Rabies and world travels

[Nexx]

Admittedly I haven't searched the forums for this topic

But I'm planning on travelling to India in January and had a question about rabies vaccines. I was vaccinated with the post-exposure series in 1999 and tested at 'post vaccine' levels (i.e. pretty high still) 5 years later.

It's now 11 years after my initial vaccine and I'm in a country that doesn't deal with rabies that often except to give travel vaccs. I'm trying to do my research before heading to the travel doc next week so I'm looking to see if anyone has been in this situation or has found a source of legitimate info to show what the protocols are and if it's reasonable that my immunity has lasted another 6 years

Keep in mind I'm not asking for medical advice I am really just trying to have info on hand before I get to the doctors office and also figure out if I should budget for titre and vaccine,just the titre, or just get a booster (probably both to be safe ) I just don't know the availability of a titre over here, it's cost, or how long it takes to process.

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[Tobysgirl81]

I was vaccinated back in 2002 the first time. I had my titres pulled in 2008 at adequate levels, and again this year showing my levels were adequate. Typically HERE (Virginia, USA) it takes about a week to get the results back. I'm not sure how long it would take to get them back in another country.

I guess if I were in your situation and and was unsure of how long it might take to get the results back, I'd probably be tempted just to get a booster to save myself the headache. This would cover you in pretty much all cases - you won't have to prove you are still protected and you can prove that you have been vaccinated. And keep in mind, you don't get revaccinated if you have adequate titre levels... You get revaccinated when your titre levels are LOW. The only thing pulling a titre would do is prove that you have adequate antibody levels which would rule you out from needing the vaccine.

However, if you prefer NOT to get boostered, the best person to answer your questions will likely be your doctor or the health department.

 

[Packen]

I just had my titre taken in May, and I was also initially vaccinated in 2002 with no boosters since then. It came back high average. I had to have it sent off to MSU, I *think*. I had to tell my MD where to send the blood sample and what type (i.e. red top tube vs purple top). But it was MUCH cheaper than getting a booster which the doc estimated to cost about $250 without insurance coverage.


BTW, Tobysgirl, you weren't vaccinated while working for Marion DuPont Equine Medical Center by any chance were you? Jsut thought I may know you

 

[Tobysgirl81]

Packen - I actually just moved to this area about 2 1/2 years ago from CA I was working at the Cat Colony at UC Davis in 2002! Though, I think I would have preferred working at the equine center!!

 

[Packen]

Packen - I actually just moved to this area about 2 1/2 years ago from CA I was working at the Cat Colony at UC Davis in 2002! Though, I think I would have preferred working at the equine center!!

Pretty sure I don't know you then- I worked with a girl there and we both got our rabies at the same time and she was very serious with a guy named Toby and I think they were engaged or married last I heard.

 

[Tobysgirl81]

Pretty sure I don't know you then- I worked with a girl there and we both got our rabies at the same time and she was very serious with a guy named Toby and I think they were engaged or married last I heard.

Oh, how funny and random! One of my dogs is named Toby which is where it came from in the name. That's a funny coincidence!

 

[slowlybutshelly]

I was in Africa ( Kenya in 1992) and heard a horror story of a Peace Corps Volunteer who died of Rabies. She had received a pre exposure Rabies vaccine. She was at her site and had a cat and the cat bit her. She wrote in her journal "I hope the cat does not have rabies". And she did not go to the capital to get a Post -exposure shot. So 9 months later, she ended up dying in Nairobi of Rabies. Sad story.

Personally, I received the pre-exposure shot in 1990. I asked for a post exposure shot at a clinic where I was doing a rotation and the docs there said it was unavailable. Is it still reserved just for government workers?

How long does a Pre-exposure shot last? I am going on 20 + years now and am concerned.

I would appreciate some advice.

 

[NStarz]

I was in Africa ( Kenya in 1992) and heard a horror story of a Peace Corps Volunteer who died of Rabies. She had received a pre exposure Rabies vaccine. She was at her site and had a cat and the cat bit her. She wrote in her journal "I hope the cat does not have rabies". And she did not go to the capital to get a Post -exposure shot. So 9 months later, she ended up dying in Nairobi of Rabies. Sad story.

Personally, I received the pre-exposure shot in 1990. I asked for a post exposure shot at a clinic where I was doing a rotation and the docs there said it was unavailable. Is it still reserved just for government workers?

How long does a Pre-exposure shot last? I am going on 20 + years now and am concerned.

I would appreciate some advice.

Please someone correct me if I'm wrong

The rabies pre-exposure vax series consists of 3 shots. The post-exposure vax series consists of 5 shots. If you receive the pre-exposure vax series and you have been bitten by an animal suspected of having rabies, you need to get the other 2 shots of the series (immunoglobulin?). If you were not vaccinated beforehand, you would need all five shots.

Post-exposure shots are available at any hospital emergency room. They are required to carry it or have easy access to it. Pre-exposure shots are a commodity right now because of a shortage, but they are still available. I received my series from a travel health clinic.

If your pre-exposure vaccines were that long ago, I would get a titer to check if you need another series. Some people need repeat vaccines sooner than others.

The pre-exposure series does not guarantee that you won't get rabies if you are bitten, it just means that you need two less shots if a critter takes a bite out of you.

Hope this helps!

 

[Nexx]

Please someone correct me if I'm wrong

The rabies pre-exposure vax series consists of 3 shots. The post-exposure vax series consists of 5 shots. If you receive the pre-exposure vax series and you have been bitten by an animal suspected of having rabies, you need to get the other 2 shots of the series (immunoglobulin?). If you were not vaccinated beforehand, you would need all five shots.

Post-exposure shots are available at any hospital emergency room. They are required to carry it or have easy access to it. Pre-exposure shots are a commodity right now because of a shortage, but they are still available. I received my series from a travel health clinic.

If your pre-exposure vaccines were that long ago, I would get a titer to check if you need another series. Some people need repeat vaccines sooner than others.

The pre-exposure series does not guarantee that you won't get rabies if you are bitten, it just means that you need two less shots if a critter takes a bite out of you.

Hope this helps!

You're mostly right I think I got 6 initial shots for post-exposure (based on BW). But then after that I had to go on a set schedule for roughly 4-5 more shots after that. So technically by getting a pre-exposure you are saving yourself 5 additional jabs and probably about $500.

Side note: Australia can pull titres, it's going to take at least three weeks to run though -- still not sure of the cost, getting it done on Wednesday.

 

[sumstorm]

NStarz, you have the protocol correct for the states, at least...and that may be the current protocol in other countries as well.

The only answer is to go through whatever the current protocol is again (remember, it takes some time between injections) or have titers pooled, which may still require revaccinating.

 

[david594]

Please someone correct me if I'm wrong

The rabies pre-exposure vax series consists of 3 shots. The post-exposure vax series consists of 5 shots. If you receive the pre-exposure vax series and you have been bitten by an animal suspected of having rabies, you need to get the other 2 shots of the series (immunoglobulin?). If you were not vaccinated beforehand, you would need all five shots.

Pre exposure is 3 shots. (days 0, 7, and 21-28)

Post exposure with no previous vaccination is Immunoglobulin(multiple shots on day 0) and then 4 shots of vaccine spaced over the following month(days 0, 3, 7, 14). *****

Post exposure with previous vaccination is just 2 shots of vaccine(days 0 and 3)


***** The number of post exposure vaccines given for a person with no previous vaccine history was recently changed by the CDC from 5 shots (0,3,7,14,28) to 4 shots (0,3,7,14) due to there being no difference in efficacy when looking retrospectively at those who failed to get the last vaccine. This being pushed since the vaccine has been in such short supply in recent years. The manufactures have been opposed to this though claiming it is only labeled for the 5 shot series and as such should be given that way.

CDC reference: http://www.cdc.gov/rabies/medical_care/index.html

 

[nyanko]

Yeah, the point is you only need the immunoglobulin post-exposure if your body hasn't generated any immune response to the virus before (aka been vaccinated already). It's not really "the other two" injections that you need for post-exposure if you've had pre-exposure.

 

[Bill59]

How long does a Pre-exposure shot last?

Depends on the individual. The best way to know is to have a titer checked. Whether this is indicated and if so, how frequently depends on your risk category. I'm in the "frequent" category of risk exposure (veterinarian working in a rabies endemic region) and so I get a titer checked every 2 years. It has always been >1:5 and my series was >20 years ago.

If you're in the infrequent or rare risk category, serologic testing is not recommended. For the continuous category (mostly researchers working with RV) serology is recommended q 6 months.

 

[Nexx]

Quick update for people who may need this info in the future

Australia can run the titre, it was sent to a lab over on in the eastern states and cost me a whopping $15. Took about 4-5 weeks for results and after a hurried conversation with the travel doctor (I'm back in the US at the moment) I am going to need to get a booster.