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Rabies

Important

Have you been bitten, scratched or licked by a mammal when you were overseas in a rabies infected country?

You cannot tell by looking at the animal if it has rabies If you wait until you get symptoms of rabies – it is fatal. Rabies disease can incubate for many years.

DONT RISK IT – GET A MEDICAL OPINION FROM SOMEONE WHO FREQUENTLY MANAGES RABIES PRONE WOUNDS

The QLD Government will even currently FUND your post exposure rabies vaccine.

Dr Deb and her staff frequently look after travellers who have been exposed to the risk of rabies. We have the vaccine in the clinic.

If you would like to consult Dr Deb re your wound, phone the clinic on 07 32219066. Inform the reception staff you have had an animal bite overseas. They will make you an appointment – usually that day. We keep the rabies vaccine in stock. If you need the RIG ( see below), the RIG has to be sent to us, but is usually available within 24 hours

Background Information On Rabies Treatment

The rabies virus is present in mammals in most developing countries.

Dogs are the most common source of rabies being transmitted to humans. Other less common transmitters are cats, monkeys and bats, however all mammals have the potential to transmit rabies. Rats are rarely reported to carry rabies.

If you are in a rabies infected country, and are bitten by a mammal, you will need post-bite rabies vaccine. See a reliable doctor immediately. Any mammal in a rabies area must be suspected of having rabies. Even a vaccinated animal can carry rabies. A study in Thailand showed 3-6% of rabid dogs had been vaccinated. Never delay vaccination while the animal is observed for signs of rabies.

If the skin is broken, you need vaccination.

A lick over broken skin is also significant, as this is enough to allow the rabies virus to enter. If the skin is not broken, you do not need to be vaccinated. Sometimes it is hard to be sure if there is a break in the skin. In that case, it is safer to be vaccinated.

The safest rabies vaccines are the modern ones; HDVC (Human Diploid Cell Vaccine), Verorab or Rabipur. These are injected into the arm. The older, animal brain based vaccines (e.g. Semple) are cheaper, given in the stomach, and cause more side effects. Ensure all injections are given with sterile needles and syringes. Chloroquine, alcohol and immune suppressive drugs should be ceased during the course of rabies vaccine as they interfere with the vaccine. (In 1982, a traveller in Kenya died of rabies because she was vaccinated while taking chloroquine).

The World Health Organisation (WHO) post-bite regime is as follows:

  • Day 0 should be the day of the bite, but it is never too late to start.
  • If you have been previously vaccinated, Two doses of vaccine are given in the upper arm, one each on day 0, 3.
  • If you have not been previously vaccinated, 4-5 doses of vaccine are given in the upper arm, one each on day 0, 3, 7, 14, and sometimes day 28 (if local vaccine is unreliable).

The vaccine takes about 2 weeks to induce protective immunity. This is why you also need Rabies Immunoglobulin (RIG)…preferably human derived RIG (HRIG) on the day of the bite. Dose is 20 IU (International Units) per kg of body weight injected into the wound to stop the virus attacking the brain, while the vaccine takes effect.

If your vaccines were given overseas, sometimes we do a blood test at the end to check the vaccines have been effective. ( If vaccines are not made or stored properly they will not work.)

 

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