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    Can rabies be contracted when a patient is on post-exposure prophylaxis?

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Posted on Thu, 2 Jun 2016 in Medicines and Side Effects
Question: I got bit by a pet dog around 19 days back. Since then the dog has not died. I have taken 4 rabies vaccine as per 0,3,7,14 day schedule. I'll take the fifth one on 28th day.
This is the list of events that occurred after the dog bite:
Dog bite around 13th March, 6:00 pm
First Rabipur vaccine around 14th March 8:00 pm
Second Rabipur vaccine around 17th March 9:00 pm
Third Rabipur vaccine around 21st March 10:30 pm
Fourth Verorab vaccine around 28th March 9:30 pm
Fifth Rabipur vaccine to be taken around 12th April 7:30 pm

I have the following concerns which are making me really worried to the point it's disturbing my sleep and I'm not able to concentrate on anything else because of fear of getting rabies disease.

1. The dog who bit me is a pet dog. I believe, based on what dog owners have told me, that they have been regular in getting it vaccinated yearly. The dog has not died in almost 20 days time. Do I still need to take the last vaccine?

2. The pet dog who bit me belongs to my wife's family. The dog used to lick her on her face. She used to feed it, then eat without washing hands. I asked her to get vaccinated as well but she is adamant and refusing to take any vaccines. My parents and her parents also feel that I'm getting worried without any reason. I'm worried that I'll get rabies from her and my vaccines won't work.

3. I took my first rabipur (rabies vaccine) around 26 hours from exposure instead of normal 24 hours window. Is it alright? 

4. I have read that rabipur vaccine should be kept in temperature between 2 to 8 degree celsius. But my doctor gave it to me approximately 2 hours after I bought it during which it was at higher temperature than this range. Is it alright? I have read that these vaccines contain inactivated rabies virus, I am particularly worried that the virus won't have got activated in this period. All the other three I believe were given within 45 mins from the time of buying from shop where they were kept in refrigerator. Could it have any negative impact?

5. My 4th vaccine which I took on 28th around 9:30 pm was verorab, since rabipur was not available at the place where I was. I believe both of them are same and hence interchangeable. Is it okay?

6. Keeping all these scenarios in mind like the delay in getting vaccines, time during which the vaccines were kept at higher temperature than the approved range, my wife's refusal to get vaccinated herself, me taking verorab as 4th vaccine instead of rabipur, is there anything I need to do more?

Thanks in advance for giving your precious time.
doctor
Answered by Dr. Panagiotis Zografakis 1 hour later
Brief Answer:
the vaccination has to be concluded

Detailed Answer:
Hello,

post-exposure prophylaxis consists of administration of rabies immunoglobulin (which is ready antibodies against rabies) and vaccination in days 0,3,7,14,28 (in order to make your body create antibodies fast). Thorough wound cleansing is the first very important step in prevention since it may reduce the risk for rabies by as much as 90%!

1. the answer is that you should take it. You can't take the risk, although I don't believe it is a rabid dog... 20 days is a long time for rabies. The dog should have had either serious symptoms or died. The 'official' recommendations are that a dog without symptoms after 10 days of close surveillance does not constitute a good enough reason to receive treatment.
2. the dog's saliva does contain the virus (if it's diseased).
3. the sooner the better, but it's fine.
4. I don't believe there is any risk... We don't expect a vaccine to become inactivated after being exposed to room temperature for a couple of hours.
5. it's perfectly OK.
6. I don't believe you should do anything more than that. Obviously the most complete treatment would have included your wife's treatment but since the dog seems to be fine, there is no real medical reason for it.

I think you've done as much as you could right now. And I believe you should stop worrying!

Kind Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 27 minutes later
Thanks for the answers and removing all these worries from my head. But as you know the dog survived long enough, do I still need to worry about my wife getting rabies. Also, can I get infected from her even after taking vaccines?
doctor
Answered by Dr. Panagiotis Zografakis 20 minutes later
Brief Answer:
no...

Detailed Answer:
You're welcome!

Since the dog is OK 20 days after the incident, your wife does not require treatment, so you shouldn't worry about her. After a new exposure we usually give a couple of booster doses, but your first post-exposure treatment is still not complete, so there is no reason to do something more. I don't know of adequate studies about the vaccine's efficacy but some data suggest that it's very effective, although 100% effectiveness cannot be guarantied.

Kind Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 8 hours later
Thanks again, I am really grateful to you for giving your precious time to me. As per you, since the dog has not died after 20 days, my wife won't have got infected. So I need not to worry about her getting infected or I getting infected from her. But just to be on safer side I'll take the last injection as well. Is my understanding correct? Also, can you tell after approximately how many days I can be sure everything is alright since the dog bite? Given the dog has not died, even then do you think I should go for booster doses after my 5th dose? If you think it helps, I can go for booster doses before my 5th dose as well if it doesn't have any major negative impacts. Lastly, the inactivated rabies virus inside Rabipur/Verorab vaccine does not get activated if the conditions are different from what is recommending for storing the vaccine, right?
doctor
Answered by Dr. Panagiotis Zografakis 6 hours later
Brief Answer:
it may take months...

Detailed Answer:
Your understanding is quite correct...

Unfortunately the incubation period can be long ranging from weeks to months.
When the suspected animal is OK, we usually stop preventive measures, so the recommendation is to stop now but it's a matter of taking the risk. I would have stopped, if I were you but I can see that you're too anxious about it, so perhaps stopping vaccination might give you more problems (anxiety I mean) than continuing it.

I would recommend against having booster doses.

Do not worry about the storage conditions. You can't get rabies by receiving the vaccine, no matter what the conditions were.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis 1 hour later
Thanks a lot sir, it has reduced my worries quite a bit. So, I don't have to worry of my wife getting it or me getting it from my wife as well, right?
doctor
Answered by Dr. Panagiotis Zografakis 44 minutes later
Brief Answer:
that's right!

Detailed Answer:
Yes... that's right! You can forget about it completely!

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3694 Questions

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