Often children who love pets are scratched or bitten accidentally while playing with dogs, cats, rabbits or even rodents, and often struggle with whether they should get rabies vaccinations. So, what kind of animals can transmit rabies? When do we need rabies vaccination and when do we take the “ten-day observation method”? First, it is important to know what rabies exposure is. Rabies exposure is defined as a bite, scratch, licking of mucous membranes or broken skin, or open wounds or mucous membranes in contact with saliva or tissue that may contain rabies virus, by a rabid dog, a suspected rabid dog, or a host animal whose presence or absence of rabies is uncertain. In rare cases, organ transplants and aerosol inhalation can also be used as routes of exposure to rabies virus. The majority of rabies cases in China are caused by injuries to dogs, accounting for about 90% of cases, followed by cats, accounting for about 5%, and other animals causing injuries, including horses, squirrels, pigs, bats, monkeys, and badgers. Rabies virus-infected animals have a number of characteristics at the onset of the disease: the early stage will appear depressed, like to sleep in a dark place, omnivorous, licking and biting wounds; into the excitement phase, will be irritable, barking, barking, emotional, easy to bite people or other animals; into the late stage of rabies, reluctant to move much, drooling a lot, limbs stiff and numb, and finally died of whistling failure. Rabies usually takes less than 10 days from the appearance of symptoms to death. If the injured animal has developed the above symptoms, rabies vaccination is recommended and the decision to inject anti-rabies serum or rabies human immunoglobulin is based on the size, depth and extent of the wound. If your pet dog or cat has been vaccinated against rabies for two consecutive years, or has never been taken out, has no risk of rabies virus infection, and is in good spirits, and has been accidentally bitten or scratched, there is no need to be anxious for the time being, and the “ten-day observation method” should be adopted. Basically, the risk of virus infection can be ruled out. In addition, rabies post-exposure prophylaxis is usually not required for exposure to rodents, rabbits or hares. Poultry, fish, insects, lizards, turtles, and snakes are not infected with or transmit rabies virus. Second, what is post-exposure grading for rabies? What should be done? Depending on the post-exposure wound grading, our treatment differs. Grade I exposure: contact with or feeding of animals; intact skin licked; intact skin contact with secretions or excretions from rabid animals or human rabies cases. Those judged to have Class I exposure do not require medical treatment and are advised to wash the contact area. Grade II exposure: light bite on exposed skin; minor scratch or abrasion without bleeding. Those judged as Grade II exposed should have their wounds treated immediately and be vaccinated against rabies. Grade III exposure: Those who meet one of the following conditions: single or multiple penetrating skin bites or scratches, licking of broken skin, contamination of mucous membranes with animal saliva, exposure to bats. Those determined to have a Grade III exposure should immediately treat the wound, use a passive rabies immunization preparation (injection of anti-rabies serum or rabies human immune globulin), and receive rabies vaccination. Those with confirmed Grade II exposure who are immunocompromised, or those with Grade II exposure on the head and face and where the injured animal cannot be determined to be healthy, should be treated according to Grade III exposure. For Grade II and III exposures, thorough wound management is essential. Wound management includes thorough irrigation and disinfection of the interior of the wound and subsequent surgical management
If pain is severe during cleaning or disinfection, local anesthesia may be given first. The first step is wound irrigation, alternating between soapy water and running water at a certain pressure for at least 15 minutes for each bite and scratch, and saline for the wound to avoid residual soap solution or other cleaning agents. After thorough rinsing, rub or disinfect the interior of the wound with dilute iodophor, benzalkonium chloride, or other skin and mucous membrane disinfectants with viral inactivating effect. In severe cases, surgical debridement and tissue repair are required. What should I do if I get scratched and bitten again after vaccination? Prompt and thorough standardized wound management should be performed after any exposure, as detailed above. Re-exposure within six months does not generally require re-immunization for previously fully vaccinated individuals; re-exposure within six months to one year should result in one dose of vaccine on day 0 and one dose on day 3;
Those who are re-exposed within 1-3 years should receive 1 dose of vaccine on days 0, 3 and 7; those who are more than 3 years old should receive the full course of vaccination. If re-exposure occurs during the immunization process, the vaccination can be completed according to the original procedure without increasing the dose. For those who have not completed the full course of immunization before, the re-exposure should be treated as the first exposure. For Class III exposures or re-exposures requiring passive immunization, no anti-rabies serum or rabies human immunoglobulin is required for those who have completed full immunization (with cell culture vaccine) after 2005, while passive immunization preparations are required for those who have not completed full immunization. If the re-exposure occurs within 7 days of the first dose of vaccine and the wound is grade III or meets the
If the re-exposure occurs within 7 days of the first dose of vaccine and the wound is Grade III or meets the special criteria for disposal under Grade III, the passive immunization agent should be used. How do we respond to the recent rabies vaccine incident? According to the Interpretation of the Renewal and Catch-up Program for Vaccination with Changchun Changsheng Rabies Vaccine published by the National Health and Wellness Commission of the People’s Republic of China on August 7, 2018, free renewal or catch-up vaccination is implemented for recipients who have received Changchun Changsheng rabies vaccine. For those who have not yet completed the vaccination process, the vaccination unit will renew the qualified vaccine from other companies free of charge. For those who have completed the vaccination process, based on the characteristics of rabies onset and after a comprehensive expert assessment, it is recommended that a catch-up vaccination is not required.The “Medical Staff Manual for Follow-Up Observation and Consultation Services for Changchun Changsheng Company Rabies Vaccine Vaccine Recipients (for Trial Implementation)” published by the National Health and Wellness Commission of the People’s Republic of China on August 7, 2018, states that for vaccinees who have been vaccinated with Changchun Changsheng Company rabies vaccination for less than 3 months Focused observation is required. The vaccinees can go to the vaccination unit’s follow-up and consultation service point through the published address and have on-site observation and consultation with the medical staff; if it is not convenient to go to the vaccination unit, they can also consult with the medical staff through the published contact information of the vaccination unit by telephone or internet. For vaccinees who have been vaccinated for more than 3 months and less than 1 year, self-observation is recommended, and if there are greater doubts, telephone and internet consultation or on-site consultation at the vaccination unit can be conducted. For those who have been vaccinated with rabies vaccine from Changchun Changsheng for more than 1 year, in principle, observation is not required, but if there are any abnormalities or doubts, timely consultation can be made by telephone or internet, or at the vaccination unit. In summary, disposal after rabies exposure needs to be completed under the guidance of a professional physician, and wound disposal, rabies vaccine and passive immunization preparations should be administered as early as possible and within a reasonable and safe range.