What's the _real_ deal on rabies shots?

[Hail_Ants]

I’ve never gotten them nor have I ever met anyone who did. But they’ve been a standard ‘horror’ story for as long as I can remember. I’ve heard variously:

[ul][li]Its 20 shots[/li][li]Its 14 shots (1/day for 2 weeks)[/li][li]An improved version cuts it down to just 4 shots[/li][li]The needles are 4 inches long[/li][li]They need to be injected into muscle/stomach (?)[/li][/ul]
So are any/all of these true? Anyone here ever actually go thru it? I’m sure its not pleasant, but is it as bad as its made out to be?

[Q.E.D]

[url=http://www.cdc.gov/mmwr/preview/mmwrhtml/00056176.htm]Post-exposure rabies immunization
[/quote]
:

Postexposure antirabies vaccination should always include administration of both passive antibody and vaccine, with the exception of persons who have previously received complete vaccination regimens (preexposure or postexposure) with a cell culture vaccine or persons who have been vaccinated with other types of vaccines and have had documented rabies antibody titers. These persons should receive only vaccine (see Postexposure Therapy for Previously Vaccinated Persons). The combination of RIG and vaccine is recommended for both bite and nonbite exposures (see Rationale for Treatment), regardless of the interval between exposure and initiation of treatment.

Rabies Immune Globulin Use. RIG is administered only once (i.e., at the beginning of antirabies prophylaxis) to previously unvaccinated persons to provide immediate antibodies until the patient responds to HDCV, RVA, or PCEC by actively producing antibodies. If RIG was not administered when vaccination was begun, it can be administered through the seventh day after the administration of the first dose of vaccine (78). Beyond the seventh day, RIG is not indicated since an antibody response to cell culture vaccine is presumed to have occurred. Because RIG can partially suppress active production of antibody, no more than the recommended dose should be administered (79). The recommended dose of human RIG is 20 IU/kg body weight. This formula is applicable to all age groups, including children. If anatomically feasible, the full dose of RIG should be thoroughly infiltrated in the area around and into the wounds. Any remaining volume should be injected intramuscularly at a site distant from vaccine administration. This change in the recommendations for RIG administration is based on reports of rare failures of postexposure prophylaxis when smaller amounts of RIG were infiltrated at the exposure sites (80). RIG should never be administered in the same syringe or in the same anatomical site as vaccine.

Vaccine Use. Three rabies vaccines are currently available in the United States (Table_1); any one of the three can be administered in conjunction with RIG at the beginning of postexposure therapy. A regimen of five 1-mL doses of HDCV, RVA, or PCEC should be administered intramuscularly. The first dose of the five-dose course should be administered as soon as possible after exposure. Additional doses should be administered on days 3, 7, 14, and 28 after the first vaccination. For adults, the vaccination should always be administered IM in the deltoid area. For children, the anterolateral aspect of the thigh is also acceptable. The gluteal area should never be used for HDCV, RVA, or PCEC injections because administration of HDCV in this area results in lower neutralizing antibody titers (81).

[Oregon_sunshine]

Not bad, it’s just a regular IM shot. The immunoglobulin is a huge amount, so it’s a little stressful, and after the 3rd or so shot some pain/swelling of the muscle where the shot was given can occur. Other than that, just like getting a flu shot.

[edwino]

I should just point out that IIRC the RIG is about the consistency of honey and a large amount of fluid so it can be pretty ugly. RIG is apparently distributed at 150 IU/ml, so for an average 70 kg man getting 20 IU/kg = 1400 IU, so about 9 ml.

Second, rabies is bascially 100% fatal (the highest case-fatality rate of any disease). In fact, in a disease that kills between 30,000-70,000 per year and has been known for thousands of years, only one person not previously vaccinated has survived a rabies infection. So you should seek medical attention for any kind of bite. The recommendations differ by species (I’m looking this up on UpToDate, a medical encyclopedia, I’m no expert…) so not all bites will need the shots, but the disease is scary enough to choke down any needle phobia.

The vaccine course that is given is used to prevent the infection from taking hold after a bite (post–exposure prophylaxis). Basically, the rabies virus enters a nerve and then starts to work its way up to the central nervous system. The prophylaxis prevents this process, and there has been no failures of the regimen reported.

[plnnr]

I’ve had post-exposure rabies shots.

It was a series of 5 shots in my shoulder. The material was a thick, purple “goop” that, as was pointed out, looked like it had the consistency of honey. It left a little lump in my shoulder and I felt kind of wiped out after getting them, but it wasn’t a terrible experience.

Getting to the hospital, expecting to get the shots with the big hypodermic needled, right in the stomach, THAT was a horrible experience.

[missbunny]

I know someone who just a week ago started the post-prophylaxis series because she was bitten by an animal whose rabies status was unknown. She said:

“Tonight I had to have a tetanus shot in the arm, 3 rabies shots in the butt and one rabies shot directly into each of the 4 tooth holes in my arm. Not a fun evening. And I have 4 more shots to look forward to beginning Friday and every Friday thereafter for 4 weeks. All this and antibiotics for a week.”

And this was someone who had already had the pre-prophylaxis series.

[missbunny]

Don’t fool around with rabies. If they told me I had to have shots directly into my eyeballs, I’d do it. Rabies is not the disease you want to die of. I believe QtM has a story about a patient he saw in the last stages of rabies. Not pleasant.