Rabies vaccine question

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Sunny908

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Happy Wednesday!

Does anyone have a good answer as to why the 3-shot series of rabies PrEP is not sufficient in the event of an exposure, even if its recent after a full vaccine course? Why do you still need the vaccine on day 0 and 3?

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Caveat: this is 100% conjecture.

Rabies is pretty much a fatal disease and everyone has different responses to the vaccine (some have titers that remain protective for decades after, some decline much more rapidly). Getting post exposure series is covering your butt in case your current protection levels were not adequate for the exposure. Ramps up the immune response, ensuring you are as well protected from the disease killing you as you can be.
 
Happy Wednesday!

Does anyone have a good answer as to why the 3-shot series of rabies PrEP is not sufficient in the event of an exposure, even if its recent after a full vaccine course? Why do you still need the vaccine on day 0 and 3?
By law, you still have to get the rabies vaccine if your skin is broken by an animal to ensure that your immune system mounts a proper response, and also to make extra sure that you don't pass the virus on to other people or animals should they come in contact with your blood or saliva. Yes, the preventative vaccines help, but, the vaccine at the time of exposure adds to the protection.

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By law, you still have to get the rabies vaccine if your skin is broken by an animal to ensure that your immune system mounts a proper response, and also to make extra sure that you don't pass the virus on to other people or animals should they come in contact with your blood or saliva. Yes, the preventative vaccines help, but, the vaccine at the time of exposure adds to the protection.

By law? Which law is that? I'm not aware of any actual law that dictates it. Maybe in your state....? Here exposure is managed on a case-by-case basis with consultation of the MN Dept of Health for human exposure. But there's certainly not a specific "you are required to get treatment if your skin is broken by an animal" law.

I assume you are oversimplifying (or incorrect), or your state has something specific?

Happy Wednesday!

Does anyone have a good answer as to why the 3-shot series of rabies PrEP is not sufficient in the event of an exposure, even if its recent after a full vaccine course? Why do you still need the vaccine on day 0 and 3?

Your question is a bit hard to parse, you might have to reword. Are you asking:

Why a previously rabies-vaccinated individual has to get the vaccine on day 0 and 3?

If so, the day 0/3 vaccines are (I would guess - I'm certainly no immunologist) to stimulate a strong anamnestic response to insure sufficiently high levels of immunoglobin (IgM then IgG, I suppose?) are present to manage the exposure.

In a bigger picture sense, it's because individual variations in immune response just don't guarantee protective coverage without those Day 0/3 stimulations of the immune system.

We have someone around SDN who, while not a true immunologist, has a strong interest in it. They would know. I can't remember who it is, though.

I'm not 100% sure you've got the protocol right (at least, in the U.S.). The PrEP protocol is vaccine on days 0/7/21 or 28.

Then, PEP protocol is:

-- For people with PrEP: Vaccine on Day 0/3. Some places used to (and may still) do 3 vaccines instead of just the 2, but just the 2 are now considered sufficient. No HRIG (unnecessary and in some cases contraindicated).

-- For people with no PrEP: Vaccine on Day 0/3/7/14 <and> HRIG on Day 0.

In both cases, those two doses close together are for the same purpose - to stimulate a strong anamnestic response. I think. Caveat: Just a dumb ER doc.
 
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The Center for Disease Control mandates the extra vaccine upon exposure, and they are part of the government, so, therefore, they're part of the law, aren't they?

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The Center for Disease Control mandates the extra vaccine upon exposure, and they are part of the government, so, therefore, they're part of the law, aren't they?

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Mandates? No, I don't think so. You should be careful about your language/word choice. A law or mandate is a very legal thing - a requirement.

I could be wrong, for sure, but I very much do not think the CDC mandates that (I'm not even sure they have the authority to do so). At least in MN, rabies vaccination is definitely (I'm sure about that much, at least) not automatically done "if your skin is broken by an animal" as you said.

For starters, it's not automatically done if your skin is broken by a vaccinated animal, like a pet. But even beyond that, it's not even automatically done if a non-pet or non-vaccinated animal causes the injury; it's assessed on a case-by-case basis, and our state's Dept of Health makes themselves available to help decide about any particular case.

In any case, it is not automatic and if it is indeed "mandated" by the CDC, then our entire state is violating that mandate, which I very much doubt.

There are a few questions to ask when a human is bitten by an animal. Just a couple that we use here in MN and I would bet many (most? all?) other states use:

1) Is it a species of concern? You get bitten by a mouse out here and guess what - no rabies vaccine. The reason? Mice don't (usually) survive an attack that would have spread the disease to them so therefore they are a very low risk vector for humans. Not every state has the same vectors of concern for human exposure.

2) Is the animal available for monitoring? If so, and the bite is to an extremity on the human, then no (automatic) rabies vaccine. The reason? You can just monitor for the animal for 10 days and if they don't show signs of the disease by then, they weren't transmitting (rabies, specifically) at the time of the bite. If the animal is available for monitoring and is an animal of concern AND the bite is to a location near the central nervous system? Then the state might recommend it, on the other hand, rather than wait the 10 days. The CDC doesn't come into play.

Please be careful when you choose to answer questions like the OPs. It does a disservice to disseminate inaccurate information. The CDC certainly does make information about it available, and they drive nation-wide programs (to do things like increase the availability of vaccines), but (to my knowledge) they do not mandate any treatment for human exposure. They do provide recommendations with regards to appropriate treatment (like the PrEP and PEP), but they do not mandate them.
 
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Mandates? No, I don't think so. You should be careful about your language/word choice. A law or mandate is a very legal thing - a requirement.

I could be wrong, for sure, but I very much do not think the CDC mandates that (I'm not even sure they have the authority to do so). At least in MN, rabies vaccination is definitely (I'm sure about that much, at least) not automatically done "if your skin is broken by an animal" as you said.

For starters, it's not done if your skin is broken by a vaccinated animal, like a pet. But even beyond that, it's not automatically done if a non-pet or non-vaccinated animal causes the injury; it's assessed on a case-by-case basis, and our state's Dept of Health makes themselves available to help.

It is not automatic and if it is indeed "mandated" by the CDC, then our entire state is violating that mandate, which I very much doubt.

There are a few questions to ask when a human is bitten by an animal. Just a couple that we use here in MN and I would bet many other states use:

1) Is it a species of concern. You get bitten by a mouse out here and guess what - no rabies vaccine. The reason? Mice don't (usually) survive an attack that would have spread the disease to them so therefore they are a very low risk vector for humans.

2) Is the animal available for monitoring? If so, and the bite is to an extremity on the human, then no (automatic) rabies vaccine. The reason? You can just monitor for the animal for 10 days and if they don't show signs of the disease by then, they weren't transmitting (rabies, specifically) at the time of the bite.

Please be careful when you choose to answer questions like the OPs to ensure you actually know what you're talking about. It does a disservice to disseminate inaccurate information. The CDC certainly does make information about it available, and they drive nation-wide programs (to do things like increase the availability of vaccines), but (to my knowledge) they do not mandate any treatment for human exposure. They do provide recommendations with regards to appropriate treatment (like the PrEP and PEP), but they do not mandate them.
I was going off what I read on the CDC's website. Perhaps I misinterpreted it.

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I was going off what I read on the CDC's website. Perhaps I misinterpreted it.

I think you did, and in two ways:

First, they are recommendations. Not mandates. Not law.

Second, nowhere on the CDC's website (that I know of) does it say anything about automatic treatment "if your skin is broken by an animal".

That is way, way too oversimplified.
 
I think you did, and in two ways:

First, they are recommendations. Not mandates. Not law.

Second, nowhere on the CDC's website (that I know of) does it say anything about automatic treatment "if your skin is broken by an animal".

That is way, way too oversimplified.
Okay. My apologies.

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I had a neurologic cat bite me during my internship, barely breaking the skin. The cat had been neurologic for months (probable brain tumor and was being managed by the neurologist), so we definitely didn't feel like it was rabies or else it would have been dead a long time ago even though it was a year overdue on his vaccine. The owners had come for probable euthanasia and it bit me getting it out of the carrier. The internist I was on er with and I called the state health department to see if we had to send the cat in for rabies testing if I euthanized it (because technically he had neuro symptoms even though we really really didn't think it was rabies but he did break my skin)...they told me it was completely up to me if I even sent the thing off for rabies testing or quarantined the animal (which was a surprise, we'd assumed that neuro for any reason + bite = test/quarantine) and that I didn't need to get vaccinated. I'd already told the owners I'd likely have to send it off before the health department returned my call, so they eventually declined euthanasia and took the cat home...where he lived for another year.


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Happy Wednesday!

Does anyone have a good answer as to why the 3-shot series of rabies PrEP is not sufficient in the event of an exposure, even if its recent after a full vaccine course? Why do you still need the vaccine on day 0 and 3?
Just seeing this, but got tagged about it in different place. It's because people respond quite differently to vaccines, and they need to cover their butts with exposure protocols. Especially with super deadly diseases like rabies. Aka better super safe than have one death from inadequate coverage
 
Just seeing this, but got tagged about it in different place. It's because people respond quite differently to vaccines, and they need to cover their butts with exposure protocols. Especially with super deadly diseases like rabies. Aka better super safe than have one death from inadequate coverage
Hey I was right! Woo
 
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