Rabies: first aid after a bite

First aid

• Rinse the wound abundantly with soap and water for 10-15 minutes. This is extremely important to wash away saliva and the virus it contains.
• If there is no soap in the immediate vicinity, rinse with water.
• If you get to water even after several hours, you should still rinse the wound thoroughly.
• After the wound is washed, dry the wound with a clean cloth.
• Treat the wound with any antiseptic, such as an aqueous solution of iodine (povidone iodine, betadine, etc.).
• Consult a doctor to prescribe specific medications.

What drugs are used?

There are basically 2 drugs used in the prevention of rabies:

• Anti-rabies vaccine;
• Anti-rabies immunoglobulin;

What is the difference and what is needed when?

Anti-rabies vaccine

An anti-rabies vaccine is a special preparation containing particles of an inactivated (killed) virus that looks like a rabies virus. It is administered to activate the immune system, which begins to produce antibodies that can neutralize the virus.

Vaccination gives the immune system the necessary “instructions” on how to recognize the virus and stop it before it reaches the brain.

But the vaccine is prevention. Why is it administered after a bite?

This is a fair question! Although the vaccine is usually used for prevention, in the case of rabies, its role goes beyond the usual prevention of the disease.

The fact is that rabies has a long incubation period - usually about 2-3 months, but sometimes it can last even a year. During this time, the virus slowly travels through the nerve pathways to the brain. During this time, if the body has information about the virus and has time to develop enough antibodies, the disease will not develop and the person will remain alive.

When should I start vaccination?

It is necessary to start vaccination as soon as possible after the bite, because we do not know how quickly the virus will move to the brain. Also, remember that there is no deadline for starting vaccination. As you may remember, the virus can move from the wound to the brain for as long as a year, so even if the bite by a suspicious animal occurred a few weeks ago, you should start vaccination.

How many shots are needed? Really 40 shots in the stomach?

The myth of “40 shots in the stomach” is now a myth. The full course of vaccination consists of 5 injections. The day of the 1st dose is considered day 0. The vaccine is administered on days 0, 3, 7, 14, 28.

The vaccine is administered, like the vast majority of other vaccines, intramuscularly in the deltoid region. In children under 2 years of age, it can be injected into the anterior outer thigh.

Important! Do not inject the anti-rabies vaccine into the buttock!!! If the vaccine is injected into the buttock, it is not counted!!!

As you know, the incubation period can be very short, even 5-7 days. During this time, the body may not have time to develop antibodies, even if the vaccination is started immediately. If there is such a risk, ready-made antibodies should be administered, and this is anti-rabies immunoglobulin.

Anti-rabies immunoglobulin.

These are ready-made antibodies against the rabies virus.

It is administered in situations that are dangerous in terms of rapid development of the disease.

When can this be?

• If there are a lot of viruses initially, then the time for reproduction at each stage will be less, and the disease will develop faster.
• The virus multiplies well in muscles and nerves, so if a lot of virus has entered them, the time before the onset of symptoms will be shorter.
• Our mucous membranes are not only located on the head, but also the epithelium is very thin compared to the skin, and much more permeable. And almost everyone has wounds on the mucous membrane. And even a minor wound is a gateway for the virus.

The indications were formulated taking into account all these nuances:

• Wide bites (more than 5 cm),
• Deep bites (reaching the muscles).
• Any bite inflicted by wild carnivores (a lot of virus in saliva)
• Direct contact with bats;
• Any bite or licking of damaged skin in the area of: head; face; neck; arms; perineum; (many nerves, close to the brain, thin skin)
• Mucous membranes can become swollen even without damage to them;

Immunoglobulin is injected into the wound edges and around the wound. In order for the antibodies to kill the virus. The faster and closer we deliver them to the virus, the better. It is not always possible to inject the entire required dose of immunoglobulin around the wound (for example, a finger wound), then the rest is injected intramuscularly, but in a different area from the vaccine (for example, the thigh).

Of course, immunoglobulin, like the vaccine, should be administered as early as possible. But in the absence of immunoglobulin, only the vaccine is available, and immunoglobulin is administered as soon as possible, but no later than 7 days after the first dose of the vaccine.

It is also important that immunoglobulin, according to the current order of the Ministry of Health, should be administered in a hospital.

Observation of the animal

The first thing to note is that the WHO clearly states that in regions that are dangerous for rabies among animals, the availability of an animal for observation should not delay the start of vaccination. That is, in Ukraine, it is necessary to start vaccination and observe the dog at the same time. Observation of the animal is carried out within 10 days from the date of the bite. If the animal is healthy, which is confirmed by a veterinarian, the vaccination is stopped. By this time, you will have received 3 out of 5 injections.

If you have been bitten by a known domestic dog or cat, you can identify for sure that it is the same animal that bit you. Then you can observe the animal. If it is not your animal, then find out the details of the animal's owner: Name of the owner, address, phone number, name and breed of the dog (this information is needed for the doctor to fill out the documentation and ensure observation of the animal).

If it is a stray animal, you are not obliged to look for it or observe it. GET VACCINATED!!!

If the animal has been vaccinated against rabies, is it possible not to vaccinate it?

There is no definite answer to this question.

If the animal is regularly and timely vaccinated against rabies, the likelihood that it will be infected tends to zero.

But!!!

In case of any dangerous contacts, there is an emergency vaccination for animals, not only for people.

Often people do not know that vaccination should be carried out annually. If more than 1 year has passed since the last vaccination, it is impossible to guarantee that the animal is protected from rabies without an antibody test.

The vaccine in animals is not always effective! for example:

• in large breeds of dogs;
• in old animals;
• in seriously ill animals;
• in animals that receive certain medications on an ongoing basis.

A regular doctor does not know and cannot know many nuances, starting from whether your dog disappeared a couple of months ago and then came back with wounds, and ending with whether your dog is taking medications that may affect the effectiveness of the vaccination. Therefore, if there is a bite, the doctor will offer you vaccination. And only you can decide whether to start vaccination or not. Also, the risks of your animal being infected with rabies can be discussed with a veterinarian who knows your animal well.

Only rabies and that's it?

It should be remembered that “rabies is not the only disease”. We must not forget about tetanus. All rabies prevention protocols draw attention to this. But it is worth remembering that tetanus prevention is not as urgent as rabies. There are several days to resolve this issue.

What not to do:

• Do not delay wound treatment and vaccination!

Do not delay washing the wound with soap and water. Do not delay the start of vaccination and the administration of immunoglobulin. Vaccination and immunoglobulin administration should be done as soon as possible after the bite. The less time that passes, the greater the chance of avoiding rabies.

What if there is a vaccine but no immunoglobulin? We inject the vaccine! Then we look for immunoglobulin. It makes sense to inject immunoglobulin no later than 7 days after the first dose of the vaccine.

• Do not inject the vaccine into the buttock!

The anti-rabies vaccine should not be injected into the buttock. It should be injected into the deltoid area. And only children under 2 years of age can be injected into the anterior outer thigh.

• Do not sew up!

Bitten wounds do not heal! Stitching up bite wounds creates an ideal environment for the virus to multiply! Stitches are applied only in rare cases. In case of continuous bleeding to stop it. In case of large wounds, single guiding stitches can be applied.

• Do not kill an animal! Do not bury a dead animal!

If the animal is conditionally healthy, do not kill it under any circumstances! For city dwellers, this may sound wild, but believe me, for villagers it is very important. If you have killed an animal, or it has died, in no case do not bury or throw away the animal's corpse! Because you will have to dig up the corpse and cut off its head to send for analysis! If the animal has died, it is necessary to inform the local Laboratory Center (“sanitary and epidemiological station” in the old way).

How to behave after vaccination? What is possible and what is not?

This is a very VERY common question… Unfortunately, there is still a myth that when vaccinated against rabies, you can’t:

• be in the sun
• eat yellow or red foods
• drink more than 2 cups of coffee a day
• steam in a bathhouse/sauna
• play sports
• drink alcohol
• get pregnant
• have sex…

ALL THESE ARE MYTHS!!! You can lead a normal life during and after vaccination!

It should be noted that the World Health Organization (WHO) emphasizes that there is no safe dose of alcohol. Any amount of alcohol consumed can negatively affect health, increasing the risk of developing various diseases.

Rabies is an extremely dangerous disease that always ends in death after the first symptoms appear. Therefore, the speed and correctness of your actions after a bite or contact with an animal can be decisive in preventing the disease and saving a life. If you have even the slightest doubt about a bite, sneeze or scratch caused by a mammal, do not hesitate - consult a doctor and start vaccination!

Authors of the article - Kireiko Viktor Petrovych