Rabies vaccination guideline: give it after 48 hours

The rabies vaccine is still effective if given more than 48 hours after being bitten by a cat or dog. There is no need to give up the vaccination just because you missed the so-called "24-hour golden period". **

A while ago, I accompanied my niece to the community health service center to get the hepatitis B vaccine. I happened to meet a young man wearing take-out clothes squatting next to the vaccination table with red eyes. He said that a stray dog in the alley rubbed his ankle while delivering food the night before, and the skin was broken. Dr. Li, who was on duty that day, had been working in disease control for almost 20 years. He was happy while writing him a bill and said that I had just vaccinated a girl last month who came for vaccination five days later. The antibody test results were all good. Why are you so anxious after only 48 hours?

In fact, the saying "must be vaccinated within 24 hours" first came from the domestic disease control guidance manual in the 1990s. The purity of the vaccine at that time was not high, the speed of inducing antibody production was slow, and many areas had insufficient disease control resources. Therefore, the saying "try to vaccinate within 24 hours" was used to urge everyone to deal with it as soon as possible. From time to time, it became "vaccination after 24 hours is useless", and even extended to the saying that it is ineffective for 48 hours, which is completely a misunderstanding. Now, whether it is the WHO's rabies prevention and control guidelines or the latest domestic disease control regulations, it is clearly written: as long as vaccination can induce the body to produce enough neutralizing antibodies before the onset of rabies, it can play a protective role. There is no fixed time cut-off line at all.

Of course, a small number of clinical infectious diseases doctors have put forward different views: If you are in an extremely high-risk situation - such as being bitten by a clearly diseased animal, the wound is in a nerve-dense area such as the head, face/neck, and the wound is deep and bleeding, the incubation period of rabies may be as short as 72 hours. In this case, the protective efficiency of vaccination after 48 hours will indeed be lower than that of vaccination as early as possible, but it is still much better than no vaccination. There is no reason to give up directly.

I have talked with friends in disease control before, and more than 90% of the people they see for daily vaccinations that last more than 48 hours are scratched and bitten by pets that are regularly vaccinated at home. The risk of infection is extremely low. In this case, even if the vaccine is given after three or four days, it will be completely protective. There is no need to scare yourself. Some people say that if you vaccinate more than 48 hours, you need to double the vaccine. In fact, it is not necessary. The purity of the current rabies vaccine is several levels higher than that of 20 years ago. A full course of regular dose vaccination can produce sufficient antibodies. Unless it is a very serious third-level exposure that requires simultaneous administration of immune globulin, there is no need to increase the dose at all, and it is a waste of money.

Of course, this does not mean that everyone can deliberately delay vaccination. After all, the earlier you get vaccinated, the earlier the antibodies will be produced and the more stable the protective effect will be. If you really didn't pay attention at the time and then reacted later, recall the exposure situation as soon as possible. Even after a week, as long as there are no suspected symptoms such as fever, numbness and itching near the wound, you should rush to the vaccination point, which is better than betting on the one in 10,000 chance of infection.

Speaking of which, there is another point that many people overlook. After being bitten, apply soapy water to the wound for 15 minutes as soon as possible, squeezing the blood while doing so. This step can wash away more than 90% of the remaining virus. Even if you go to get vaccinated a day or two later, the risk will be greatly reduced, which is much more effective than worrying about how many hours you spent at home. In fact, rabies is not as easy to catch as everyone thinks. The vaccination rate of domestic animals in China is also increasing year by year. If you are accidentally bitten, don't scare yourself and believe the dead line claims on the Internet. No matter if it has passed 24 hours or 48 hours, it is better to go to the vaccination point and ask questions than to speculate at home.