Rabies Vaccine: Do You Need More Shots After Recent Animal Bite?

Q: Rabies Vaccine: Do You Need More Shots After Recent Animal Bite?

Dear Ms. <br>Yuan：<br>1. <br>The risk of rabies in Taiwan is currently limited to wild animals in the central, southern, and eastern mountainous regions, primarily involving the badger as the main infected species, with a few cases involving the Formosan ferret-badger. <br>The cu

If you were bitten last month and received four doses of rabies vaccine, and then you were bitten again this month, you should still receive additional doses of the rabies vaccine. The post-exposure prophylaxis (PEP) protocol typically includes a series of vaccinations after a potential rabies exposure, even if you have recently completed a vaccination series. The protective period of the rabies vaccine can vary, but it is generally recommended to complete the vaccination series for each new exposure to ensure adequate immunity. It is important to consult with a healthcare professional for personalized advice based on your specific situation?

1.
Last month, I was bitten by an animal and received four doses of rabies vaccine on June 9, June 13, June 17, and June 24.
After completing the vaccination, a few days ago on July 11, I went to Tainan and suspected that I was scratched by a suspicious animal (something dark flew by and brushed against my skin, causing a slight abrasion; I suspect it might have been a bat, but I'm not sure).
Since it has been less than a month since my last vaccination, do I need to get vaccinated again, or is it sufficient to receive just two booster doses?
2.
I found information stating that after receiving the three pre-exposure prophylaxis vaccinations, only two booster doses are needed, but it did not specify the exact interval between the doses.
3.
Since I received four doses of the vaccine after exposure, does this mean I have completed the full vaccination series and have immunity? Is it the same as pre-exposure prophylaxis, meaning that if I am exposed again in the future, I would only need two doses? What is the specific interval between these doses?
4.
After completing the four doses of the vaccine last month, do I still need to get vaccinated if I was bitten again this month? Thank you.

Yuan Xiaojie, 30~39 year old female. Ask Date: 2022/07/13

Dr. Xiao Yongxun reply Family Medicine

Dear Ms.
Yuan:
1.
The risk of rabies in Taiwan is currently limited to wild animals in the central, southern, and eastern mountainous regions, primarily involving the badger as the main infected species, with a few cases involving the Formosan ferret-badger.
The current regulation states that post-exposure rabies vaccination is applicable to individuals bitten or scratched by wild mammals nationwide (excluding the Taitung City rat).
Those who do not meet the criteria may opt for self-funded vaccination.
2.
Currently, there are no reports of rabies caused by bats in our country; the Centers for Disease Control (CDC) has not mentioned this in their disease surveillance reports.
However, since bats are still considered wild animals, the possibility of rabies should still be taken into account.
3.
According to the CDC's guidelines, individuals who have received a complete rabies pre-exposure prophylaxis series and are subsequently bitten or scratched by a rabid animal may receive booster doses of rabies vaccine on days 0 and 3, although the clinical physician may make decisions based on the actual circumstances.
This means that after the full vaccination series, whether or not to administer additional doses and how many doses to give is at the discretion of the clinical physician.
Based on your description, since you were scratched less than a month after completing the vaccination series (which may fall under category II or lower wounds), theoretically, you are still within the effective period of antibody response, and I believe that additional doses may not be necessary.
However, no one can guarantee this.
Therefore, self-funding for two additional doses should not be opposed.
I recommend that you visit a surgical outpatient department at a regional hospital or above to manage the wound and discuss with a clinical physician before making a decision.

Reply Date: 2022/07/13

More Info

When it comes to rabies vaccination after a potential exposure, it's crucial to understand the guidelines and recommendations based on your vaccination history and the nature of the exposure. Given your situation, where you received four doses of rabies vaccine after a previous animal bite and then experienced a potential exposure again, here’s a detailed response to your questions.

1. Need for Additional Vaccination: Since you completed a full course of rabies vaccination (four doses) less than a month ago, you are still within the period where your body is likely to have developed adequate immunity. According to the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), individuals who have previously received a complete rabies vaccination series and then experience a new exposure should receive two booster doses of rabies vaccine. These doses are typically administered on days 0 and 3 after the exposure.

2. Timing of Booster Shots: The specific timing for the booster doses is important. The first booster should be given as soon as possible after the new exposure, ideally on the same day (day 0), and the second booster should be administered three days later (day 3). This schedule is designed to quickly boost your immune response to ensure that you are protected against rabies, especially since rabies is a fatal disease once symptoms appear.

3. Understanding Immunity: Your previous vaccination series does provide you with a level of immunity, but it is essential to recognize that immunity can wane over time, especially if there is a significant gap between exposures. In your case, since the new potential exposure occurred shortly after completing your vaccination series, your immune system is likely still primed to respond effectively. However, the recommendation to receive two additional doses is a precautionary measure to ensure that you maintain adequate protection.

4. Consulting a Healthcare Provider: It is highly advisable to consult with a healthcare provider or visit a clinic specializing in infectious diseases or travel medicine. They can assess the nature of your exposure, evaluate your vaccination history, and provide personalized recommendations. They may also consider factors such as the type of animal involved in the exposure and the prevalence of rabies in the area where the exposure occurred.

5. Additional Considerations: If you have any concerns about the nature of the animal that potentially scratched you (in this case, a bat), it is important to take those seriously. Bats are known carriers of rabies, and any potential exposure should be treated with caution. If the animal can be observed (for example, if it is a domestic animal), it should be monitored for signs of rabies for at least 10 days. If the animal shows signs of illness or dies, you should seek medical attention immediately.

In summary, given your recent exposure and vaccination history, it is recommended that you receive two booster doses of rabies vaccine as soon as possible. Consult with a healthcare professional to ensure that you follow the appropriate protocol for your specific situation. Rabies is a preventable disease, but once symptoms appear, it is almost always fatal, so taking these precautions seriously is essential for your health and safety.

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