Dr. Shubadeep Debabrata Sinha
Infectious Diseases
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I had exposure to a dog bite before six months while cycling. I could not see any abrasion on the leg nor blood. I could feel the teeth on my leg and immediately went to the hospital and took the rabies vaccine and tetanus as I was denied immunoglobulin. I clearly remember taking the 3, 7 schedule of the vaccine but not remembering the 14th-day vaccine. Before three months, I had a repeat exposure to a domestic puppy on my finger but could not see any skin penetration. I had three shots (I think on 0, 3, 7), but now the same domestic puppy again bit me last month. I was dicey about repeating the vaccine, but I took 0, 3 this was delayed by two weeks due to fear.
I had done my rabies antibody test after day 3 of rabies vaccination. Do I need to worry about rabies infection six weeks post-exposure?
Hello,
Welcome to icliniq.com.
It appears that your first vaccine post-exposure prophylaxis was inappropriate. Neither you received full course nor antirabies Ig. You were WHO category II exposure and should have taken all five doses since it appears that was your first exposure.
The next two episodes were WHO category I exposure and did not need an in-conservative approach. Four doses might have been required. Hence, considering the above, a full regime would be ideal.
As per guidelines, for category II and III, the five-dose regimen is administered on days 0, 3, 7, 14, and 28 into the deltoid muscle. This is followed by immunoglobulins.
The follow-up exposure four-dose regimen is administered as two doses on day 0 (one dose in the right and one in the left arm deltoid muscles), and then one dose on each of days 7 and 21 into the deltoid muscle.
Having said that, the dogs and puppies were domesticated and must have been vaccinated as well. Please check that out and their status after your exposure.
Patient's Query
Thank you doctor,
With regard to my antibody report, am I still protected? The dog status is unknown, but I am told that it was alive for two weeks post-exposure. After my last exposure, I did a vaccine on day 7 and day 14. But the thing is, today is day 28, and I am out of town. Can I wait for three days for the rabies vaccine, or am I still at risk? My first dog bite was six months ago.
Hello,
Welcome back to icliniq.com.
I think your history is not very clear. Before six months, the first exposure took two doses, where you should have taken five (at least four).
For the second exposure (also can be considered category II), you needed three doses (which you took correctly). The third exposure was also a bite, and the doses were correct but delayed. This puts you at risk.
I suggest not to wait any longer and complete the third dosing at the earliest. The three days is not an issue but the gap between second and third doses should be ideally seven days.
Patient's Query
Thank you doctor,
I took three doses in the first exposure, the second exposure three doses, and the third exposure I took doses two weeks delayed on 0,3,7,14.
I took the rabies antibody test also. Please see. My question is that the 28 dose is due today, or can I take it after three days?
Hello,
Welcome back to icliniq.com.
Preferably do not delay unless you have no choice.
Patient's Query
Thank you doctor,
Did you have a look at the report? Can I get infected within the next three days if I do not have the vaccine? And when I reach, I just have to take one 28 day vaccine or repeat the regime?
Hello,
Welcome back to icliniq.com.
I did look at the report (attachment removed to protect patient identity). Your values are alright. As I mentioned earlier, you should take that dose on the scheduled day, but if you cannot, please take it as early as possible. By the way, why did you do the other tests, HIV, HBsAg, lipid profile?
Patient's Query
Thank you doctor,
I do not remember the fourth dose. In total span, I have had ten shots. Will it not be enough? Is rabies antibody report protective?
Hello,
Welcome back to icliniq.com.
Yes it is. Try and take your final dose at the earliest.
Patient's Query
Thank you doctor,
I will take it on Wednesday morning.
Hello,
Welcome back to icliniq.com.
Then it will be fine.
Patient's Query
Thank you doctor,
I was actually following cdc reduced Essen regime. That is why I forgot to bring the vaccine with me.
Hello,
Welcome back to icliniq.com.
Please take your vaccine as discussed. Hope your doctor is injecting you locally. Please ensure she or he is aware and follows regimens as per her or his clinical judgement.
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