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Was bitten by cat, barely had a scratch. Got vaccination but missed fifth dose. Suggest?

Apr 2013
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General Surgeon
Practicing since : 2008
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I was lightly bitten (barely) by a cat in rural Thailand that never displayed any signs of rabies for seven days after the bit ( we have moved and could not observe it for 10 days) and have received doses of rabies post exposure vaccination on days 0, 3, 7 and 14 up until this point. Did not receive immunoglobin with first dose, I am guessing this is because I barely had a scratch from the 'bite' and there was no bleeding. I just wanted to be safe. I missed the fifth dose three days ago ( which was supposed to be day 28) and I have the following questions.

1. Everything that I have read on the Internet from CDC to WHO suggests that the new standard is four doses except in severe bites or immuno comprimised people. IS that true?

2. Do I need the fifth dose in your opinion?

3. If I do need the fifth dose will it still be effective even though today is approaching day 32 for me?

I am a little concerned and want a professional opinion and would rather be overly cautious with this situation. What would you recommend I do in this situation?

Thank you,
Posted Tue, 18 Jun 2013 in Medicines and Side Effects
Answered by Dr. Ivan R. Rommstein 1 hour later
Hi and welcome to XXXXXXX Thank you for your query.

1. Yes, it is scientifically proved today and recommended that there is no purpose of 5th dose except in some rare cases. Reason is that our immunity on rabies in healthy people is considered to be maximally developed after 4th dose.

2. This seems to be low risk incident (considering that there wasn’t deep dermal lesion and no need for Imunoglobulin) and I don’t think you need 5th dose unless you are immunocompromised, HIV+, having severe infection such as sepsis or tuberculosis or there is proven rabies + in this animal.

3. It doesn’t matter if this is taken 5 days +/-, but as I said 5th dose wouldn’t increase your immune response and you already have maximal antibodies in your blood.

It is good to be cautious but the risk of transmission is negligible. Even if there was contact with + animal (and this is already rarity), vaccine is 100% effective. In addition, symptoms in infected animals are usually easily noticed. Most of rabies signs are also seen in first 6-8 weeks after exposure. Even in Thailand, cases of human rabies can be count on fingers. Therefore, there is no need to be concerned at all.

Wish you good health. Regards
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