Reva (MP): A 14 year old boy died of rabies yesterday despite vaccination.
Post exposure prophylaxis (PEP) which includes proper wound washing, full course of modern cell culture vaccines, and rabies immunoglobulin (RIG) for severe bites, is almost 100% effective when done correctly and promptly. So can rabies still occur after PEP?
Yes, though extremely rarely, usually due to errors or special circumstances, such as:
1. Incomplete or incorrect vaccination: missed doses, wrong schedule, or poorly stored vaccine.
2. Improper technique: giving intramuscular vaccine subcutaneously.
3. Severe or highly dangerous exposure: multiple or deep bites on the head, face, or neck, especially if PEP is delayed by even few days.
4. Poor wound care: not washing thoroughly with soap and water, or not infiltrating RIG directly into Category III wounds.
In this case, as per media reports, he received only three vaccine doses. But a neck bite (Category III) requires the complete vaccination schedule and RIG infiltration around the wound. It’s unclear if he got that.
So, lessons for you:
1. Immediately wash the wound with soap and water for 15 minutes, and then see a doctor.
2. Go to a qualified doctor or a good hospital. In fact, remember that a dog bite can happen to anyone at any time, so it’s wise to identify a nearby hospital in advance.
3. Let the doctor decide what’s best for you.