Interpretation of the latest rabies vaccination guidelines

The core conclusion of the latest rabies vaccination guidelines released by the National Administration of Disease Control and Prevention in 2023 is very clear - Level 2 exposure (scratch/bite/broken skin without bleeding) requires only standardized vaccination, Level 3 exposure (bleeding/penetrating injury/exposure to Bats) require vaccines + passive immune preparations. Re-exposure within 3 months after full vaccination does not require repeated vaccination. If a healthy domestic pet causes injury and can provide a valid vaccination certificate within 1 year, a 10-day observation method can be implemented after a doctor's evaluation without blindly filling the entire course.

Last week, I accompanied a friend to a canine wound clinic near my home to treat cat scratches. I met a little girl in school uniform. She was crying while clutching the red mark on her wrist scratched by the cat at home. She said she was afraid of getting rabies and insisted that her parents pay more for her immunoglobulin injection. The doctor on duty looked through the cat’s vaccination book on her phone and confirmed that she had just completed the rabies vaccine last week. He didn’t even prescribe the vaccine for the wound. He just told her to go home and observe the cat’s condition. He said, “If you have any problems, come back to me. If the cat doesn’t die within 10 days, nothing will happen to you.”

Speaking of the 10-day observation method, this is currently the most controversial point in the industry. Many practitioners in grassroots disease control tend to be conservative: the vaccination coverage rate of domestic stray animals is less than 10%. If you are bitten by a cat or dog from nowhere, the animal will turn around and disappear. Where will you observe it for 10 days? It’s too late to wait until something goes wrong. But most pet clinicians in first-tier cities agree more with this method: WHO has confirmed the conclusion of more than 60 years. As long as the offending animal is domesticated, has clear vaccination records, and does not develop rabies and dies within 10 days, it means that it is not contagious when it bites people, and there is no need to suffer the consequences of five injections. Both statements are actually correct. The core premise is whether you can determine the status of the animal that caused the accident. If you are not sure, don't take it hard. It is better to beat it than regret it.

The first thing many people asked when they arrived at the clinic was "Are there any imported vaccines? I want to get imported vaccines." A while ago, an aunt said that domestically produced vaccines were unsafe and insisted on spending twice as much to get imported vaccines. In the end, the nurse persuaded her for a long time. To be honest, there is no statistical difference in the protection rate between domestically mass-produced Vero cell rabies vaccines and imported vaccines, and the incidence of adverse reactions is even lower than that of some imported strains. There is no need to worry about the place of production. Just get whatever is available. The difference is not as good as a supplementary vaccine for your pets at home.

As for the most frequently asked questions, "Can pregnant women take it?" and "Can pregnant women take it?", the new guidelines have made it clear: the rabies vaccine is an inactivated vaccine and will not affect the child through the placenta or milk. Not to mention pregnant women, mothers who have just given birth, and the elderly and children with low immunity can get it without any risk of teratogenesis. Those who say "you cannot have children who have been vaccinated against rabies" are all from ten years ago. There are also questions about whether you can eat spicy food, drink coffee, and exercise after vaccination. The new guidelines do not mention dietary taboos at all. As long as you are not allergic to these foods or have a hangover after drinking these foods, it will not affect the production of antibodies at all, and there is no need to specifically avoid taboos.

Oh, yes, there are still many people who don’t know about pre-exposure prophylaxis: if you have pets at home, are a veterinarian, or are a rescuer who often comes into contact with stray animals, you can definitely get 3 injections of basic vaccines in advance. Even if you are bitten later, you don’t need to take expensive immune globulin, just 2 additional injections to strengthen it. I know a volunteer at an rescue station who checks the antibody titer once a year. If it is not enough, he will get another injection. Last time, his arm was bitten by a stray dog. After treating the wound, he received 2 injections and then went home. There was no panic at all.

If you are really bitten, remember that the first priority is not to rush to the hospital, but to apply soapy water to the wound for 15 minutes, squeezing out the blood while washing. This step is much more effective than getting to the hospital 10 minutes earlier. Last month, a young man was bitten by a stray dog. He clutched the wound and ran to the clinic. When he arrived, he didn't even squeeze out the blood. In the end, the nurse held him down by the pool and washed him for 20 minutes. He grinned and said that he had known better at home.

In fact, there is no need to talk about the discoloration of rabies now. The number of rabies cases in China has dropped to a few hundred cases every year, and more than 90% of them are bitten by stray animals and are not treated in a timely manner. If you are really unsure whether to fight or not, just go to the dog injury clinic near your home and ask a doctor to evaluate it. Don’t panic by searching online. Most of the time, the risk you are worried about is not as high as you think.