It provides immediate immunity until the Rabies vaccines can begin to provide long-term protection after about 7 days. ERIG is made from the plasma of horses. HRIG is in short supply worldwide, particularly in countries that are most affected by Rabies.
Rabies is classified as a Neglected Tropical Disease because the infection disproportionally affects low-income populations in developing regions where medical services are limited particularly in rural areas and necessary post-exposure Rabies vaccines are often unavailable or in short supply. For travellers, the risk of Rabies transmission will depend on where you are going, how long you are travelling for, and the type of activities you participate in.
The benefit of the pre-exposure series is that after potential exposure to the Rabies virus, only 2 post-exposure vaccines are required and HRIG is not needed. This greatly simplifies post-exposure care, as unvaccinated travellers may need to be emergency evacuated or travel to another country to find HRIG and adequate post-exposure medical care. The need to seek vaccination promptly and the high cost of HRIG can easily derail a trip and lead to unexpected expenses. To the average traveller, the chances of encountering a rabid animal may be low but being aware of the risks and the difficulty of accessing emergency care are an important component of responsible travel.
Photo by Canva. Travel Health Journal. Rabies is one of the most deadly infections known to humans. Depending on whether you were vaccinated before exposure or not will determine what set of Rabies vaccines you require after a bite or a scratch: If you were not vaccinated against Rabies, you need a series of vaccines and the Human Rabies Immunoglobulin HRIG over a period of 14 days after the bite or scratch.
If you were vaccinated with a series of 3 pre-exposure vaccines, you have some initial protection. In the event that you are bitten or scratched, you only need 2 post-exposure vaccines. HRIG is not required.
Rabies transmission through corneal and solid organ transplants have been recorded, but they are also very rare. There have only been two known solid organ donor with rabies in the United States since Many organ procurement organizations have added a screening question about rabies exposure to their procedures for evaluating the suitability of each donor.
Bite and non-bite exposures from an infected person could theoretically transmit rabies, but no such cases have been documented. Casual contact, such as touching a person with rabies or contact with non-infectious fluid or tissue urine, blood, feces , is not associated with risk for infection. Contact with someone who is receiving rabies vaccination does not constitute rabies exposure, does not pose a risk for infection, and does not require postexposure prophylaxis.
Rabies virus becomes noninfectious when it dries out and when it is exposed to sunlight. Different environmental conditions affect the rate at which the virus becomes inactive, but in general, if the material containing the virus is dry, the virus can be considered noninfectious. All mammals can get rabies, but only a few species are important as reservoirs for the disease. All injuries were caused either by unvaccinated pups below 3 months of age or by stray unvaccinated dogs.
Four deaths were of patients who received proper wound care along with minimum 3 doses of intramuscular rabies vaccination, but rabies immunoglobulins RIG were not given or were not available. In eight cases, no PEP was sought as the patients were either not aware of its need or the PEP facility was far away or the PEP cost was not affordable or deceased believed that pups below 3 months of age do not carry a risk of rabies.
In one case, the patient was bitten by a cat 2 years back. Majority patients belonged to rural and remote areas. In the Philippines, a rabies death review of patients demonstrates that all deaths were due to dog related injuries including bites and scratches. In our settings, the minimum incubation period was 22 days due to scratches on the face in front of Lt Tragus and maximum incubation period was days due to a trivial scratch on right Forearm by a furious rabid dog.
Pathogenesis studies by Kuzmin et al. Human skin dermal layer is populated with fibroblasts that may allow the entry of the rabies virus and subsequent infection if left unattended[ 5 ] and needs further evaluation.
Latest guidelines of the WHO prescribe that the type II wounds, that include minor scratches or abrasions without bleeding, need to be given only rabies vaccine whereas additional local RIG infiltration may be required. Many national guidelines, for example, USA,[ 7 ] Canada, and Switzerland do not make a difference between category II and III wounds and recommend rabies vaccination alongwith RIG administration on potential exposure to rabid animals irrespective of the type of wounds.
National Center for Biotechnology Information , U. Indian J Community Med.
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