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Is There Any Possibility Of Rabies By Monkey Bite?

Posted on Mon, 10 Feb 2014

Question: Sir/madam My Kid who is now 3.5 years old is studying in a play school. In september,2013 while i picked him from school ,i noticed some scratch marks in his left hand ,the skin was broken at that site and some blood got clotted there. When i inquired from my kid he said that his class mate has made these scratches by his nail. when i inquired this from his school staffs,they said that they have not noticed any such things. As this school as well as my residence is in a monkey prone area, I have got some suspicion now that there might be a remote possibility of scratching/biting by any monkey. Although this seems almost impossible in the school but there might be some possibility taking into consideration neglience of school staffs. Now my question is- In the present circumstances is there any possibility of rabies by monkey bite. As my kid has not been given preventive rabies vaccine till date,should i go for post exposure rabies vaccination now to rule out any possibility of this disease. Is vaccination still effective after 4 months of possible bite. My kid does not have any problem right now related to this disease and my entire concern is based on my suspecion. As rabies is a 100% fatal disease,please suggest me comprehensive advice evaluating the very remote possibility of any animal bite.

Answered by Dr. Rakesh Karanwal (1 hour later)

Brief Answer: NO REQUIREMENT of Anti-Rabies Vaccine Detailed Answer: Hi XXXXXXX Thanks for your query. Firstly, symptoms of Rabies become manifest within 7 days' of bite by an infected monkey/dog. Your child is in perfect health even after 4 months of the incident. Further, Anti-Rabies vaccine is given within 24 hours of exposure to dog/monkey bite, for it to be effective. So, it will neither be of any use, nor required to be given. So, JUST RELAX! Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Fond regards and have a nice day, Col (Dr.) Rakesh Karanwal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Karanwal (11 minutes later)

sir But there are cases in my knowledge where rabies menifested even after 3-4 years of bite even after 12 years of bite and i have studied that in asymptomatic cases ,rabies vaccine are still effective in prevention of disease but once symptoms appear ,it is impossible to treat with any medicine. Also is there any treatment for rabies available in india. please give me comprehensive answer

Answered by Dr. Rakesh Karanwal (40 minutes later)

Brief Answer: Anti-Rabic serum available in major Indian cities Detailed Answer: Hi XXXXXXX You are referring to very rare cases. I have myself seen few such cases in my vast clinical practice of 33 years. In fact, I have had a case in which Rabies occurred 22 years after a dog-bite! After a bite by an infected animal, rabies viruses spread from the site of bite, and reach and lodge themselves in the nervous system (spine, nerves, brain) within 48-72 hours of bite. Anti-rabies vaccine(ARV) is effective ONLY AS LONG AS THE VIRUSES HAVE NOT LODGED THEMSELVES IN THE NERVOUS SYSTEM. So, vaccines have NO EFFECT WHATSOEVER, against viruses in the nervous tissues. The rare cases you are referring to, occur due to reactivation of rabies viruses. In such cases, ONLY ANTI-RABIC SERUM (ARS) (which contains specific antibodies against rabies virus) is effective. BOTH- ARV and ARS- have very serious or, even life-threatening side effects. The Guidelines- followed world over- DO NOT RECOMMEND giving preventive vaccines, 4 months after a suspected monkey bite. The final decision (to give ARV or not to your child) lies with you. The ARS- which is effective once the symptoms occur- is available in all major cities of India. Take care, Dr. Rakesh Karanwal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Karanwal (36 minutes later)

sir One more query.You have said that ARS is effective once symptoms occur. Does it mean that it can be used to treat rabies .Is it effective. As far as my knowledge is concerned,it is almost impossible to treat rabies except in few cases where drug induced coma was resorted to and this procedure has a sucess rate of only 8%. I think this procedure is still not available in india .

Answered by Dr. Rakesh Karanwal (50 minutes later)

Brief Answer: Success rate of ARS is variable Detailed Answer: ARS is the only specific treatment of rabies available. However, its efficacy depends on several factors, such as, the time lag between the onset of symptoms and initiation of ARS, virus load in the body system, development of rabies complications, adverse reactions of ARS, facilities available in the treating hospital, to name a few. I fully agree with you regarding 'drug induced coma', in which the patient is kept in a comatose condition on life support equipment, till such time ARS neutralizes the viruses and complications of rabies are brought under control. There is very little literature available on the success rate of ARS and medically induced coma. Most of the leading hospitals in India, have the expertise and facilities to treat rabies cases, but with variable success rate. Take care, Dr. Rakesh Karanwal

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar