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Is Immunoglobulin mandatory after a dog bite?

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General & Family Physician
Practicing since : 2009
Answered : 9387 Questions
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Hi Doc I was bitten by a stray dog on the 13th of Feb, 2014. I was running towards the market at around 9:30 in the night and may be the stray dogs got provoked by this, so 5-6 dogs started chasing me. One of them bit me in the thigh region. The wound was superficial with very little bleeding. There were two teeth marks plus I am not sure but there was also a scratch on my right thigh (from the same or a different dog I am not sure). I took the Tetanus injection and took my 3rd dose of rabipur on 20th feb, with 2 more still to go. The doctor at that time said that the immunoglobulin was was not necessary as the bite was not serious, as in close to the head/eyes etc. So I did not take it but i have been reading on the internet forums that my bit was category 3 bite and immunoglobulin was necessary. I have been really stressed lately about the fact that I did not take it. And now since 7 days have passed i cannot take it now. So my question is after how many days can i be sure that I am free from rabies virus? Any other advice will be appreciable. Thanks
Posted Sun, 9 Mar 2014 in General Health
 
 
Answered by Dr. Shoaib Khan 57 minutes later
Brief Answer: 3-8 weeks from exposure sir Detailed Answer: Hello sir and welcome. Thank you for writing to us. The doctor that advised you not to go ahead with the remaining 2 post-exposure shots should have been more than 100 % sure to have advised you against the remaining two shots, as all doctors are more than well aware about the fatality rate of rabies. So this is a comforting fact, but you could still visit the doctor again. Now coming to your query; the symptoms of rabies start with a mild flu-like presentation, with fever, headache, nausea, etc. They usually appear 3-8 weeks after exposure to the virus. So we could wait for about a month or two and see if you get any symptoms, and then confirm that you have nothing to worry about. I hope you find my response both helpful and informative sir. Please feel free to write back to me for any further clarifications, I would be more than happy to help you. Best wishes.
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Follow-up: Is Immunoglobulin mandatory after a dog bite? 2 minutes later
I think you are confusing the rabies vaccine shots(rabipur) with immunoglobulin. I am surely getting 5 shots of Rabipur as advised by the doctor but have not taken rabies immunoglobulin. My question is that even after taking 3 shots or 5 shots of rabipur, can the rabies still affect me ?
 
 
Answered by Dr. Shoaib Khan 13 minutes later
Brief Answer: Then there is nothing to worry about at all Detailed Answer: Hello once again sir. I am sorry for the misunderstanding. No, if you have received the rabies vaccine and have received less than 5 of the immunoglobulin shots, then there is really nothing to worry about. The immunoglobulin regimen is only advised to patients with bites closer to the head, and as yours is not, I am sure you are safe. You can rest without any worries at all. Your doctor was also correct in advising this. So do not worry at all sir. Once again sorry for the misunderstanding and wishing you a long and healthy life ahead. Best wishes.
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Follow-up: Is Immunoglobulin mandatory after a dog bite? 13 minutes later
I am sorry but I am not sure I understand what you mean by, " if you have received the rabies vaccine and have received less than 5 of the immunoglobulin shots", I have not received any immuno globulins. I have received only 3 doses of rabipur (+tetanus) with 2 more scheduled later. 1. Can i get rabies even after getting 3 shots of rabipur because the doctor said that immunoglobulin is necessary in cases when rabies can spread faster (like close proximity to the head) but Now that I have received 3 shots of vaccine and most probably my immunity is developed, can the rabies still affect me at a later stage?
 
 
Answered by Dr. Shoaib Khan 13 minutes later
Brief Answer: Explained in a more clear manner sir Detailed Answer: Hello once again sir. My apologies if I have not explained things in a manner best understood by you sir. Let me explain everything in detail for you sir. The rabies post-exposure vaccine is more than enough to help develop and immunity against rabies, as long as it is taken on the day of the bite (i.e. day zero) and is followed as per the schedule of the following shots. The immunoglobulin is only advised to those patients who have a higher risk of developing rabies as mentioned by your doctor and in my previous response, if the bite is around the face, neck, shoulder region, etc. Even in those individuals with bites with close proximity to the head, if the immunoglobulins are not given, the risk of developing rabies is very low as the post-exposure vaccine itself helps in developing an immunity which prevents rabies from affecting the individual. But only as a backup, we provide them with the immunoglobulins as these immunoglobulins act faster than the vaccine itself. These immunoglobulins help in developing an immunity much quicker than the vaccine would, and is beneficial in providing immunity in cases where an early immunity needs to be developed (in bites with close proximity to the head) sir. So as is your doctor's opinion, and mine; you do not need the immunoglobulins sir. You shall be well protected with the post-exposure vaccine and will not, and shall not require the immunoglobulins sir. Rabies cannot affect you at a later stage sir, as the bite was on the thigh, and the post-exposure vaccine will more than suffice to provide the required immunity to prevent you from contracting rabies. You are well protected with just the vaccine sir. I would also like to add to not keep the wound covered, let it be open. But I am sure your doctor has already advised you about the same. If at all the wound is covered, then please remove any/all dressing and keep the wound open. I hope I have explained this in a manner best understood by you sir. Please do not hesitate to write back to me for any further clarifications, I would be more than happy to help you. Best wishes.
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