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Are 3 Doses Of Rabies Vaccination Sufficient After A Dog Bite?

Posted on Fri, 28 Oct 2016

Question: A bitch was sprayed in the ist week of Sept. this year. It was lively before but after the spraying was done it became calm and was not taking food properly. However, it was taking food with chicken,mutton etc though not much. I feed some 10/12 stray dogs at night and clear the place with a brush of long handle. On 14 night while I was feeding the other dogs this bitch tried to chew the handle of which I was not aware. It came to my notice when I hold it. After 7/10 minutes I washed my hand thoroughly with soap,detergent and dettol. From 29th Sept the bitch is missing. Waiting for 2 days I started taking Rabipur Inj and have taken 2 shots on 2nd Oct & 5Th Oct. Previously I took 3 shots in XXXXXXX 2016 on 0,3,7. Again 2 shots on 27.2.2016 & 1.3.2016 And again 2 shots on 29.8.2016 & on 1.9.2016. Now,how many more injections are to be taken? Is there any threat to me still?

Answered by Dr. Tushar Kanti Biswas (6 hours later)

Brief Answer:
Rabies prophylaxis

Detailed Answer:
Since you are handling stray dogs(feeding 10/12 stray dogs),you have already taken pre-exposure prophylaxis of 3 doses of Inj Rabipur on 0,3,7 th day in XXXXXXX 2016 .

Now on presumed exposure to a stray dog which escaped/became untraceable (? Rabid),you have taken two booster doses of Inj Rabibur on 2.10.16(0) and 5.10.2016 (3).That suffices the post-exposure prophylaxis in your case.You don't need any further dose of Inj Rabipur.

In future if you are re-exposed ,you should undergo serum neutralizing antibody tests to determine the need for subsequent booster doses. In fact it should have been done this time before taking two booster doses as you have already undertaken two shots of Inj Rabipur on 29.8.2016 (0) & on 1.9.2016 (3).

Vaccine-induced immunity persists in most cases for years, a booster would be recommended only if rabies virus neutralizing antibody titres fall to <0.5 IU/ml.
Those who are not at continual risk of exposure through their activities, should have serological monitoring every 2 years,as against high risk of laboratory exposure to high concentrations of live rabies virus, antibody testing should be done every 6 months .

You are well protected against Rabies.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Tushar Kanti Biswas (2 hours later)

Thank u sir for a detailed reply. Pre- exposure prophylaxis was done on 0,3,7 days as against 0,7,21/28 days as provided in various literatures and WHO/National Rabies guidelines. So are 0,3,7 shots equally good? Further, in all the previous cases,there were suspected exposure though in neither case skin was abraded.Also, for enrichment of my knowledge, pl. let me know if somebody receives 5 doses on 0,3,7,14 & 28 days and takes a booster dose before completion of 12 months from the date of last shot will he be supposed fully immunised against future exposure?

Thank you once again.

Answered by Dr. Tushar Kanti Biswas (15 hours later)

Brief Answer:
Rabies prophylaxis

Detailed Answer:
For pre-exposure prophylaxis - third dose of Inj Rabipur is to be given on on Day 21/28 after 0 and 3 rd day (primary schedule).
In your case 3 doses of Inj Rabipur on 0,3,7 should have been followed by 4th dose on 14 th day to complete a schedule.A fifth dose on day 28 is no longer recommended.

After receiving 4/5 doses of Inj Rabipur (0,3,7,14 & 28 days ), annual booster is also not recommended these days . Instead for persons at frequent risk,the rabies virus neutralizing antibody titres estimations is recommended every
year;If titres are below 0.5 IU/ml at any time, one booster dose should be administered.
However literature provided along with vaccine (say Inj Rabipur ) still carries an advice of annual booster.
Considering the long term satisfactory antibody titres observed with Rabipur, if serological tests cannot be conducted due to cost considerations or inaccessible medical facilities, a booster dose one year after primary immunisation followed by one dose every 5 years would be advisable.
Hence answer to your last question is yes -it boosts up the immunity.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Tushar Kanti Biswas (4 hours later)

MY doctor has advised to take 5 shots. If i take 5 shots will there be any adverse effect? My vaccination exposure schedule is 0,3,7 in January 2016, 0,3 in March 2016, 0,3, on 2.10.2016 75.10.2016.
My daughter received 5 shots in 2010, again 5 shots in 2012 2 shots in August 2015 and recently she has an exposure (scratch) on 30.09.2016 and has taken 2 shots on 2.10 &5.10. Will she need any further dose? Rabies being a 100% fatal disease if she takes 5 shots will there be any adverse effect?

Answered by Dr. Tushar Kanti Biswas (2 hours later)

Brief Answer:
Rabies prophylaxis

Detailed Answer:
Purified chick embryo vaccine (Inj Rabipur ) though safer than earlier rabies vaccine but occasionally they can cause serious adverse reaction like demyelination syndrome (post-vaccinial demyelination leading to neuro-paralysis). To my mind you or your daughter does not need any further dose. Both of you should undergo serum neutralizing antibody titre as mentioned earlier before taking any further dose of Inj Rabipur.

Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee