory tract.

After a dog bite, you need to agree to the vaccination recommended by doctors without delay.

BITES ARE DIFFERENT

The likelihood of an unfortunate outcome from rabies depends significantly on the extent of the infection, since this determines the dose of the virus received and the speed of its spread. For example, biting two fingers increases the risk of disease by about twice as much as when only one finger is bitten. Well, if the whole palm is bitten, then the risk will be even higher.

An equally important factor is the location of the bite. The more nerve endings are affected, the more viruses are introduced, and the “closer” the place is to the brain, the more difficult it is to build a protective barrier. Therefore, the most dangerous bites are on the face or neck, since these places are both well innervated and located very close to the brain. Next come the hands, genitals, feet, shoulders and forearms.

MILWAUKEE PROTOCOL

There are no effective treatments for rabies once the virus has reached the brain. If clinical signs of the disease appear, assistance is provided symptomatically, only to relieve pain. Unfortunately, if the disease has progressed, the outcome will most likely be fatal. However, there are isolated cases of cure for rabies in the world. In particular, there is the Milwaukee protocol, which cannot even be called a protocol, because it only worked reliably five times. They tried it many more times, but no one else survived.

The first report of this protocol appeared in 2005, when 15-year-old American Jean Gies recovered after being infected with the rabies virus without vaccination: in her case, treatment was started after the first clinical symptoms appeared, which usually does not affect the outcome.

The treatment consisted of putting the girl into an artificial coma and then administering immunostimulating drugs. This slightly scary treatment method is based on the assumption that the rabies virus does not cause any permanent damage to the nervous system and only needs to be “expelled” from it. Scientists hoped that if they temporarily “turned off” most of the patient’s brain functions, the body, with the help of immunostimulants, would itself produce enough antibodies to defeat the virus. A week-long stay in a coma and further treatment for several months yielded positive results. Jean Gies was discharged from the hospital without signs of rabies.

Bitten but alive

In 2012, people were found in Peru who did not get vaccinated against rabies after being bitten by bats, but did not die (and apparently did not even get sick). There were as many as 11% of these - however, out of only 68 people. Scientists are not yet clear how this could happen.

When should a person be vaccinated against rabies?

Vaccination against rabies in humans is mandatory only after a bite from an infected cat, but doctors also vaccinate the following categories of people to prevent infection:

• personnel of veterinary stations and laboratories whose work is related to wild and domestic animals - potential carriers of rabies;
• employees of services for catching stray animals;
• hunters and forestry workers;
• specialists from research institutions and diagnostic laboratories who study rabies;
• taxidermists;
• tourists and travelers who go to an area with an unfavorable epidemiological situation for rabies.

Vaccination against rabies is mandatory for people moving for permanent residence to regions where there is a high risk of contracting rabies, but access to rabies vaccine is limited.

A person who has been bitten by a cat should contact a medical facility within 12 hours to receive a rabies vaccination. This is due to the fact that the vaccine is effective only during the first 14 days after contact with an infected animal. Once clinical signs appear, its use becomes inappropriate.

Important! A wound that has formed as a result of contact with an infected cat should be treated with laundry soap as quickly as possible, rinsed abundantly with clean water, and lubricated with iodine or any other antiseptic drug. If necessary, the doctor applies stitches, and the wounds are sutured with preliminary treatment with anti-rabies immunoglobulin.

IF YOU'VE BEEN BITED

The first thing to do immediately is to wash the bite area with plenty of water, preferably soap or hydrogen peroxide. It is necessary to rinse intensively and for a long time (for 10 minutes), but do not rub. It is recommended to wash deep wounds with a stream of soapy water - for example, using a syringe or catheter. There is no need to cauterize the wound, but a bandage should be applied to the wound after washing. After carrying out these simple manipulations, you should immediately go to the nearest emergency room, since the success of recovery from a possible illness greatly depends on how quickly you seek help.

At the emergency room, the doctor will need the following information: a description of the animal (its appearance, behavior and presence of a collar) and the circumstances of the bite. Next, you should undergo a course of treatment prescribed by your doctor. But no one gives 40 injections in the stomach now. Everything is much more humane: you will be given a vaccine and released in peace.

You most likely won't have to go to the hospital. Only if the condition of the bitten person is serious. Also, additional “aggravating” factors are diseases of the nervous system or allergic reactions, pregnancy, or vaccinations against some other diseases made within the previous two months.

At the time of vaccination and six months after it, the following conditions must be observed: try not to drink alcohol, do not get hypothermic or overheat. If there are any changes in your health, you should immediately contact your doctor to decide on the advisability of continuing vaccination.

What to do with a “biting” animal?

If the owner of a dog or cat cannot provide vaccination certificates, then there are two ways to determine whether the animal that bit you is dangerous:

1. Put him to sleep and get a sample of his brain tissue. Cells of the hippocampus are especially suitable for this, in which the virus causes characteristic changes - Babes-Negri bodies appear.
2. Place the animal in quarantine at a veterinary clinic for 10 days. If during this time no signs of rabies appear, then the animal is considered healthy.

Conquering rabies

Alexey Vodovozov, doctor, scientific editor of the ABC medical magazine

“Popular Mechanics” No. 12, 2012

Even 150 years ago, a person bitten by a rabid animal was doomed. Today, scientists are improving weapons in the war against an ancient and extremely dangerous enemy - the rabies virus.

Know the enemy by sight

The causative agent of rabies ( Rabies virus

) belongs to the family of rhabdoviruses (Rhabdoviridae), containing a single-stranded linear RNA molecule, genus
Lyssavirus
. In shape it resembles a bullet with a length of about 180 and a diameter of 75 nm. Currently, seven genotypes are known.

Rabies virus under a transmission electron microscope (36,700x magnification). In the computer image in red

the protein shell of the virus is shown - the capsid, and
in yellow
- the additional lipoprotein shell

Insidious virus

The rabies virus has tropism (affinity) for nervous tissue, just as influenza viruses have affinity for the epithelium of the respiratory tract. It penetrates the peripheral nerves and moves at a speed of approximately 3 mm/h to the central parts of the nervous system. Then, through a neurogenic route, it spreads to other organs, mainly to the salivary glands.

The likelihood of the disease depends on the location and severity of the bites: when bitten by rabid animals on the face and neck, rabies develops on average in 90% of cases, in the hands - in 63%, and in the thighs and arms above the elbow - only in 23% of cases.

Sources of infection

The main wild animals - sources of infection - are wolves, foxes, jackals, raccoon dogs, badgers, skunks, and bats. Among domestic animals, cats and dogs are dangerous, and it is the latter that account for the maximum number of confirmed cases of rabies transmission to humans. Most sick animals die within 7–10 days, the only exception described is the yellow fox-shaped mongoose Cynictis penicillata

, capable of carrying the virus without developing a clinical picture of infection for several years.

The most characteristic and reliable sign of the presence of a virus in a human or animal body is the detection of so-called Negri bodies, specific inclusions in the cytoplasm of neurons with a diameter of about 10 nm. However, in 20% of patients Negri bodies cannot be found, so their absence does not exclude the diagnosis of rabies.

The first, but extremely important step towards the fight against rabies was taken by the brilliant French chemist and microbiologist Louis Pasteur. He began developing a vaccine against this disease in 1880, after he had to observe the agony of a five-year-old girl bitten by a rabid dog.

Rabbits and dogs

Although rabies was first described in the 1st century BC. Roman Cornelius Celsus, almost 2000 years later, very little was known about this disease. It was not until 1903, eight years after Pasteur's death, that the French physician Pierre Remlenger discovered that rabies was caused by a submicroscopic life form - a filterable virus.

How viruses reproduce

To enter a cell, the rabies virus uses the endosomal transport system: the cell itself must capture it and draw the vesicle formed from the cell membrane - the endosome, the “inner body” - into the cytoplasm. Activation of this process occurs after the virus binds to special receptor proteins on the cell membrane. The resulting endosome disintegrates over time, the viral particle releases RNA, and then everything goes according to the standard scenario.

Pasteur, without this information, was nevertheless not going to give up: to create a vaccine, he chose a workaround - to find a container for the “poison” and turn it into an antidote. It was reliably known that something transmitted from a sick animal to another animal or person along with infected saliva affects the nervous system. During the experiments, it was found that the disease had a very long incubation period, but this only spurred Pasteur and his colleagues, since it meant that doctors had the opportunity to influence the slowly developing pathological process - the “poison” needed to reach the spinal nerves through the peripheral nerves. , and then the brain.

Then experiments began on rabbits in order to obtain the most lethal rabies “poison” in large quantities. After dozens of transfers of brain tissue from a sick animal to the brain of a healthy one, from that to the next, etc., scientists managed to achieve that a standard extract from the brain killed a rabbit in exactly seven days instead of the usual 16–21. Now it was necessary to find a way to weaken the rabies pathogen (the method of creating vaccines - weakening the pathogen - was also Pasteur’s discovery). And they found a way: drying rabbit brain tissue soaked in the virus for two weeks over moisture-absorbing alkali.

After administering a suspension of the resulting drug, the dog infected with rabies not only recovered, but also became completely immune to rabies, no matter how much “poison” was injected into it.

Viruses and bacteria

Doctors fight bacterial infections quite successfully. It's not that simple with viruses.

Fickle Enemy

Antibiotics and vaccines are doing their job, and sanitation and epidemiology are excellent. Viruses are much more difficult to fight. Suffice it to recall the flu, which the world's population suffers from with enviable regularity, despite all the achievements of science and the availability of vaccines and antiviral drugs.

This is primarily due to the ability of viruses to change in the most unpredictable ways. Some, like influenza pathogens, change the proteins of their shell like gloves, so it is still not possible to develop high-precision weapons against them.

In the fight against diseases, success came when a weak double was discovered in the virus, which did not kill a person, but left behind powerful cross-immunity. Deliberate infection with a weaker strain made it possible to protect against a deadly one. The classic case from which the history of vaccination began is natural and cowpox, then a similar story was repeated with polio. In the summer of 2012, there was hope that a similar scenario would help control rabies.

Plant viruses

Plant viruses were first described in 1892 by the Russian scientist D.I. Ivanovsky. He called them “bacteria that pass through the Chamberland filter, which, however, are not able to grow on artificial substrates.” The term “filterable virus” (lat. virus)

- poison) appeared in 1898, a year after the isolation of the foot-and-mouth disease virus - a disease of cattle, and the first virus causing a human disease - yellow fever - was discovered in 1901.

Having finally made sure that vaccinated dogs were not affected by the same seven-day laboratory “poison,” the researchers conducted a cruel experiment: they introduced their rabid relatives to the vaccinated dogs. The bitten mongrels did not get sick!

40 injections in the stomach

Then it was the people's turn. But where to find volunteers? Driven to despair, Pasteur was ready to sacrifice himself for the sake of science, but, fortunately, His Majesty Chance intervened.

On July 6, 1885, a tearful woman appeared on the threshold of Pasteur’s Paris laboratory, holding the hand of her nine-year-old son, Joseph Meister. Three days earlier, the boy was bitten by a rabid dog, inflicting 14 open wounds on him. The consequences were quite predictable: at that time it was already known that death in such cases was almost inevitable. However, the boy's father had heard a lot about Pasteur's work and insisted on bringing the child from Alsace to Paris. After serious hesitation, Pasteur injected the little patient with an experimental drug, and Joseph became the first person in history to be saved from rabies.

From the laboratory diary of Louis Pasteur, 1885

“The death of this child seemed inevitable, so I decided, not without serious doubts and anxiety, which is well understandable, to try on Joseph Meister the method that I had found successful in treating dogs. As a result, 60 hours after the bites, in the presence of doctors Villepeau and Grandchet, young Meister was vaccinated with half a syringe of an extract from the spinal cord of a rabbit that died of rabies, previously treated with dry air for 15 days. I made a total of 13 injections, one every day, gradually introducing an increasingly lethal dose. Three months later I examined the boy and found him completely healthy.”

People from all over the world flocked to Paris - Algerians, Australians, Americans, Russians, and often they knew only one word in French: “Pasteur”. Despite such success, the discoverer of a vaccine against a deadly disease had to hear the word “killer” addressed to him. The fact is that not all those bitten survived after vaccination. In vain Pasteur tried to explain that they contacted too late - some two weeks after the animal attack, and some even a month and a half later. In 1887, at a meeting of the Academy of Medicine, colleagues directly accused Pasteur of simply killing people with pieces of rabbit brains. The scientist, who devoted all his strength to science, could not stand it - on October 23 he suffered a second stroke, from which he never recovered until his death in 1895.

Pasteur's legacy

On the memorial plaque of the house in which Pasteur's first laboratory was located, his discoveries are listed: the enzymatic nature of fermentation, the refutation of the hypothesis of the spontaneous generation of microorganisms, the development of ideas about artificial immunity, the creation of vaccines against chicken cholera, anthrax and rabies. Pasteurization and other “little things” were not included in this list

But ordinary people supported him. By subscription, over a year and a half, residents of many countries around the world collected 2.5 million francs, with which the Pasteur Institute was created, officially opened on November 14, 1888. On its territory there is a museum and tomb of the researcher who saved humanity from a deadly infection. The date of Pasteur's death, September 28, was chosen by the World Health Organization (WHO) for the annual World Rabies Day.

For a long time, the vaccine was administered under the skin of the anterior abdominal wall, and up to 40 injections were required to complete the full course. A modern immunotherapy drug is administered intramuscularly into the shoulder; six visits to the emergency room are sufficient.

Milwaukee Miracle

During the 20th century, the situation with rabies was clear: if the victim was not vaccinated on time or did not receive the vaccine at all, the matter ended tragically. According to WHO estimates, 50–55 thousand people die every year in the world after attacks by rabid animals, 95% of them occur in Africa and Asia.

The possibility of fully treating the infection was only discussed in the 21st century. This was connected with the case of American Gina Gies, who for the first time in the history of medicine did not receive a vaccine, but survived after the onset of rabies symptoms. On September 12, 2004, 15-year-old Gina caught a bat that bit her on the finger. The parents did not consult a doctor, considering the wound to be trivial, but after 37 days the girl developed a clinical picture of infection: a rise in temperature to 39°C, tremors, double vision, difficulty speaking - all signs of damage to the central nervous system. Gina was referred to Children's Hospital of Wisconsin, and to the laboratories of the Centers for Disease Control and Prevention .

, CDC) in Atlanta confirmed rabies.

The parents were offered to try an experimental treatment method on the girl. Having received consent, doctors used ketamine and midazolam to put the patient into an artificial coma, essentially turning off her brain. She also received antiviral therapy with a combination of ribavirin and amantadine. Doctors kept her in this condition until her immune system began to produce enough antibodies to cope with the virus. This took six days.

A month later, tests confirmed that there was no virus in the girl’s body. Moreover, brain functions were minimally impaired - she graduated from school, and a year later received a driver's license. Currently, Gina has graduated from college and intends to continue her studies at the university. It is not surprising that she sees biology or veterinary medicine as her future profession, and plans to specialize in the field of rabies.

The treatment protocol that was used on the girl was called the “Milwaukee” or “Wisconsin” protocol. They have repeatedly tried to reproduce it in other medical institutions... but, alas, without much success. The first version of the protocol was tested on 25 patients, of which only two survived. The second version, which removed ribavirin but added drugs to prevent vasospasm, was used in ten patients and prevented the death of two of them.

During epidemiological investigations, it turned out that patients who were cured using the Milwaukee Protocol were bitten by bats. It is this fact that has allowed some scientists to suggest that in fact the treatment method has nothing to do with it, but the point is precisely in these mammals, or rather, in the fact that they are infected with a different strain of the virus, less dangerous to humans.

The Bat Riddle

In 2012, this assumption received the first confirmation. In American Journal of Tropical Medicine and Hygiene

an article appeared by a group of CDC experts, American military virologists and epidemiologists from the Peruvian Ministry of Health. The results of their research produced the effect of a bomb exploding: in the Peruvian jungle they were able to discover people who had antibodies to the rabies virus in their blood. These people have never been given any vaccines, moreover, they don’t even remember being sick with anything serious. This means that rabies is not 100% fatal!

“From this area of ​​the Peruvian Amazon jungle, there have been numerous reports of exposure to vampire bats and cases of rabies in humans and domestic animals over the past 20 years,” lead study author Dr. Amy Gilbert, who works in the CDC's Rabies Research Program, explains to PM. . “The villages and farms that we examined are located in places very remote from civilization—the nearest hospital, for example, is two days away, and in some areas movement is only possible by boats on water.”

In a survey of residents, 63 out of 92 people reported bat bites to scientists. Blood samples were taken from these people, as well as from local vampire bats. The test results were unexpected: seven samples contained antibodies that neutralize the rabies virus.

The presence of antibodies could be explained by the administration of anti-rabies (lat. rabies

- rabies) vaccine, but, as it turned out, only one in seven people received such a vaccine. The rest suffered from rabies not only without death, but even without any serious symptoms. In two Peruvian villages, more survivors of this infection were found than described in the entire medical literature! Not surprisingly, Gilbert's group spent two years rechecking their findings before deciding to publish them.

“It is likely that there is a unique set of circumstances where the local population is regularly exposed to a particular non-lethal strain of the rabies virus,” says Dr Gilbert. “In this case, natural vaccination occurs, which is confirmed by fairly high titers of antibodies. However, this still requires additional confirmation and clarification.”

Her point of view is shared by her Russian colleagues. Virologist Alexander Ivanov from the Laboratory of Molecular Bases of Action of Physiologically Active Compounds, Institute of Molecular Biology named after. V.A. Engelhardt, whom PM asked to comment on the discovery of CDC experts, emphasized that these results, strange at first glance, may have a completely scientific explanation: “Based on the available data, it can be assumed that local residents were infected with variants of the virus, which in a number of ways causes had low replicative activity (the ability to reproduce) and low pathogenicity (“toxicity”). In my opinion, this may be due to several factors. First, each virus has a huge number of variants due to its relatively high variability. Infectious disease experts suggest that even for a successful transition from bats to other species, the rabies virus must undergo several specific mutations. If this is true, then many strains of the virus carried by bats may be of little danger to humans. Secondly, mutations in the genome of the virus affect its recognition by the immune system, as well as the ability of the virus to block the immune response to infection. At the same time, it is those variants of the rabies virus that are able to evade the innate immune system that have increased pathogenicity. Thus, these facts really suggest the existence in the bat population of such strains of the rabies virus that are promptly recognized and destroyed by the human immune system without causing fatal consequences.”

But in no case - this is emphasized by all experts, including the authors of the study - should one refuse to administer an anti-rabies vaccine when bitten by wild animals. Firstly, it may indeed turn out that another version of the virus lives in bats, a weaker one, and the luck of Peruvian peasants does not extend to strains transmitted by dog ​​or raccoon bites. Secondly, the results and conclusions of this study may turn out to be erroneous, so there is no point in taking further risks.

RACE RACE, GRAND PRIZE – MOZ

Rabies is a rare case when vaccinations are given not for prevention, but for treatment. The virus travels along the nerves to the brain for quite a long time (about 2 weeks), that is, there is a real opportunity during this time to form immunity with the help of a vaccine. In addition, vaccination can slow the spread of the virus. I note that the likelihood of illness increases sharply with a delay in vaccination: for example, a week’s delay in vaccination increases the likelihood of death by five times!

A FEW WORDS ABOUT VACCINATION

The first vaccination against rabies was carried out by Louis Pasteur on July 4, 1885. Pasteur's vaccine was pieces of dried nervous tissue of an animal that died of rabies. Modern vaccines, like most vaccines with viruses, are made from infected chicken or duck embryos, and they are relatively easily tolerated.

The rabies vaccine is administered no later than the 14th day from the moment of the bite. The best prevention is the administration of specific immunoglobulin and/or active immunization (vaccination).

The vaccine is administered intramuscularly, 1 ml 5 times: on the day of infection, then on the 3rd, 7th, 14th and 28th day. This regimen creates good immunity, but WHO also recommends a 6th injection 90 days after the first. The best place for grafting is the deltoid muscle or thigh. If a person is bitten, but before the bite he was vaccinated according to the full scheme and he has enough antibodies, he is vaccinated according to a special scheme without the use of immunoglobulin. Therapy may be discontinued if the biting animal is kept under supervision and remains healthy for 10 days of observation or if rabies virus is not detected by testing.

What is the rabies vaccination?

For rabies injections in humans after a cat bite, inactivated rabies vaccines are used. In case of severe bites or tears of tissue by claws, as well as in case of injuries to the face, neck, hands or mucous membranes, a person should additionally receive injections with anti-rabies immunoglobulin.

Rabies vaccine

For rabies injections in humans after cat scratches or bites, rabies vaccines from the following manufacturers are used:

• "Kokav" (Russia);
• "Indirab" (India);
• "Rabipur" (Germany);
• "Kav" (Russia).

All drugs contain inactivated rabies virus, which cannot provoke the development of clinical signs of the disease.

Anti-rabies immunoglobulin

If a person has had contact with a sick cat without damaging the skin (feeding, grooming, stroking), as well as minor injuries, the administration of rabies immunoglobulin will not be advisable. It is used once for deep wounds at a dose of 40 IU/kg (with an activity of 200 IU), but not more than 20 ml. Half of the dose of the drug is administered pointwise around lesions on the skin, and the second half is administered intramuscularly.

Important! The use of AIH is effective only for three days after the bite.

In the manufacture of the drug, a certain fraction of immune horse serum is used. The set includes 2 ampoules. The ampoule containing undiluted AIG is marked in blue; the vessel with red markings contains immunoglobulin; it is diluted in a ratio of 1:100 and is used to identify allergic reactions to the drug.

To conduct an allergy test, an intradermal injection of 0.1 ml of diluted AIH is made in the area of ​​the inner surface of the forearm. The result is regarded as negative if there is no hyperemia at the injection site or swelling with a diameter of less than 10 mm is observed. The remaining dose is administered subcutaneously into the shoulder, in equal portions with an interval of 10-15 minutes.

If the reaction is positive, the patient is preliminarily administered parenteral antihistamines. To prevent anaphylactic shock, injections of a 0.1% adrenaline solution are also prescribed.

Important! Immunoglobulin is used only before the administration of the rabies vaccine.

AND FOR PREVENTION

People at risk (veterinarians, dog handlers, hunters) need to be vaccinated in advance, according to a special scheme, with the first revaccination after 12 months and then every 5 years.

Preventive vaccination for those traveling abroad consists of three doses administered according to a schedule of 0–7–21 (or 28) days. It turns out that if you are vaccinated against rabies, you should do this no later than a month before your trip. This vaccination protects against rabies for three years.

Side effects for all vaccines are approximately the same: swelling and hardening at the injection site, enlarged lymph nodes, general malaise, weakness, headache, sleep and appetite disturbances, fever. Sometimes allergies to vaccine components occur. However, it seems to me that this is still a small price to pay to be alive, healthy and travel to the “crazy” countries of Southeast Asia.

Possible side effects

The rabies vaccine may cause the following side effects:

• hyperemia, swelling, pain or itching at the injection site;
• enlargement of regional lymph nodes;
• headaches, nausea, digestive disorders;
• increased body temperature;
• pain in the abdomen (extremely rare);
• disorders of the nervous system in the form of impaired coordination of movements, dizziness, decreased sensitivity of certain parts of the body;
• allergic reactions in the form of itching, swelling, hyperemia of the skin.

In most cases, the negative effects of vaccination go away without the use of medications. But in severe cases of an allergic reaction, antihistamines can be used.

Mad countries

In terms of the rabies epidemic situation, Vietnam, the Philippines, Laos, India, Indonesia, China, everyone’s favorite Thailand and South America are severe.
I strongly recommend that you get vaccinated against rabies before traveling to these countries! According to the Ministry of Agriculture, in 2014, veterinarians registered 1,964 cases of rabies among animals in our country. Sick:

• 1023 foxes
• 421 domestic dogs
• 316 domestic cats
• 10 ferrets
• 9 martens and arctic foxes each
• 4 each of muskrat and corsac (steppe fox)
• 3 hedgehogs
• 2 bears and a badger each
• 1 boar, rat and hamster
• and some other animals.

Over the past 5 years, 52 people have died from rabies in Russia.

Author: Olga Georginova Published: June 17, 2016