Rabies treatment is a set of emergency preventive measures following exposure to the rabies virus, primarily involving vaccination and immunoglobulin injections. The core goal is to block the virus from spreading within the body and prevent it from entering the nervous system, which could lead to fatal outcomes. This treatment plan must be implemented promptly after exposure to ensure 100% prevention.
The treatment is divided into active and passive immunization. Vaccines stimulate the body to produce neutralizing antibodies, enabling the immune system to recognize and eliminate the virus; immunoglobulin provides pre-formed antiviral antibodies that immediately neutralize the virus near the wound site. Both are used together to form a dual protection mechanism with different timeframes.
Applicable in cases of suspected rabies virus exposure, including bites or scratches from dogs, bats, or other host animals, or mucous membrane contact with contaminated secretions. Special attention is given to third-degree exposure (hemorrhagic wounds) and fourth-degree exposure (mucous membrane contact), where immediate initiation of the full treatment process is required.
The vaccine is administered in five doses on days 0, 3, 7, 14, and 30, with the first dose given within 24 hours after exposure. Immunoglobulin dosage is calculated based on body weight, using international units (IU), typically 20 IU/kg, and should be thoroughly infiltrated into and around the wound.
Common local reactions to the vaccine include redness, swelling, or fever at the injection site, occurring in about 5-10% of patients, with some experiencing headache or fatigue. Immunoglobulin may rarely cause allergic reactions, which can be severe and lead to respiratory difficulties requiring immediate medical attention. Very rarely, cases have been reported where post-vaccination fever exceeds 38.5°C, necessitating medical evaluation.
Key precautions: A full assessment of exposure risk level should be conducted before vaccination; treatment is necessary regardless of wound size if rabies exposure is suspected. Contraindications are limited to severe allergies to the vaccine, but if exposure risk is high, vaccination should still be administered under observation. Immunosuppressed patients require additional doses, and HIV-infected individuals should receive immunoglobulin concurrently.
Vaccines should be spaced at least 28 days apart from other viral vaccines, but in emergencies, they can be administered simultaneously. Patients on immunosuppressants should inform their physicians, as these may affect antibody production. During vaccination, excessive alcohol consumption or vigorous exercise should be avoided to prevent exacerbating local reactions.
Global data show a 100% survival rate among fully vaccinated individuals. WHO statistics indicate that timely treatment can prevent 99.9% of rabies infections. Clinical trials confirm that the five-dose schedule can produce sufficient antibody titers within 7 days post-exposure to effectively neutralize the virus.
Currently, there are no alternative therapies; post-exposure treatment is the only effective method. Unvaccinated individuals who develop symptoms have a 100% mortality rate, making vaccination the only option for prevention. Pre-exposure vaccination can serve as an adjunct, but additional doses are still required after exposure.
What is the sequence for rabies vaccination and immunoglobulin administration? Why is it crucial to adhere strictly to the schedule?
The procedure involves first injecting immunoglobulin at the exposure site to neutralize the virus, followed by vaccination at the same site. This order prevents antibodies from interfering with the vaccine-induced active immunity. The vaccination schedule (e.g., days 0, 3, 7, 14, 28) must be strictly followed; delays can reduce protective efficacy, and once the virus invades the nervous system, treatment becomes impossible.
What should be done if fever or swelling occurs at the injection site after rabies vaccination?
Mild fever or redness/swelling is common and can be alleviated with antipyretics or cold compresses prescribed by a physician. If allergic reactions such as difficulty breathing or widespread rash occur, immediate medical attention is necessary. Severe discomfort should not be managed by stopping medication alone; discuss with a doctor to adjust the vaccination plan.
If a wound is cleaned after an animal bite but medical attention is delayed beyond 24 hours, will the treatment be less effective?
Even if medical attention is sought after more than 24 hours, treatment should be started immediately. Rabies symptoms are nearly 100% fatal once they appear, so any treatment at any time is better than delay. Studies show that the effectiveness of treatment drops sharply after the 7th day post-exposure, so earlier intervention increases survival chances.
During rabies treatment, should other vaccines or specific medications be avoided?
Concurrent administration of other live virus vaccines (such as measles) should be avoided within 4 weeks. Use of steroids or immunosuppressants may reduce efficacy; patients should inform their physicians of all medications they are taking, and doses may need adjustment or monitoring of immune response.
After completing all doses, is regular antibody level testing necessary? Who should undergo follow-up?
Generally, post-exposure prophylaxis does not require routine antibody testing. However, immunocompromised individuals (such as HIV patients) or those with unknown vaccination history may be advised by their physicians to measure neutralizing antibody titers 1 to 3 months after vaccination. This helps confirm adequate immune response and assess the need for booster doses.
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