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Rabies is a deadly viral infection transmitted to humans by infected animals’ saliva. It targets the central nervous system, and infected canines account for 99% of all cases.
According to a recent Lancet study, approximately 5,726 human rabies deaths occur each year, despite a general decline in deaths over the last few decades.
This need quick medical attention following a dog bite or scrape. While many people believe that the rabies vaccine alone is sufficient, experts warn that in some situations, rabies immunoglobulin (RIG) is also required to prevent the virus from spreading.
IMMEDIATE MEDICAL HELP IS CRUCIAL
Dr. Mohammed Hussain, popularly known as The Cancer Doctor, highlighted the severity of rabies in an X (formerly Twitter) post: “Rabies has a 100% death rate. So never hesitate to visit your doctor after a dog bite. Don’t take chances.”
Even a slight scrape from a possibly rabid animal warrants prompt medical attention. According to Dr. Neha Rastogi Panda, Consultant-Infectious Diseases at Fortis Memorial Research Institute, Gurugram, the rabies vaccine alone is insufficient in severe cases, and rabies immunoglobulin (RIG) is essential for providing rapid protection.
HOW THE RABIES VACCINE WORKS
The Anti-Rabies Vaccine (ARV) encourages the immune system into producing antibodies against the rabies virus. It includes an inactivated (dead) virus that the body can detect and fight if it is exposed.
Types of Rabies Vaccination:
Pre-exposure prophylaxis (PrEP) is given to high-risk persons such as veterinarians, animal handlers, and travelers visiting rabies-endemic areas to assist them establish immunity ahead of time.
Post-exposure prophylaxis (PEP) is administered following a bite or scratch to prevent the virus from entering the neurological system. PEP involves a series of vaccination shots and, in certain cases, RIG.
WHY RABIES IMMUNOGLOBULIN (RIG) IS NECESSARY
Rabies Immunoglobulin (RIG) is an injection that quickly protects a person from rabies following an animal bite. It includes ready-made antibodies that neutralize the rabies virus at the wound site.
It prevents the infection from spreading to the nervous system. Dr. Sanket Mankad, Infectious Diseases Consultant, Shalby Hospitals, Ahmedabad, said that immunoglobulin provides “immediate protection for people who have not been immunised against rabies” in the past while the body’s immune system responds.
Many people believe that receiving a rabies vaccine after a dog bite is adequate, but in extreme situations, rabies immunoglobulin (RIG) is critical because it delivers rapid antibodies to neutralize the virus at the exposure site.
According to Dr. Neha Rastogi Panda, the vaccination takes approximately 7-14 days to trigger the body’s immune response, leaving a window for the virus to spread if RIG is not delivered.
Without RIG, the virus has a higher chance of reaching the central nervous system before the vaccination takes action, resulting to deadly rabies.
WHAT IS THE STANDARD TREATMENT PROTOCOL AFTER A DOG BITE?
The World Health Organisation (WHO) guidelines outline the steps that should be taken immediately after a dog bite:
Immediate Wound Care
Wash the wound thoroughly with soap and running water for at least 15 minutes. Apply antiseptics like iodine or alcohol (70%) to reduce viral load.
Seek Medical Care Promptly
Visit a healthcare facility to assess the need for vaccination and RIG.
Categorise the Exposure
Category I: Touching or feeding animals, licks on intact skin – No treatment needed.
Category II: Minor scratches or nibbling on unbroken skin – Vaccine required.
Category III: Deep bites, wounds, or contamination of mucous membranes – Vaccine and immunoglobulin required.
Rabies Vaccination Schedule
For post-exposure prophylaxis (PEP), WHO recommends the 4-dose intramuscular regimen: Days 0, 3, 7, and 14 (with a 5th dose on Day 28 for immunocompromised individuals).
If the person received pre-exposure prophylaxis (PrEP) earlier, only 2 doses (Day 0 and Day 3) are needed, and RIG is not required.
Rabies Immunoglobulin (RIG) Administration
RIG should be injected directly into and around the wound for maximum effectiveness.
Timeframe for RIG Administration
RIG is most effective within 7 days of the first rabies vaccine dose. After this period, the vaccine itself produces enough antibodies, making RIG unnecessary.
If RIG is delayed:
- Within 7 days: Still effective and should be administered as soon as possible.
- After 7 days: Generally not needed as the vaccine has started working.
- Beyond 7 days without RIG: The risk of the virus reaching the nervous system increases, making rabies fatal.
A typical rabies vaccine costs between Rs 300 and Rs 400, an immunoglobulin injection cost ranges from Rs 4,000 to Rs 6,000.
Source: IT
