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Had monkey bite. had stitches and tt and rebivax injection. Had rabipurs injection. Is treatment right?

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General & Family Physician
Practicing since : 2006
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Hello Doctor,
I am XXXXXX
I had a monkey bite on my left calf on 20th April 2013 in Hospital Premises. After bite, Doctor (B.A.M.S.) clean my wound within 10 minutes with Detol & Savlon as well as spirit and stitch the wound. After that he had given me injection of TT. After 1 Hour he had given me Rebivax injection of 1 ml in my gluteal area.

But on 23rd I had to go in sasoon hospital,Pune for further tratment, The doctor remove my stitches & gave me equrab injuction around the wound & in gluteal area. As well as they start me rabipur injection of 0.1 ml in left side & 0.1 ml in right side ( i.e. 2 cc). And advice me to start injections from 23rd and course will be 4 injuctions i.e. Day 0, 3 , 7 & 28.

On 26th April 2013 2nd Injection of rabipur given to me. 3rd injection on 30th April 2013. But on the same day my wound has some infection, so Doctor at Sasoon remove my natural cover on wound ( i.e. Khapali in Marathi Language) and reopen the wound.

I would like to ask you that
1) Is my treatment on the right way?
2) Rabipurs 4 injections ( Of 0.1 ml on right hand & 0.1 ml on left hand) is sufficient on days 0,3,7 & 28? ( I also refer National guidelines for rabies vaccine, they also suggest only 4 dose)
3) Is it ok that i had taken 1st injection of rabivax of 1 ml in gluteal area on the day of exposr & restart the rabipur course on 4th day of exposer.
4) What is the right course of taking injections?
5) Booster dose on day 90 is necessary for me ?
6) What are the chances of rabies for me ?
7) What are the symptoms of rabies ?
8) What kind of test i need to have for prevention basis as well as to whom i consult it ?
9) Is it true that rabies will occure after 20 years also ?
10) Rabies not get person rabid but also ger paralised or heart failure etc. Is it true ?

Please help me doctor i am very much afraid that i am going to die by rabies.

Posted Tue, 28 May 2013 in General Health
 
 
Answered by Dr. Jay Patel 2 hours later
Hi,

Thanks for your query.

I am Dr. XXXXXXX I will try my level best to help you.

Let me start answering questions one by one in order of which they are written.

1) Yes, your treatment is according to the Indian Standards.
Indian standards are to take 4 doses as you mention. But World health organization has five doses as I will mention in subsequent answers.

2) Yes, four doses are sufficient if they are intramuscular, but in your case you took are, one intramuscular (1 ml) and others was intra-dermal (0.1)ml which you took on two arms.

3) According to World health organization they do not prefer an injection in gluteal area, but you already had the vaccination so it does not matter now. If you change from intramuscular to the intra-dermal it does not make much difference but the dose of intra-dermal is (2-2-2-0-1-1) and so you will still have to take one extra shot for shake of safety is my opinion.

4) As per world health organization for intramuscular injections i.e 1ml dose ones are (0, 3, 7, 14 and 30.)
While the intra-dermal i.e 0.1 ml, two separate sites are also five doses and are spread as 2-2-2-0-1-1 fashion.

5) Booster for tetanus is only needed if you never had any Tetanus toxoid immunization before in your early life, if received such immunization no need to take booster dose for TT. Now for rabies you do not need any booster dose.

6) There is near zero % chances of rabies as long as you take all the necessary vaccine and preventive measure.

7) Following is list of symptoms of rabies
a) Fever
b) Headache
c) Agitation
d) Anxiety
e) Confusion
f) Difficulty swallowing
g) Excessive salivation
h) Fear of water (hydrophobia) because of the difficulty in swallowing
i) Hallucinations
j) Insomnia
k) Partial paralysis.

8) Rabies tests are as follow
(a) Saliva can be tested by virus isolation or reverse transcription followed by polymerase chain reaction (RT-PCR)
(b) Serum and spinal fluid are tested for antibodies to rabies virus.
(c) Skin biopsy specimens are examined for rabies antigen in the cutaneous nerves at the base of hair follicles.

Preventive measure is Post exposure vaccination, and cleaning wounds with alcohol will kill most of the viruses.

9) Rabies will not reoccur or comeback once it’s all gone. Post exposure Vaccination is best and 100% cure for the rabies along with wound care.

10) Yes rabies can get paralyze the person and may result in heart failure.

Please relax you will not have Rabies; just take all the doses of vaccine and possible take one extras as i mentioned just to be on safer side.

Hope this answer will relive much of anxiety and in case of any question feel free to contact me.

Thanks for the question.
Dr. XXXXXXX XXXXXXX


Above answer was peer-reviewed by
 
Follow-up: Had monkey bite. had stitches and tt and rebivax injection. Had rabipurs injection. Is treatment right? 7 hours later
Thank you so much Doctor....

But as you mention, when should i take extra dose of injection ? After compliiton of my course ? Is there any side effects of extra dose ?

As well as in mail question i was asked Is it true that rabies will occure after 20 years also ?

Also reply me that when the person get paralysed afrer expouser from animal ?
There is any chances for me ?

Awaiting for your reply.
 
 
Answered by Dr. Jay Patel 33 minutes later
Hi,

Here are the answers to the question:

1) You were going to take vaccine four times as 0,3,7 & 28 days. You can add an extra shot at "15 day" as per World health organization's recommendation.

2) There is no side effect as these are basically the antibodies against rabies virus. Further no harm is done by extra shot.

3) Rabies will not reoccur or comeback once it’s all gone. Post exposure Vaccination is best and along with wound care it provides 100% cure against rabies infections. Hence it is highly unlikely that you will have recurrence/paralysis at a later stage.

4) Rabies active state starts from 2-10 day post exposure and if no vaccination is taken then the signs like paralysis can show up as early as the 10th day. However as described above, your chances to get rabies is close to "ZERO".

As per the research and clinical results, as long as patient had vaccine on 0-3 days post exposure and did clean wound with alcohol/ antiseptic solution/ warm water. there is "zero" case of rabies.
(The trial and results are derived from thousands of cases world wide and not a single person had rabies once they took vaccine).

Please try to relax and simply take care of your wound and keep taking vaccination as per schedule, nothing is going to happen to you.

Feel free to contact me in case of any other question/ doubts that arises in your mind.

Thanks again.
Dr. XXXXXXX XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Had monkey bite. had stitches and tt and rebivax injection. Had rabipurs injection. Is treatment right? 1 hour later
Thanks Doctor..

Last follow up ... AS iI mentioned that After monkey bite, Doctor (B.A.M.S.) clean my wound within 10 minutes with Detol & Savlon as well as spirit and stitch the wound. And after 4th day Doctor at sasoon hospital,pune remove the stitches & give me equirab injection.

I am confused that in 3 days my wound was closed. Can It makes difficulty to me or can create problem in future ?


As well as day 15th was gone. Can I take extra dose on day 90 ?

Please guide me. Rabies is not going to happen me na ? Please help.
In addition to above follow up i would like to ask, Is it mandetory for me to undergo check up suggested by you ?

If I not get the check up done, what will be the problem ?
 
 
Answered by Dr. Jay Patel 46 minutes later
Hi,

I understand that you are pretty nervous, it's quite normal to feel in that fashion.

Let me now answer the questions.

1) The closure of wound in 3 days is not a problem and contrary good sign to get the wound closed. No, the closure on wound in 3 days will not create any problems to you in future.

2) There is no harm if you want to take an extra dose at 90th day. You can take it as I mentioned earlier it's an antibodies against rabies and it will not harm you.

3) You will not get rabies for sure, please follow and complete vaccination on time.

4) There is no need for you to take any of the tests which I mentioned in the first response, I was just answering your question about test that can be done. I never intended that you must undergo any of the above test.
Again the tests for rabies were for information only no one ever does it. And you will not have any problems if you do not undergo any of test.

Please calm down; you will be fine and normal. Feel free to contact me in case of any other future questions or any other doubts. And please do not feel awkward in asking any question that comes to your mind. I do understand how hard it might be on you.

Hope I did answer all your questions in detail.

Thanks again,

Dr. XXXXXXX XXXXXXX

Above answer was peer-reviewed by
 
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