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Query about rabies vaccination after dog bite.

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Hello Doctor,

My name is Aditya and im a 27 year old male. I was bitten by a stray dog on 27th night on my lower left leg, after which i immediately went to the emergency room within 20 minutes of been bitten. In the emergency room the had cleaned the wound with soap and water and administered me with a tetvac injection.

They informed me that i will have to start taking the Rabipur Vaccine. To which i had agreed and they had administered me the first shot on the my left intragluteal region.

Next day i had time to clearly go through the instruction on the Rabipur vaccine. It is clearly mentioned that the vaccine should not be given in intragluteal region and should only be given on the deltoid region. Tomorrow is my schedule for the 2nd vaccine.

Im really worried now, since they have given it in the wrong region. Doctor could you please explain the complications of this. Should i start the vaccine process again from day 0 and take it on my deltoid..? Im really having sleepless nights about this. Could you please help me out with this doctor. Any information will be much appreciated

Regards

Aditya

Category: Infectious Disease Specialist

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Category: HIV- AIDS Specialist
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Hello Aditya,

Thank you for choosing DoctorSpring.

I understand your concern and try my best to help you here. Rabipur IM injections have better absorption and availability when give in deltoids when compared to gluteal region. But this DOES NOT mean the injection is ineffective when given in the buttocks. So you need not be overly worried about this.

But one concern here is that yours is a Category 3 bite. Also the dog is stray dog (bit higher risk). So you might have to take something called Anti Rabies Immunoglobulin injection in addition to the Rabipur vaccines. You should discuss this option with an expert. The best bet would be to visit a Government Medical College Rabies Clinic. The Immunoglobulin which is costly MIGHT be available free of cost, but more than this Medical colleges are better in treating Dog Bites.

Alternatively you can contact a good local Physician for the Immunoglobulin. If there is no immunoglobulin available a double dose can be taken next time. ( That is 2 dose in both deltoids same day ). I understand this could be frustrating, but it is better not to take chances.

I would like to know whether the bite was a provoked bite or not.

Hope this helps
Feel free to ask followups
Thank you


Patient replied :

Hello Doctor,

Thank you so much for your quick reply. Doctor the bite was unprovoked, I was riding my bike at night time, from no where the dog started chasing me, caught up and bit my leg. Doctor i have visited two hospitals till now, Fortis & Manipal.. I had met general physicians and showed them the wounds. I went to two doctors because i had the same doubt, wether or no to take Anti Rabies Immunoglobulin injection. Both the physicians said its not required and asked me to just carry on with the rabies vaccine. Now im really worried about this, doctor is it necessary that i take the Anti Rabies Immunoglobulin injection.


Hello,

In your case if it was me, I would suggest Immunoglobulin. BUT DO NOT WORRY. Rabipur itself will give you excellent cover. But in case of Dog bite we do not give even 0.01% for chace. So just be to extra sure Immunoglobulin can be taken.

I agree that there are some recommendations which suggest your kind of injury does not recommend Immunoglobulin. But as per 2007 National Guidelines Immunoglobulins are recommended in your pattern of injury. Another factor is the bite, which was unproved - which puts you in a higher risk category. That is why I suggested that you can get in touch with a medical college where they have more exposure in treating Dog bites.

Another issue which I have personally observed is that - If a hospital does not have Immunoglobulin stock, the Doctors tend to not to prescribe it. So you can directly mention your Doctor what you have learned.

Rabipur with double dose on day 0 at 2 different sites intramuscularly
(0 day – 2 doses on left and right deltoid, 3, 7, 14 and 28 days). can be taken as the alternative. Anyway rest assured if Rabipur is taken properly you NEED NOT worry. Atleast make sure you get two shots next time. (on 2 arms)

Hope this helps
Feel free to ask followups.

Ref : http://www.ncdc.gov.in/Rabies_Guidelines.pdf


Patient replied :

Hello Doctor,

Thanks for the fast response. Doctor I have decided to go ahead and take the Immunoglobulin. Before i do, i just wanted clarity on a few more doubts.

1) Like i mentioned earlier the 1st rabipur vaccine was administered in my left intragluteal region, which is incorrect.

The 1st vaccine was given on 27th, So tomorrow which is the 2nd would be the schedule for the 2nd vaccine. Doctor i wanted to know wether its fine to go ahead and continue as per the shedule and get my 2nd vaccine tomorrow and mark it as the 3'rd day vaccine, or should i start fresh tomorrow and mark the vaccine as day the 0'th day vaccine, since the first vaccine was administered incorrectly.

2) Doctor could you please suggest a good brand of Immunoglobulin that will go well with the Rabipur vaccine.

3) Since the Immunoglobulin is supposed to be taken on the 0'th day, is it fine for me to go ahead and take it tomorrow along with my 2'nd vaccine. There is a 3 day gap since i was bitten. Will the Immunoglobulin be effective?

4) Tomorrow i will be getting my 2nd rabipur vaccine on the deltoid, is it okay to get the 2 shots of Immunoglobulin simultaneously with the rabipur vaccine or should i give a time interval between them.


5) Doctor ive visited 2 more clinics today, both the doctors said I should be fine with the Rabipur vaccine and no need of Immunoglobulin. Now if i take the Immunoglobulin, will the be any undesired effects? What i mean to say is the Immunoglobulin will only help and yield a positive outcome right? there will be no negatives to think of while taking the Immunoglobulin.

6) I forgot to mention about my Past medical history. Doctor i some daily and have been a smoker for the past 10 years. I drink but only occasionally. Will any of these factors affect the current situation i am in?

7) On Which region of the body am i supposed to take the Immunoglobulin shots?

8) How do i calculate how much of Immunoglobulin i require? my weight is 68kgs doctor.

9) Should i go for Human Rabies Immunoglobulin or Equine Rabies Immunoglobulin

Thank you


1. Go ahead and continue per schedule as 2nd dose
2. Generic Anti Rabies Ig will do.
3. Yes it will be effective. Not as effective as it would be on Day 0 , still it should work.
4. You can have both together
5. Immunoglobulin HAS adverse effects like all medications from minor to serious allergic reactions. YOU WILL NEED a Doctors prescription for this. Your Doctor will only able access the risk benefit ratio and give you final opinion.
6. No
7. At Injury site,

Please consult your Doctor for final opinion and decision on Ig. My opinion is stated in the previous replies.

Hope this clarifies. Thank you


Patient replied :

doctor Should i go for Human Rabies Immunoglobulin or Equine Rabies Immunoglobulin


Which ever is available you can go for it. Human Rabies Immunoglobulin (HRIG) is better.


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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