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Article Overview: Most pet owners probably have a general understanding of rabies vaccines for dogs. However, when it comes to how to administer the vaccine and exactly when it should be given, I believe some owners still have only a vague idea. Today, we’ll break it down for you.
Rabies is currently widespread across the globe; reports of deaths from rabies have been documented on every continent except Antarctica. Even with today’s advanced medical technology, 60,000 people still die from rabies each year, making it the deadliest zoonotic disease.
Currently, 99% of human rabies cases occur in developing countries, primarily in Asia, Africa, and Latin America and the Caribbean. Asia accounts for the highest number of rabies cases globally, with an estimated 30,000 deaths annually. India is currently the country with the most severe rabies epidemic, with an estimated 20,000–30,000 new cases annually and an incidence rate of 2 per 100,000 people.China ranks second only to India in terms of human rabies incidence; at the peak of the epidemic in 2007, the number of reported cases reached 3,300 annually. From 2004 to 2014, rabies consistently ranked among the top three causes of death from infectious diseases in China.
Rabies is a zoonotic disease caused by infection with the rabies virus. The rabies virus primarily enters the human body through broken skin or mucous membranes. Clinically, the disease is characterized by specific symptoms such as aphobia of wind and water, laryngeal spasms, and progressive paralysis. In recent years, the number of reported deaths from rabies has consistently ranked among the highest for notifiable infectious diseases in China, posing a serious threat to public health and safety.
Most human cases of rabies result from bites by rabid animals; a small number result from scratches or contamination of wounds or mucous membranes. There have also been occasional reports of cases resulting from transplants of organs or tissues donated by rabid patients; however, the virus cannot penetrate intact skin.
When a bite occurs, the wound is exposed to the rabies virus, which enters the body through the broken skin and remains dormant in the nervous system. The incubation period can range from a few days to several years; once symptoms appear, the fatality rate is nearly 100%.
The incubation period for human rabies ranges from 5 days to several years (typically 2–3 months, rarely exceeding 1 year); the length of the incubation period is related to factors such as the virulence of the virus and the distribution of nerves at the site of entry.
Post-exposure prophylaxis for rabies
Post-exposure prophylaxis for rabies is generally not required following exposure to rodents, domestic rabbits, or wild rabbits. However, the U.S. CDC does not provide specific guidelines on whether to administer the vaccine and recommends making a decision based on a case-by-case assessment.
The U.S. CDC explicitly states that non-mammalian animals such as poultry, snakes, lizards, fish, and insects do not carry the rabies virus.
If you are bitten by a wild animal—including ferrets, coyotes, skunks, foxes, raccoons, or any other carnivore—or by a pet exhibiting unusual behavior or with no history of vaccination, it is recommended that you receive a vaccination.
Bites to the head, face, neck, hands, and external genitalia are classified as Category III exposures. (WHO recommendation: Because the head, face, neck, hands, and external genitalia are highly innervated, exposures to these areas are classified as Category III exposures.)
Following an exposure, the exposure level must be assessed, and appropriate measures must be taken based on that level:
① Individuals classified as having Level I exposure do not require any intervention;
② Individuals classified as having a Level II exposure should immediately treat the wound and receive rabies vaccinations in accordance with relevant regulations;
③ Individuals classified as having a Level III exposure should immediately treat the wound, administer rabies passive immunoglobulin in accordance with relevant regulations, and receive the rabies vaccine.
The wound should be immediately rinsed under running water with alkaline soapy water for at least 15 minutes, followed by disinfection. Minor wounds may be bandaged, while larger wounds are generally not sutured in the first stage. For Level II exposure, a rabies vaccine should be administered. For Level III exposure, in addition to the rabies vaccine, passive immunoglobulin and a tetanus vaccine should also be administered.
However, rabies serum/immunoglobulin is administered on a voluntary basis at the patient’s own expense; it is not mandatory, and a consent form must be signed prior to administration. This medication is relatively expensive, administered via intramuscular injection at a dose of 20 IU per kilogram of body weight, and the injection site can be quite painful. Therefore, patients must be fully informed of these details. It is worth noting that if the wound is large or if the animal is confirmed to have rabies, patients must be strongly advised to receive the injection; if they still refuse, they must sign a refusal form.
There are two vaccination schedules for rabies vaccines: the 5-dose schedule and the 2-1-1 schedule. Follow the recommendations in the product insert. Some rabies vaccine product inserts specify that only the 5-dose schedule should be used.
The vaccination schedule for the 5-dose immunization program is as follows: 0 days, 3 days, 7 days, 14 days, and 28 days after exposure. In principle, vaccinations must be administered strictly according to this schedule; early administration is strictly prohibited. The first two doses must be administered on schedule. The third dose may be delayed by 1–2 days, the fourth dose by 2–3 days, and the fifth dose by 3–5 days.
The 2-1-1 schedule involves administering two doses on day 0, one dose on day 7, and one dose on day 21.If the rabies vaccine is administered according to the immunization schedule, no additional rabies vaccine is required within six months of subsequent exposure. Between six months and one year, two booster doses should be administered according to the schedule; between one and three years, three booster doses should be administered; and after three years, the vaccination series should be restarted. In cases of subsequent exposure, because the body’s immune system remains active, antibodies are rapidly produced following re-vaccination; therefore, passive immunization is not required.