Is It Safe to Delay the Final Rabies Vaccine Dose While Traveling?

Q: Is It Safe to Delay the Final Rabies Vaccine Dose While Traveling?

Dear Mr. Xiao Guo： 1. Currently, there are two known rabies vaccines： a. Verorab® (Sanofi Pasteur), which is cultured in African green monkey kidney cells. b. Rabipur® (Novartis), which is a purified chick embryo cell vaccine. 2. Clinically, it

Does missing the last rabies vaccine dose make a difference?

Hello Dr.
Hsiao, I was bitten by a dog while traveling in India, and I have already received four doses of the rabies vaccine.
However, the final dose is scheduled for two weeks from now, and I will be in Sri Lanka at that time.
I'm not sure if the same vaccine is available in Sri Lanka; I received Rabipur.
Can I receive a vaccine from a different manufacturer? Additionally, my visa for India will expire, making it impossible for me to complete the final dose there before leaving.
I won't return to Taiwan until May 12.
Would it be possible for me to get the vaccine in Taiwan later? Thank you for taking the time to respond amidst your busy schedule.

Xiao Guo, 30~39 year old female. Ask Date: 2019/04/05

Dr. Xiao Yongxun reply Family Medicine

Dear Mr.
Xiao Guo:
1.
Currently, there are two known rabies vaccines: a.
Verorab® (Sanofi Pasteur), which is cultured in African green monkey kidney cells.
b.
Rabipur® (Novartis), which is a purified chick embryo cell vaccine.

2.
Clinically, it is preferable to use the same vaccine formulation and brand throughout the entire rabies vaccination schedule; although both vaccines are equally effective based on evidence.
However, since you will be traveling abroad and may receive the fifth dose in Sri Lanka, if Rabipur® is not available, it is medically acceptable to use Verorab® instead, as there are no absolute objections to this practice.
3.
In our country, the standard rabies vaccination protocol after a bite has traditionally been five doses (Day 0, Day 3, Day 7, Day 14, Day 28).
However, the Centers for Disease Control recently announced a revised schedule of four doses (Day 0, Day 3, Day 7, Day 14).
Nevertheless, for patients with concerns about immunocompromised status or other considerations, the five-dose regimen can still be administered.
Therefore, I personally believe it is advisable for you to continue with the five-dose schedule while abroad.
4.
Additionally, it is important to monitor for potential wound infections, such as cellulitis or tetanus infections, and to seek local treatment if necessary.
5.
If you have any further questions, please consult a local physician for guidance.

Reply Date: 2019/04/05

More Info

When it comes to rabies vaccination after a potential exposure, timing and continuity in the vaccination schedule are crucial. Rabies is a viral disease that is almost always fatal once symptoms appear, making post-exposure prophylaxis (PEP) essential for anyone who has been bitten or scratched by an animal that may carry the virus.
In your case, you have already received four doses of the rabies vaccine (Rabipur) while in India, and you are due for your fifth dose in two weeks while you will be in Sri Lanka. It is understandable that you are concerned about the availability of the same vaccine and the implications of potentially switching to a different brand.

1. Switching Vaccine Brands: The rabies vaccines available globally include Verorab and Rabipur, among others. While it is generally recommended to complete the vaccination series with the same brand for consistency, if Rabipur is not available in Sri Lanka, you can receive a different vaccine like Verorab. Current medical guidelines indicate that there is no absolute contraindication to switching between these vaccines, as they are both effective in providing immunity against rabies. However, it is always best to consult with a local healthcare provider to ensure that you receive the appropriate vaccine and dosage.

2. Timing of the Final Dose: The rabies vaccination schedule typically consists of five doses administered on days 0, 3, 7, 14, and 28 after exposure. Since you have already received four doses, it is crucial to receive the fifth dose as scheduled. Delaying the final dose beyond the recommended timeline could potentially compromise your immunity against rabies. If you are unable to receive the vaccine in Sri Lanka, consider returning to Taiwan as soon as possible to complete your vaccination series.

3. Travel Considerations: Since you mentioned that your visa for India will expire, it is important to plan your travel accordingly. If you can find a healthcare facility in Sri Lanka that offers rabies vaccinations, that would be ideal. Make sure to carry your vaccination record with you, as it will help the healthcare provider understand your vaccination history and ensure you receive the correct dose.

4. Wound Care and Infection Prevention: In addition to vaccination, it is essential to monitor the wound for signs of infection, such as redness, swelling, or pus. If you notice any concerning symptoms, seek medical attention immediately. Proper wound care is crucial in preventing infections that could complicate your situation further.

5. Consulting Local Healthcare Providers: If you have any doubts or concerns while traveling, do not hesitate to consult local healthcare providers. They can offer guidance on vaccination options available in the area and help you make informed decisions regarding your health.

In summary, while it is preferable to complete the rabies vaccination series with the same brand, switching to a different vaccine is acceptable if necessary. Ensure that you receive your final dose as soon as possible, whether in Sri Lanka or upon returning to Taiwan. Always prioritize your health and safety, especially when traveling in areas where rabies is a concern.

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