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Hi Doctor, I Need Your Help. I Had A Small

Posted on Thu, 7 Feb 2019

Question: Hi doctor, i need your help.
I had a small blood clot and a wound in my left leg on december 22nd. It didnt look like a dog bite as i dont recollect being bitten by any dog. There was a very small bleeding but the area around the wound was clotted. I dont know how i got it. There are squirells, rats and rodents at my place and i assume i was may be bitten by them while sleeping.

I am vaccinated with rabipur full five dosage in 2012 and also in 2013. I did receive booster doses once in 2015. That was my last vaccine.

Right now i am worried and terrified because its been 18 days and i have not received any vaccine because it was not a dog bite. But all the websites say that even squirell, rats, mongoose, rodents can transmit rabies.
Now i dont know what to do?

The last booster dose that I had was almost 3 years back do you think I will still have immunity which would save me with this bite if I had an exposure?

How long the immunity with additional booster dose?

What is the protective titer one should have?

Should i get vaccinated immediately?

Answered by Dr. Bhagyesh V. Patel (10 hours later)

Brief Answer:
vaccine recommended with proper antiseptic wound care.

Detailed Answer:
Hello and welcome to Ask A Doctor services.
I have read your query and here is my advise.

* As per my clinical experience, previous booster dose of rabies vaccine gives a fair
immunity coverage for around 8-10 years.

* It is the specific group of people ( as health care providers ) where there is high risk of
exposure to rabies virus, health authorities recommend booster every 3-5 years,
otherwise not.

* As you had booster before 3 years, you are having better immunity at this stage
against rabies ( antibody titre is not a need in your case ).

* However, as there was definite blood clot, suggesting breach in the continuity
of the skin with rodents around, it is always recommended from medical point of view
to be on safer side and take vaccination immediately ( though it is a span of 18 days ).

* Do consult your nearby physician and get further care regarding your wound care and
vaccination.

Hope this information will serve you best.
Wish you best health.

Take care.
Dr Bhagyesh

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (1 hour later)

Dear doctor

Do you think in XXXXXXX mammals like rodents squirrels rats mongooses and mice can transfer rabies virus to humans?

Have you seen any such case?

Also i did something called rabies antibody igg test through a lab and the report says rabies antibody igg is >= 4eu/ml. I am not able to understand or interpret the report. Could you please help me to understand and what it means and do i still need vaccine?

Answered by Dr. Bhagyesh V. Patel (2 hours later)

Brief Answer:
follow up.

Detailed Answer:
Hi Pakkasham
Welcome for the follow up.

* Though it is very rare to get rabies from rodents, mice etc. ; it is possible.
( In my surgical practice of 18 years, I have not encountered such case )

* The report is suggestive of antibody titre of sufficient level to protect you against
rabies currently.

* So as per the report you have fair reason of no need to take the vaccine presently.

Wish you good day.
Regards.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (1 hour later)

Hi Doctor,

Few questions.

1. I came across some sites which says IU/ML is the unit to measure antibody but this says EU/ML. what is the difference doctor?

2. What is the protective titer value?

3. Do you even though i am not vaccinated my protective titer would neutralize the rabies virus if in case? So am i safe with vaccine?

Thanks

Answered by Dr. Bhagyesh V. Patel (1 hour later)

Brief Answer:
follow up .

Detailed Answer:
Hi
Kindly find relevant answers to your questions below.

1. EU is the comparative unit used by the lab as standard reference range, it may be
European standard or others.
IU means international standard, where as there are lot many different standards
used as BU ( british ) and others.

2. Protective titre is above 0.5 IU/ml

3. There are almost best chances to fight against the possible virus in your body with
this value, but ultimate response depends upon the body`s ability of Major
Histocompatibility complex known as MHC to confer the immunity when the virus
enters in the body.

4. So you are safe with vaccine almost, still if you want it to be more precise to 100 %
just take a booster dose in which there is no harm at all.

The issues happen at very microscopic level in the body system, what at a glance one can confer that you are best level protected at this stage.

Regards.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Bhagyesh V. Patel (31 minutes later)

Thank you very much Dr

I visited the nearby hospital today and they told me that they have only Rabipur vaccine which was manufactured in 2017 and expiry date as 2021 and also told me that this vaccine is not getting manufactured now And the last batch was 2017 which is what they are selling and it has been stopped now and not produced anymore. I didn’t find any other vaccine near by.

All my previous vaccination was done using rabipur only. Can I go ahead and get a booster dose with rabipur in this case? Should there be any concern with this vaccine please let me know.

Thanks

Answered by Dr. Bhagyesh V. Patel (1 minute later)

Brief Answer:
follow up .

Detailed Answer:
Hi
You can safely take the vaccine of 2017 manufacturing with equal efficacy and safety in 2019 without any issues.

As there are very stringent steps taken to preserve the vaccine up to last date of use.

Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (4 days later)

Hi Doctor
I took the first dose on 19th day post unknown bite.
Do I need to take the second one as per the guidelines or since I had titer of more than 4 EU/ML and taken a booster dose already can i stop it here? Please suggest.

Also after the first vaccine I’m having tiredness pain in my legs. I also get occasional Paraesthesia, pins and needle and cold feet but not something major. I can still come to office and work normally.

Answered by Dr. Bhagyesh V. Patel (1 hour later)

Brief Answer:
follow up .

Detailed Answer:
Hi Pakkasham
Welcome for the follow up.

* You are considered for schedule 1 of post exposure prophylaxis of previously vaccinated
persons and hence you do not require another dose.

* You can work normally as per your casuals.

Take care.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (59 minutes later)

Hi doctor,

It says previously immunised people need 2 doses of vaccine on 0 and 3 day. But I received only one and before the vaccination my titer was greater than 4 iu/ ml.
So you still consider one dose is enough?

Answered by Dr. Bhagyesh V. Patel (17 hours later)

Brief Answer:
follow up .

Detailed Answer:
Hi Pakkasham

* 2 doses are recommended for known exposure or health care professionals dealing with
rabies virus as lab technician, research workers or so ; but not for unknown exposure or
other group of people.

* So for you single shot is enough for immunity coverage.

Thank you.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (2 hours later)

Thank you doctor.
I kind of have a very big fear about this disease. I caught this fear in 2012 when I was actually attacked by a dog. It was unprovoked. Since then I have taken 5 complete dose once. One booster in 2013 , one in 2014 and one in 2015 and one now in 2019. The latest one is this which is 4th one since the one I had in 2015. A total of one 5 dose and 4 booster. I hope this would cover me from the current exposure ( pretty sure that I was not bitten by dog and cat atleast) from rodent mice or squirrel whatever.

From you medical experience sir, can I be sure that I am out of danger? Sorry for bothering sir as this disease is 100% fatal.

Also sir, is there anyway to check if the person has caught rabies before the symptom appears through some blood test?

Thanks

Answered by Dr. Bhagyesh V. Patel (13 hours later)

Brief Answer:
follow up .

Detailed Answer:
Hi Pakkasham
Welcome for follow up.

* As per my experience, you are surely under complete coverage against possible rabies for sure without any doubts.
* There are no tests available to detect rabies before symptoms.

Regards.

Note: For further inquiries on surgery procedure and its risks or complications book an appointment now

Above answer was peer-reviewed by : Dr. Prasad