Brief Answer:
Please do antibody level testing and take booster only if required

Detailed Answer:
Hi XXXX,
Thanks for writing in.

I have read through your query in detail.
Since you have taken anti rabies complete course only recently, your anti body levels might be in the safe range and you do not need a re vaccination as you are only assuming that the dog has bit you and are not sure.

In your case, it will help to measure the antibody levels in your blood before deciding to take further vaccination. Antibody levels after vaccination is usually done after 30 days from first dose using a specific test. In humans a result of 0.5 IU/mL or higher is considered an acceptable response to rabies vaccination according to the World Health Organization (WHO) guidelines. Please contact a well known laboratory in your place and ask for the test to be done since 30 days are complete from start of vaccination and only if the antibody level is below acceptable then you can take a booster dose again for further protection.

As you have taken 3 doses recently, therefore the antibody levels will be in the acceptable range. If you continue t frequent rabies prone areas then the routine procedure is antibody testing every 6 months; booster vaccination if antibody titer is below acceptable level.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

---

Brief Answer:
Please contact NIMHANS and St Johns Medical College XXXXXXX for test

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

International guidelines are followed in the matter of administration of anti rabies vaccines to humans. The current guidelines for those at risk of rabies is as given below

Schedule of vaccination: Pre-exposure vaccination is administered as one full dose of vaccine intramuscularly or 0.1 ml intra-dermally on days 0, 7 and either day 21 or 28.

Laboratory staff and others at high continuing risk of exposure should have their neutralizing antibody titres checked every 6 months during the initial two years period after the primary vaccination. If it is less than 0.5 IU/ml a booster dose of vaccine should be given. Subsequently, sero-monitoring is recommended every two years. Because vaccine-induced immunologicalmemory persists in most cases for years, a booster would be recommended only if rabies virus
neutralizing antibody titers have dropped to less than 0.5IU/ml. Such individuals on getting exposed to rabies virus after successful pre-exposure immunization require only two booster injections of vaccine given on days 0 and 3 and no RIG.

My observations keeping in mind the above guidelines is as follows
1. Your last dose was on 18th January 2015 and the suspected dog contact occurred on 25th January 2015 which is one week after last dose. Therefore no requirement of re vaccination.

2. If the dog bit you more than 30 days after last dose will require the 2 doses on day 0 and day 3 as described in guidelines above. If you take two more vaccinations right now then it will be more than required. But if the dog bit you after 20 February 2015 then you need two vaccinations at day 0 and day 3.

3. You can contact Microbiology department at NIMHANS or St.Johns Medical College, both of which are in XXXXXXX and enquire about this test. Please ask that you want to know anti rabies antibody levels in blood after vaccination.

4. The vaccines taken in 1998, 2004 and 2009 will not have any side effects. However, if you continue to be involved in street photography then please follow a regular schedule as described in guidelines above.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

---