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Can Rabies Still Be Contracted If Second Shot Is Delayed By Seven Days?

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Posted on Wed, 18 Oct 2017
Question: Dear Sir, on September 3rd,2017 I accidentally stepped on the tail of a stray dog and in order to free himself, I suspect he touched me with his teeth on my right foot. There was no blood but in a few hours a small red dot maybe 2mm in diameter showed up and disappeared within a few hours.

I made the stupid mistake of not consulting a doctor and bought the rabies shots myself from a pharmacy.

I got the rabies shot within few hours which happened to be the Day 0 shot (Indirab by XXXXXXX Biotech), however I got the next shot on day 7(XPrab by Novartis) instead of day 3 as I had mistakenly read the PEP chart instead of PrEP chart. Is this going to have a major bearing? I had a 5 shot PEP (Rabipur) back in 2011 as well. What should I ideally do now?

Till date as on Sep 19,2017 I've received four shots on day 0,7,10&14. The first two were not in a hospital so were administered in the gluteal area. Please prescribe the future course of action.

Am I still at risk?

doctor
Answered by Dr. Monika Dede (2 hours later)
Brief Answer:
I think there is little to no risk for rabies.

Detailed Answer:
Hello,
Thank you writing in healthcare magic.

Based on your history,being vaccinated before and having a small red dot on your foot after few hours (and not immediatly) after the dog touched you I think there is little to no risk for rabies.
Usually this kind of contact is included in category 2 and according the guidelines in this cases PEP vaccination is required.
In your case delay in your PEP schedule because of the mismanagement (administrated in gluteal area) the regimen should be followed as closely as possible. However, a one or two day deviation from the PEP regimen is acceptable.
It is recommended that persons who had previously received full pre-exposure treatment like you, should be given only two booster doses, either intramuscularly (in deltoid) or intradermally, on days 0 and 3, but no rabies immunoglobulin.
Furthermore, if you have concerns during this time I suggest to do a phisical examination by a doctor in order to evaluate your situation.

I hope my answer helps you.
Regards.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Monika Dede (19 hours later)
Thanks Doctor XXXXXXX

Does this mean that the first two injections taken in the gluteal area woul be totally ineffective?

Also, I read that the UK guidelines say that people who have been immunised before need a vaccine on day 0 and the second one on days 3-7. Is this correct?

Also, after the vaccination what is the risk that the virus can still infect me?
doctor
Answered by Dr. Monika Dede (27 hours later)
Brief Answer:
Please don't worry!

Detailed Answer:
Hello,
I am sorry for my late response.

You should know that application of the vaccine in gluteal area is not indicated because could be ineffective (maybe not totally).
According the guidelines the person who is vaccinated before should apply 2 dose of vaccine .

Please don't worry after the recent vaccination as well being vaccinated before,there is no risk of rabies infection .

I hope my answer helps you.
Regards.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Monika Dede (21 hours later)
Thank you for the answer doctor. Hope you understand that this rabies anxiety is bothering me all the time and thats where the questions come from.

I have two more questions however:

1) If my previous vaccination in 2011 was administered in the gluteus, would I then be considered previously vaccinated? Since it has been a long time I dont remember where I took those injections on my body. I mean if they were administered in the gluteal area, should I still go for just two shots of vaccine now?

2) Also, can I go for a Rabies antibody titer test to know the effectivity of the first two shots that were taken in the hip?

Once again I'm sorry to be asking too many questions!
doctor
Answered by Dr. Monika Dede (14 hours later)
Brief Answer:
You should perform a rabies serology antibody titer.

Detailed Answer:
Hello,
Thank you for writing back.

No, if the previous doses of rabies vaccine were given in the gluteal area in 2011 should not be counted as valid and should be repeated according to the CDC guidelines.

If they were applied in the gluteal area then this should apply a full vaccination scheme.

Yes, it is better that you should perform a rabies serology antibody titer after administration of the final dose (4 doses) to ensure an adequate immune response to the series.

I hope my answer helps you.
Regards.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Monika Dede (33 hours later)
Hello Doctor XXXXXXX

I understand I'm asking too many questions but please understand my situation

As advised I went for a Rabies Antibody Test yesterday and the reports shall be available in 5-7 days.

My Vaccine schedule was

September 3 - Day 0 shot (Indirab by XXXXXXX Biotech) taken in gluteal region
September 10- Day 7 (XPrab by Sun Pharma) taken in gluteal region
September 13- Day 10 (Rabipur) taken in deltoid
September 17- Day 14 (Rabipur) taken in deltoid

The doctor I consulted yesterday for the rabies antibody blood test said that the shot taken on Day 10 - September 13 would now be considered my first shot of vaccine and gave me another Rabipur shot in Deltoid and has suggested two more shots on September 27 and October 10th


My questions now are as below:

*Now, effectively my vaccination started 10 days after exposure, what is the efficacy of a rabies vaccine started 10 days after exposure- Please reply to this question in detail

*Will this test tell the efficacy of the first the vaccine shots that were taken in the gluteus if there was any efficacy?

*What can be expected out of the report at this stage?

* Are rabies vaccines totally effective before the virus reaches the nervous system?


*Also, you'd have noticed that I switched the brands of vaccine- Is this permitted, my doctor said it was a bad idea. Is interchanging of vaccines allowed?

*Also, by October 10 I would have taken 7 shots of the vaccine- Is this going to be an overdose?

Please take some valuable time out of your busy schedule to answer this as I'm spending sleepless nights and becoming very depressed,

Regards,
Atish

doctor
Answered by Dr. Monika Dede (26 hours later)
Brief Answer:
An overdose of rabies vaccine is unlikely to occur.

Detailed Answer:
Hello,
I am sorry for my late response.


If you do not have the symptoms of a rabies, the sooner, the better, but it's never too late, even if you start 10 days later. Delay can increase the risk but not necessarily lead to rabies if the virus has not invaded the system nervous until then. As soon as the symptoms appear, you have an incurable rabies and the vaccine will not work.There is no standard duration for this as virus,if present, progresses in nervous system at variable speed.

The rabies antibody blood test could tell us for immunity status from the previous vaccination, and not for the recent vaccination in gluteus, because the body needs approximately 2 weeks to produce antibodies for rabies after vaccination.

Yes, the rabies vaccination is very effective before the virus invades the nervous system.
Usually, it is not recommended to change the brand of vaccine, but this doesn't mean that are ineffective.
Please don't worry, it is not over dose after taking 7 shots of vaccination, (2 in gluteus and 5 in deltoid).An overdose of rabies vaccine is unlikely to occur.

I hope my answer helps you.
Regards.


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Monika Dede (1 hour later)
Hi Doctor,

Today is the eleventh day after I took my first vaccine in the deltoid.

I'm however experiencing tingling sensation in the toes of my feet. If this is due to rabies, hoe effective a vaccine that was taken 10 days ago would be?

I've no fever or any other sickness

Regards,
Atish Chauhan
doctor
Answered by Dr. Monika Dede (12 hours later)
Brief Answer:
I think your immunization is effective.

Detailed Answer:
Hello.
Thank you writing back.

You should know that the first symptoms of rabies are similar to those of the flu including weakness , fever, or headache and may last for days.
There may be also discomfort or a prickling or itching sensation at the site of bite, progressing within days to symptoms of cerebral dysfunction, anxiety, confusion, agitation.
So, based on this above mentioned symptoms I think you shouldn't worry because is not related to your case.
Having a rabies vaccination after 10 days of exposure and being vaccinated before the exposure I think your immunization is effective.

I hope my answer helps you.
Regards.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Monika Dede (22 hours later)
Hello Doctor XXXXXXX

How long do the antibody titers last in blood, practically?


Awaiting your response....
doctor
Answered by Dr. Monika Dede (18 hours later)
Brief Answer:
Long term immunity.

Detailed Answer:
Hello,
Thank you writing back.


Usually, long term immunity completely depends upon the individual's response to the anti rabies vaccine. An average of 10 years and a minimum of 5 years has been observed by WHO and other independent studies.

I hope my answer helps you.
Regards.

Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Monika Dede

Infectious Diseases Specialist

Practicing since :2003

Answered : 997 Questions

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Can Rabies Still Be Contracted If Second Shot Is Delayed By Seven Days?

Brief Answer: I think there is little to no risk for rabies. Detailed Answer: Hello, Thank you writing in healthcare magic. Based on your history,being vaccinated before and having a small red dot on your foot after few hours (and not immediatly) after the dog touched you I think there is little to no risk for rabies. Usually this kind of contact is included in category 2 and according the guidelines in this cases PEP vaccination is required. In your case delay in your PEP schedule because of the mismanagement (administrated in gluteal area) the regimen should be followed as closely as possible. However, a one or two day deviation from the PEP regimen is acceptable. It is recommended that persons who had previously received full pre-exposure treatment like you, should be given only two booster doses, either intramuscularly (in deltoid) or intradermally, on days 0 and 3, but no rabies immunoglobulin. Furthermore, if you have concerns during this time I suggest to do a phisical examination by a doctor in order to evaluate your situation. I hope my answer helps you. Regards.