How does someone go about getting a pre-exposure rabies vaccination? Are they available to anyone who requests them? Or is proof of elevated risk required (Veterinary/Zoo employees or similar)? Do you simply ask your GP for this?
Is it a simple one-and-done shot, or is there a series of inoculations?
Last question: Are all rabies vaccinations the same? Or does the recipient need to identify which animal they (might) need protection from?
Thanks in advance for any help. I’m completely ignorant of this subject. Note: I have NOT been bitten, so no urgency.
I can’t answer about pre-exposure since I only got rabies shots after being bitten by a dog. But to answer the other question - I don’t believe the species of animal makes a difference. IIRC, rabies is rabies, and the vaccine covers it from every possible animal carrier. But my shots were nearly a decade ago, so my memory is fuzzy.
In my case, I needed 3 shots, spaced out over weeks. Thankfully, it’s a normal shoulder injection now, no longer the dreaded needles going into one’s abdominal fat.
My son got a rabies series recently, after not being bitten by a bat. (There was a bat in his home. There was concern he might have been bitten and not noticed.) He said at least one of the shots was into his leg, and was so much volume that his leg swelled up painfully just from the volume, and it was hard for him to get home.
Also, can confirm it’s just one series for “rabies”, and that it is a series of shots. The subsequent ones might not have been as unpleasant as the first one.
I was advised to get the rabies vaccine before I went to India in 2005.
I also knew some LEO’s that got the preemptive vaccine. All of them game wardens. I occasionally run into rabid animals working in the city. I imagine it’s many, many more working in the wilderness.
So yes, the vaccine is available and your regular doctor can give it to you. He may have to order it.
My doctor wouldn’t use vaccine that was reserved for post exposure for preemptive use. He instead ordered additional doses which arrived in less than 24 hours.
I’m planning a trip and just spoke with a doctor about immunizations. The pre-exposure vaccination consists of two immunizations. If you’re bitten after that, they treat you with two more immunizations.
If you don’t have the pre-exposure vaccination and are bitten, you need an immediate injection of immune globulin plus four immunizations. Depending on where you’re traveling you may not have the immune globulin immediately available, which is why you’d want to do the pre-exposure vaccination.
When I received pre-exposure prophylaxis rabies vaccination (for work travel to a nation in Central Asia that was subsequently cancelled) there was a three dose sequence injected into the thigh. It was moderately painful but the swelling declined within a day with each injection being more tolerable. Apparently it is now a two dose (days 0 and 7) intramuscular rabies vaccination series replacing the three dose schedule for protection up to three tears, with a one-time titer or booster dose every subsequent two year period. When I got inoculated it was recommended to not receive other inoculations at the same time which was tricky because of my travel schedule. I don’t see anything in the current CDC guidance to that effect so that may have been just my doctor’s recommendation rather a ACIP guidance.
Note that rabies isn’t just transmitted through bites (although that is the typical mode); it can also be transferred through saliva and other fluids, and can lay dormant for many months (in some cases for years) before expression. Once signs and symptoms are are apparent death is inevitable (nearly 100% of cases in humans) so pre-exposure prophylaxis is critical if there is a reasonable chance of exposure (working with wild or feral animals, close contact with bats during building restoration or spelunking). You can get the vaccine through your personal physician. There are several associated Lyssavirus species but vaccination should protect against exposure to all of them.
Makes sense. My son’s first set of shots was an “emergency” (or totally unnecessary, but if needed, it was needed fast.) the rest of the shots were scheduled in advance, though, and those also had to be administered in the emergency department. That’s just where that medical group kept rabies vaccine.
Thanks everyone for your information and responses. Especially @Stranger_On_A_Train for the CDC links and info.
One issue I’m trying to resolve is the timeline to seek treatment after a bite (from unvaccinated animal). The only time reference I found in the CDC pages was “Right Away”.
Quoting CDC article: To sum up: rabies in humans is completely preventable, but you must get medical help right away.
I still don’t know whether “right away” means within the hour, or within a week. I’m going to be in the presence (repeatedly) of a feral, unvaccinated animal that has bitten others, and I don’t want to end up hunting for an ER in in the middle of the night, in unfamiliar areas.
The exact circumstances surrounding this are better suited for IMHO and I may ask opinions there later, but for now I’m sticking to FQ just to learn the specifics of the disease and treatments.
If the countdown clock from “Just got bitten” to “terminally infected” is measured in days, I can just return home to my own medical professionals and get the vaccines and treatment. And I probably won’t need the pre-exposure shots.
But if the clock is measured in hours, I probably need the pre-exposure treatment to buy time (until I can return to “civilization”).
I will make an appointment next week with my own PA to ask for info and her opinions on this. Good to know that my own docs are the place to start.
IANA medical anything. I just read up on it on the medical professional website I subscribe to. Their article intro includes this sobering bit
Rabies is a highly neurotropic virus that evades immune surveillance by its sequestration in the nervous system. Upon inoculation, it enters the peripheral nerves. A prolonged incubation follows, the length of which depends on the size of the inoculum and its proximity to the CNS. Amplification occurs until bare nucleocapsids spill into the myoneural junction and enter motor and sensory axons. At this point, prophylactic therapy becomes futile, and rabies can be expected to follow its fatal course, with a mortality rate of 100%.
The rabies virus travels along these axons at a rate of 12-24 mm/d to enter the spinal ganglion. Its multiplication in the ganglion is heralded by the onset of pain or paresthesia at the site of the inoculum, which is the first clinical symptom and a hallmark finding. From here, the rabies virus spreads quickly, at a rate of 200-400 mm (7-15 inches) per day, into the CNS, and spread is marked by rapidly progressive encephalitis. Thereafter, the virus spreads to the periphery and salivary glands, where it may be transmitted to others.
Sounds like the disease has two phases: trying to get into your nerves, then absolutely unstoppably killing you once it has. The bite or whatever exposure starts the clock. The clock runs out and the treatment window closes the first time some virus gets into your nerves. Big bite in a bad spot might be real fast. Teeny bite in a favorable spot? Might be awhile.
Digging through the rest of the article I didn’t see anything specific about urgency of treatment after the pt arrives. Then again, the medics don’t really control when the pt shows up at whatever treatment facility and they get to work promptly once they have. So details on the treatment window aren’t really relevant from their POV. From yours? Huge; life and death huge.
Interesting. Sounds like where you are bitten makes a huge difference, then. If you are bitten on the foot by a rabid animal, then the virus takes a long time to reach your spinal cord and brain, but if you’re bitten on the face or neck, it could get to your brain really quick.
The thing I found chilling was the idea that the first overt symptom of infection occurs after you’re already doomed. So you need to treat on the possibility it’s rabies as soon as you’re aware of being exposed to / bitten by any relevant critters.
Honestly, that right there sounds like an excellent reason to get the pre-exposure shots. Especially as the PReP described by Stranger’s link:
Just two shots, a week apart, sounds pretty manageble and will presumably buy you wiggle room should you get bitten. (Especially if you get it done shortly before likely exposure.) And I think it was the initial immunoglobulin that my son found most painful. From that link:
PrEP does not eliminate the need for PEP; however, it does simplify the rabies PEP schedule (i.e., eliminates the need for rabies immunoglobulin and decreases the number of vaccine doses required for PEP).