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Hi, I am currently in Laos and I was scratched

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Posted on Fri, 15 Feb 2019
Question: Hi, I am currently in Laos and I was scratched by a dog tonight. I have seen the doctor already and had my first rabies shot. I had a course of pre-exposure rabies vaccinations last year, but I had the last one later than recommended.

I had one at the start of May, one a week later and a final one in October last year. I know that normally you are supposed to get all three vaccinations in the same month. There was a bit of language barrier with the doctor here, so I just wanted to confirm that, given the fact that my vaccinations were spread out over 6 months, I am still ok to just get two vaccinations now and I don't need Rabies Immune Globulin as well.
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Answered by Dr. Antoneta Zotaj (1 hour later)
Brief Answer:
Detailed explanation below

Detailed Answer:
Hello,

Thank you for asking at "Ask a Doctor" service. I carefully went through your query.

There is not much information available related to the effect of the rabies vaccine if there is delay in doses (as is in your case, they are taken within 6 months time period). On the other hand something you can discuss with your doctor is the chance that serology (blood tests) might help in your case: the serology for rabies which is blood tests to check for antibodies (protective structures that the body produces against the infection) against rabies.
There are a few types of tests that can be used but the most reliable one is "Rapid Fluorescent Focus Inhibition Test- RFFIT". This test takes around 20 hours to show the results and can tell you for sure if you have already developed enough immunity to protect you or not. It is mostly recommended to prove immunity after the vaccination so it is generally done weeks after the vaccine but it is worth discussing its possible help in your case.
ELISA is another possible test to detect if you have developed immunity but is not as accurate as the first one.

Because you should take 2 doses of the vaccine even if you had a good pre-exposure vaccination, so you will need a dose in day 3 anyway, you might have enough time to do the test and have the results and make sure if you still have some protection or not and if you need the other two doses (day 7 and 14). This is an approach you can talk with your doctor and see if he finds it doable or helpful in your case.

As for the immunoglobulin, if you had just a scratch that did not bleed, very likely rabies immunoglobulin is not needed according to the recommendations. If the scratch was deeper and it bleed, in this case it will all depend if you will be considered properly vaccinated pre-exposure or not (maybe the serology will help in this case as well). If not sure for the level of protection then very likely having the immunoglobulin is safer.

If the serology is not possible to be done or the doctor thinks will not be appropriate in your case then the safest way to go is to have all the 4 doses and the immunoglobulin for better protection because rabies is an infection that is lethal if not well prevented.

A third approach would be to have the 7th day dose vaccine as well (it means only one extra because you will be getting two anyway) and meanwhile in day 10 the dog can be examined for signs of rabies (if this is possible) and if the dog is not having rabies you do not need the 4th dose in day 14.


I hope I have answered your query. Let me know if I can assist you further.

Regards,
Antoneta Zotaj,
General & Family Physician


Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Antoneta Zotaj

General & Family Physician

Practicing since :2004

Answered : 4363 Questions

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Hi, I am currently in Laos and I was scratched

Brief Answer: Detailed explanation below Detailed Answer: Hello, Thank you for asking at "Ask a Doctor" service. I carefully went through your query. There is not much information available related to the effect of the rabies vaccine if there is delay in doses (as is in your case, they are taken within 6 months time period). On the other hand something you can discuss with your doctor is the chance that serology (blood tests) might help in your case: the serology for rabies which is blood tests to check for antibodies (protective structures that the body produces against the infection) against rabies. There are a few types of tests that can be used but the most reliable one is "Rapid Fluorescent Focus Inhibition Test- RFFIT". This test takes around 20 hours to show the results and can tell you for sure if you have already developed enough immunity to protect you or not. It is mostly recommended to prove immunity after the vaccination so it is generally done weeks after the vaccine but it is worth discussing its possible help in your case. ELISA is another possible test to detect if you have developed immunity but is not as accurate as the first one. Because you should take 2 doses of the vaccine even if you had a good pre-exposure vaccination, so you will need a dose in day 3 anyway, you might have enough time to do the test and have the results and make sure if you still have some protection or not and if you need the other two doses (day 7 and 14). This is an approach you can talk with your doctor and see if he finds it doable or helpful in your case. As for the immunoglobulin, if you had just a scratch that did not bleed, very likely rabies immunoglobulin is not needed according to the recommendations. If the scratch was deeper and it bleed, in this case it will all depend if you will be considered properly vaccinated pre-exposure or not (maybe the serology will help in this case as well). If not sure for the level of protection then very likely having the immunoglobulin is safer. If the serology is not possible to be done or the doctor thinks will not be appropriate in your case then the safest way to go is to have all the 4 doses and the immunoglobulin for better protection because rabies is an infection that is lethal if not well prevented. A third approach would be to have the 7th day dose vaccine as well (it means only one extra because you will be getting two anyway) and meanwhile in day 10 the dog can be examined for signs of rabies (if this is possible) and if the dog is not having rabies you do not need the 4th dose in day 14. I hope I have answered your query. Let me know if I can assist you further. Regards, Antoneta Zotaj, General & Family Physician