Latest Rabies Vaccination Guidelines 2020

If the immune function of the secondary-exposed people is low, or the exposed parts are in nerve-dense areas such as the head, face, neck, and hands, they need to be injected with rabies immune globulin simultaneously; clarify the compliance and application prerequisites of the "Ten-day Observation Method" in China. In non-high-risk exposures, as long as the animals remain healthy within 10 days, subsequent vaccinations can be terminated; in addition to the traditional 5-injection method, the "2-1-1" 4-dose procedure is officially included in the recommendation, and the full vaccination only requires 3 disease control visits.

When I worked as a volunteer for community disease control in the past two years, the most common question I encountered was "Should I get an injection if my cat scratches a red mark but does not bleed?" In fact, there are basically three types of exposure situations that people usually encounter: either the skin is not broken or even has some animal saliva, just wash it off without injecting; or the skin is broken but does not bleed, and there is no need for injection. It is often referred to as secondary exposure. In the past, vaccination was all that was required. The 2020 version specifically adds two special circumstances: if you are taking immunosuppressants, have poor immunity such as AIDS, or are scratched and bitten in places close to nerves such as the face, neck, or hands, it is better to take immune globulin, which is much safer.

Speaking of this, some people must ask whether the ten-day observation method is reliable. In fact, there have been different opinions on this matter in the clinical circle. One group is based on strict benchmarking guideline requirements: as long as the dog or cat that bites you is a domestic cat or dog, has been vaccinated against rabies every year, and has not been in contact with wild animals outside, you can receive the first injection while observing the animal's condition. If it is still alive and kicking for 10 days, subsequent injections are not necessary. This is an operation clearly recognized by the WHO and my country's guidelines. However, there are also many senior doctors in grassroots disease control who believe that the rate of rabies infection among stray animals in China is still higher than that in Europe and the United States. If you can't find the animal that bit you, or it is a wild animal running around, don't wait for ten days to observe, and it is safest to get the injection first. After all, the mortality rate of rabies is 100%, and no one can afford this risk.

Oh, by the way, in the past, everyone knew that rabies vaccinations required 5 injections, one injection each on days 0, 3, 7, 14, and 28. Many office workers were afraid that full attendance would be deducted and they would not be able to go. The 2020 version directly included the "2-1-1" procedure as a regular recommendation: 1 injection in each arm on day 0, and 1 injection each on days 7 and 21. A total of 4 injections and 3 injections are enough. The effect is exactly the same as the 5-injection method. I once met a young man who works on the Internet. He was bitten by a stray dog ​​downstairs. He didn't want to take the injection for fear of delaying the progress of the project. When he heard that he only needed to run 3 times, he took the first two injections that day, and nothing happened afterwards.

There is another silly question that everyone often asks: Should I hit someone if I am bitten by a hamster or scratched by a rabbit? The 2020 version of the guide clearly states that rodents and lagomorphs basically do not carry rabies virus. Unless they are abnormal individuals who have been bitten by a mad dog, there is no need to get vaccinated at all. Don’t get those few shots in vain. By the way, some people ask whether they should get vaccinated again if they have been vaccinated before and are bitten again. The standards given by the guide are: if you are exposed within six months after the full vaccination, you do not need to get vaccinated; if you are vaccinated six months to one year, you should get 2 booster shots; if you are vaccinated 1 to 3 years, you should get 3 shots; if you are more than 3 years old, you should get the full vaccination again. But I have also encountered special circumstances mentioned by clinical doctors: If the head and face are bitten by a wild dog this time, even if it has just been six months, it is recommended to take 2 more booster shots. After all, the risk is too high, so it is always right to be cautious.

When many people are bitten, their first reaction is to run to the disease control center. In fact, the first thing to do is to flush the wound: alternately flush the wound with soapy water (or other weakly alkaline detergent) and running water for at least 15 minutes. When flushing, squeeze the surrounding blood a little. Don’t be afraid of the pain. If this step is done well, more than 80% of the virus can be flushed away, which is much more effective than the ten minutes you spent in a hurry. If the wound is deep, you will have to go to the hospital for debridement after cleaning. Don't just put a band-aid on it.

In fact, the 2020 version of this guideline has been revised to be quite down-to-earth. On the one hand, it gives everyone a lot of room for flexibility, so that you can get all 5 shots in any situation. On the other hand, it also makes up for high-risk situations to prevent everyone from being careless. If you are really unsure, go directly to the nearby disease control or dog injury clinic and let the doctor take a look. It is much better than scrolling through Baidu for a long time to scare yourself.