Do You Need Approval for Paying Out-of-Pocket Rabies Vaccination?

Q: Do You Need Approval for Paying Out-of-Pocket Rabies Vaccination?

Dear Mr. <br>Hsiao：<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 in the white-nosed coati. <br>The current regul

Is it necessary to submit an application for receiving a rabies vaccine at one's own expense?

Hello, Doctor.
I was bitten by my neighbor's dog on the evening of July 12.
Since I was wearing long pants, I only had a small bruise and a minor abrasion.
The next day, I went to the hospital to see a surgeon.
After evaluation, the doctor prescribed antibiotics and performed simple wound care.
I asked whether I needed a rabies vaccine, and he told me it was not necessary since rabies is not prevalent at the moment.
Later, I read some articles online that mentioned observing the dog's condition for 10 days to determine if there was a risk of infection.

On the afternoon of July 17, I encountered my neighbor walking the dog (their garage door is usually closed, so I rarely see the dog or the owner).
The neighbor showed me the dog's vaccination certificate, and the dog appeared to be normal at that time, which reassured me a bit.
Due to my work schedule, I have seldom seen the neighbor walking the dog since then.
However, about a month ago, I noticed that the dog seemed different from what I remembered (they have four mixed-breed dogs, and since I don’t see them often, I can’t be sure if the dog that bit me has been replaced).

By that time, two months had passed, and I felt uncomfortable asking for details.
Now, I am worried that the dog might have had issues, which is why it was replaced.
Additionally, in the past month, the area where I was bitten has occasionally been itchy and tingly.
I understand this could be a physical reaction due to my anxiety, but I am still a bit scared.
It has now been over 110 days since the bite.
Although I read online that the incubation period for rabies is mostly between one to three months, it can also last up to a year.
Since I did not observe the dog again on the 10th day, I am feeling anxious.

I heard that in Taiwan, it is not recommended to administer the vaccine to those without confirmed risk.
I would like to ask the doctor if, given that it has been almost four months since the dog bite, I would face difficulties applying for the vaccine if I decide to pay for it myself.
Also, I want to know if I truly have a risk of contracting rabies at this point.

Xiao, 20~29 year old female. Ask Date: 2022/11/01

Dr. Xiao Yongxun reply Family Medicine

Dear Mr.
Hsiao:
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 in the white-nosed coati.
The current regulation states that rabies vaccination for humans after exposure 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.
According to the monitoring data from the Council of Agriculture regarding stray dogs and cats, all results have been negative.
Additionally, there is a continuous effort to promote rabies vaccination for dogs and cats domestically, resulting in an extremely low risk of rabies virus infection in domestic dogs and cats.
Therefore, individuals bitten by stray dogs and cats are treated similarly to those bitten by pet dogs and cats, and vaccination is not provided unless the animal shows suspected rabies symptoms within 10 days of observation, and there is a high suspicion from animal health authorities.
3.
Consequently, your dog bite incident is currently not within the scope of public-funded rabies vaccination by the Centers for Disease Control.
If you remain concerned, it is recommended that you consider self-funded rabies vaccination.
4.
The rabies virus is transmitted through the saliva of infected animals via wounds caused by bites or scratches.
Therefore, theoretically, if bitten by an animal with rabies, the likelihood of contracting the disease is very high if there is a sufficient viral load.
Clinically, if the animal is observed for 10 days without any abnormalities, there should be no concern for infection.
5.
You will need to clarify the situation with the owner of the dog that bit you.
If you wish to self-fund your rabies vaccination, you can go to a hospital that provides rabies vaccines.
Theoretically, for bites from mammals such as dogs and cats, the first dose should be administered on day 0, followed by a complete schedule of four doses; the total cost may amount to several thousand New Taiwan Dollars.

Reply Date: 2022/11/01

More Info

When it comes to rabies vaccination after a potential exposure, it's essential to understand the risks and the guidelines surrounding vaccination. Rabies is a viral disease that is almost always fatal once symptoms appear, making timely vaccination critical after a bite from a potentially rabid animal.

In your case, you were bitten by a neighbor's dog, and while the initial assessment by the doctor indicated that rabies vaccination was not necessary, your ongoing concerns about the dog's health and your symptoms warrant further discussion.

Firstly, rabies vaccination is typically recommended if there is a risk of exposure to a rabid animal. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend that if a person is bitten by an animal that is suspected to be rabid, they should receive post-exposure prophylaxis (PEP) as soon as possible. This usually consists of a series of rabies vaccinations and, in some cases, rabies immune globulin (RIG).

In your situation, since you have observed changes in the dog and are experiencing symptoms at the site of the bite, it is advisable to consult with a healthcare professional, preferably one specializing in infectious diseases or a public health expert. They can assess your risk based on the current health status of the dog and your symptoms.

Regarding your concern about the need for approval for paying out-of-pocket for the rabies vaccination, it is generally not a matter of needing approval but rather a matter of medical necessity. If a healthcare provider determines that you are at risk for rabies, they can recommend vaccination, and you can proceed with receiving it, even if it is self-paid. However, if the provider assesses that there is no risk based on the dog's vaccination status and health, they may advise against it.

As for your anxiety about having contracted rabies, it is important to note that rabies has a long incubation period, which can range from a few weeks to several months, and in rare cases, up to a year. However, the majority of rabies cases present symptoms within one to three months after exposure. Given that it has been over 110 days since your exposure, the likelihood of developing rabies is low, but it is not impossible. The symptoms you are experiencing, such as itching and pain at the site of the bite, could be due to anxiety or other non-rabies-related issues, but they should not be ignored.

In summary, it is crucial to consult with a healthcare provider about your concerns. They can help determine if you should receive the rabies vaccine based on your exposure risk and current symptoms. If you decide to pursue vaccination, it is typically straightforward, but the decision should be guided by a medical professional's assessment of your situation. Remember, when it comes to rabies, it is always better to err on the side of caution.

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