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How to administer a rabies vaccination

How to administer a rabies vaccination

Rabies vaccine can prevent rabies.

Rabies is mainly a disease of animals. Humans get rabies when they are bitten or scratched by infected animals.

  • Human rabies is rare in the United States. Wild animals like bats, raccoons, skunks, and foxes are the most common source of human rabies infection in the United States.
  • Rabies is more common in other parts of the world where dogs still carry rabies. Most rabies deaths in people around the world are caused by bites from unvaccinated dogs.

Rabies infects the central nervous system. After infection with rabies, at first there might not be any symptoms. Weeks or even months after a bite, rabies can cause general weakness or discomfort, fever, or headache. As the disease progresses, the person may experience delirium, abnormal behavior, hallucinations, hydrophobia (fear of water), and insomnia.

If a person does not receive appropriate medical care after an exposure, human rabies is almost always fatal.

Rabies can be prevented by vaccinating pets, staying away from wildlife, and seeking medical care after potential exposures and before symptoms start.

Rabies vaccine is given to people at high risk of rabies to protect them if they are exposed. People at high risk of exposure to rabies should be offered pre-exposure rabies vaccination, including:

  • Veterinarians, animal handlers, and veterinary students
  • Rabies laboratory workers
  • Spelunkers (people who explore caves), and
  • Persons who work with live vaccine to produce rabies vaccine and rabies immune globulin.

Pre-exposure rabies vaccination should also be considered for:

  • People whose activities bring them into frequent contact with rabies virus or with possibly rabid animals.
  • International travelers who are likely to come in contact with animals in parts of the world where rabies is common and immediate access to appropriate care is limited.

For pre-exposure protection, 3 doses of rabies vaccine are recommended. People who may be repeatedly exposed to rabies virus should receive periodic testing for immunity, and booster doses might be necessary. Your health care provider can give you more details.

Rabies vaccine can prevent rabies if given to a person after they have had an exposure. Anyone who has been bitten by an animal suspected to have rabies, or who otherwise may have been exposed to rabies, should clean the wound and see a health care provider immediately regardless of vaccination status. The health care provider can help determine if the person should receive post-exposure rabies vaccination.

For post-exposure protection:

  • A person who is exposed and has never been vaccinated against rabies should get 4 doses of rabies vaccine. The person should also get another shot called rabies immune globulin (RIG).
  • A person who has been previously vaccinated should get 2 doses of rabies vaccine and does not need Rabies Immune Globulin.

Your health care provider can give you more information.

Tell your vaccine provider if the person getting the vaccine:

  • Has had an allergic reaction after a previous dose of rabies vaccine, or has any severe, life-threatening allergies.
  • Has a weakened immune system.

In some cases, your health care provider may decide to postpone a routine (non-exposure) dose of rabies vaccination to a future visit.

People with minor illnesses, such as a cold, may be vaccinated. People who are moderately or severely ill should usually wait until they recover before getting a routine (non-exposure) dose of rabies vaccine. If you have been exposed to rabies virus, you should get vaccinated regardless of concurrent illnesses, pregnancy, or breastfeeding.

Your health care provider can give you more information.

  • Soreness, redness, swelling, or itching at the site of the injection, and headache, nausea, abdominal pain, muscle aches, or dizziness can happen after rabies vaccine.
  • Hives, pain in the joints, or fever sometimes happen after booster doses.
  • Very rarely, nervous system disorders such as Guillain-Barré syndrome (GBS) have been reported after rabies vaccine.

People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears.

As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death.

An allergic reaction could occur after the vaccinated person leaves the clinic. If you see signs of a severe allergic reaction (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness), call 9-1-1 and get the person to the nearest hospital.

For other signs that concern you, call your health care provider.

Adverse reactions should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your health care provider will usually file this report, or you can do it yourself. Visit the VAERS website external icon or call 1-800-822-7967. VAERS is only for reporting reactions, and VAERS staff do not give medical advice.

  • Ask your health care provider.
  • Call your local or state health department.
  • Contact the Centers for Disease Control and Prevention (CDC):
    • Call 1-800-232-4636 (1-800-CDC-INFO) or
    • Visit CDC’s rabies website

    Many Vaccine Information Statements are available in español and other languages. See http://www.immunize.org/vis external icon .

    Vaccine Information Statement
    Rabies Vaccine (1/8/20)

    Department of Health and Human Services
    Centers for Disease Control and Prevention

    Under Section 2030(g)(1) the law requires veterinarians who are performing aseptic surgery, to maintain a room, separate and distinct from all other rooms reserved for aseptic surgical procedures. The Board is working with its new advisory multidisciplinary committee to update the Board´s policy to address the immediate need for clarification and to develop regulations as a long term solution to developing specific requirements based on current policy. The current policy guidelines are as follows:

    A surgery room that is separate and distinct from all other rooms must not be accessible to casual cross traffic through the room and must have doors that:
    (1)Are able to be fully closed,
    (2)Fill the entire door space,
    (3)Are made of non-porous material, and
    (4)Are not accessible from outside into the hospital.

    Storage in the surgery room shall be limited to items and equipment normally related to surgery and surgical procedures. Recommendations include:
    (1)Removing autoclaves,
    (2)Eliminating a functioning sink. An open drain is a viable source of bacteria, so if you have a functioning sink in the surgery room, the Board recommends either disabling the sink and covering the open area with a non-porous material or removing the sink entirely,
    (3)Radiographic equipment that is used exclusively for surgical patients only would be acceptable, but general office radiographic equipment should be housed outside the surgery room.
    (4)Open shelving gathers dust and animal hair that can compromise your surgery room. Open shelving should be removed or doors installed.
    (5)Dental cleaning procedures should not be done in the room reserved exclusively for aseptic surgery and the equipment used for dentals should not be stored in the surgery room.

    I am so glad you asked. Why? Because rabies is a viral disease that is almost always fatal once symptoms appear, and proper vaccination is the best and only way to keep you and your dog safe.

    There is no test that can be done on a living person or an animal to tell if they are infected, and there is no treatment that can stop the virus once symptoms occur. As soon as you are able to tell if you or your pet is infected with the virus, it is too late.

    Not to mention, if your dog is not up to date on her rabies vaccine and she bites, gets bitten or has a wound of unknown origin that could possibly be a bite, the state law may require that your pet be quarantined or even euthanized to keep other pets and people safe.

    Keeping your pets current with their rabies vaccines is absolutely essential and even required by law. Here is what you should know about rabies vaccinations.

    Recommended Rabies Vaccine Schedule for Your Dog

    Each state has its own laws for the required rabies vaccine schedule for dogs.

    In most states, the first rabies vaccination is generally given to puppies at or before 16 weeks of age. The second rabies vaccination is given one year after the first vaccine.

    Then, your dog will be vaccinated every year or every three years depending on the state law and the vaccine used.

    Your veterinarian is your best resource for your state’s rabies vaccination requirements. The AVMA also maintains a list of state rabies laws.

    How Long Does a Rabies Vaccine Last?

    This is a legal question as well as a medical one. State law determines how long your dog’s vaccination is considered protective, and the law varies from state to state.

    There are rabies vaccines that are labeled as being effective for either one year or three years, though the actual contents of the vaccine may be the same. Labeling is a legal matter of testing and proof, and the difference between the two vaccines is the testing done by the manufacturer.

    Some states require your pet to be vaccinated against rabies annually, no matter if the vaccine is considered to be effective for one year or three. Your veterinarian will know the legal requirements of your state and will help you to stay on schedule with your pets.

    Why Does My Pet Need Rabies Boosters?

    The rabies vaccine tells the body how to recognize the rabies virus and how to create an immune system response that will kill the virus should it ever occur.

    Over time, the effectiveness of the vaccine starts to wear off, which is why booster vaccines are required for your dog to stay protected.

    Can a Vaccinated Dog Get Rabies?

    The rabies vaccine is extremely effective. That said, no vaccine is 100 percent effective, and there are a few reported cases of vaccinated animals contracting the rabies virus.

    The best prevention is to keep up to date on your dog’s rabies vaccines over the course of their life.

    Are There Any Rabies Vaccine Side Effects?

    Common side effects can include mild discomfort or swelling at the vaccination site, a slight fever, and a decreased appetite and activity level. These symptoms can start within hours of the vaccination and should go away in a day or two.

    If the side effects worsen or continue longer than a few days, contact your veterinarian so they can help ease them.

    Occasionally, the small, firm swelling at the injection site can last for a few weeks. If it persists more than three weeks or seems to be getting larger, you should contact your veterinarian.

    Less common, but more serious, side effects to be aware of include:

    Vomiting or diarrhea

    Swelling of the muzzle and around the face, neck or eyes

    Severe coughing or difficulty breathing, and even collapse

    These serious side effects usually occur minutes to hours after receiving the vaccine. They may be life-threatening emergencies that require immediate emergency veterinary care.

    How Much Does a Dog Rabies Vaccine Cost?

    The cost of a rabies vaccine will vary depending on your provider. Typically, the vaccine costs between $30 and $50.

    How to administer a rabies vaccination

    Animal Control sends a notice stating that your dog’s rabies vaccination is due.

    Some of us will vaccinate readily.

    Because it’s legally mandated, it must be safe, right? Besides, what choice do we have?

    Others of us panic, desperate to avoid the shot at any cost. We remember what happened the last time our dog had a rabies vaccination. We wonder, will our dog survive another?

    World renowned pet vaccination scientist, Dr Jean Dodds, wrote recently: “Rabies vaccines are the most common group of biological products identified in adverse event reports received by the USDA’s Center for Veterinary Biologics (CVB).”

    An adverse reaction to a rabies vaccine may exact a high price – to your dog’s health and your wallet. Here’s what you need to know to make vaccinating your dog safer:

    1. Learn to recognize adverse reactions

    Short-term reactions include vomiting, facial swelling, fever, lethargy, circulatory shock, loss of consciousness and even death. (If your pet appears distressed, contact your vet immediately.) Reactions occurring days or months after vaccination can be difficult to recognize. They include:

    • Fibrocarcinomas (cancer) at the injection site
    • Seizures and epilepsy
    • Autoimmune disease
    • Chronic digestive problems
    • Allergies
    • Muscle weakness or atrophy (eating inappropriate materials, including feces)
    • Behavioral changes (aggression, separation anxiety, compulsive behaviors and more)

    If you suspect a health or behavior problem may be connected to a vaccine, you may have to convince your vet. It’s common to hear “it couldn’t be the shot” or “a reaction like that is impossible.” Even the drug’s manufacturer (to whom you should immediately report the reaction — giving them the brand and lot# — may deny the connection.

    Insist on seeing the product’s package insert, viewable on-line or from your vet. Also know that long-term reactions aren’t usually documented or even studied.

    Note: a vaccine reaction, especially one supported by your vet, may entitle you to compensation for medical expenses from the drug manufacturer.

    2. Vaccinate healthy dogs only

    Vaccinating an unhealthy animal can exacerbate illness and do irreparable harm.

    Also, immunity may not develop after vaccination because of the dog’s compromised immune system. This is especially dangerous as you may presume immunity that does not exist. Pets with autoimmune disease or cancer are obviously “not healthy,” but neither are pets suffering from stress from a move or surgery, a virus or infection, or allergies or skin problems or any other condition compromising health. (Never allow your pet to be vaccinated during surgery.

    3. Ask for a rabies vaccination exemption

    If your dog has documented health problems, ask your vet to apply for a rabies vaccination extension or exemption.

    Many localities permit them even if state law doesn’t specifically allow them. If your vet won’t apply for an exemption, go elsewhere. You may want to contact a holistic vet who may better understand the dangers of vaccinating an unhealthy animal. If local law forbids exemptions, change the law. Numerous states are in the process of adding exemptions to their laws.

    Click this link to check your state’s rabies law and pending exemptions.

    4. Don’t vaccinate against rabies within three weeks of other vaccinations or medication for parasites

    Multiple vaccines given at once greatly increase the chance of reactions. Multiple vaccines are especially risky for small dogs.

    5. Make sure your dog gets the correct vaccine

    If you’re vaccinating a puppy, make sure your vet administers a one-year vaccine initially (as late as legally possible) and a three-year vaccine (or whatever is required in your area) thereafter.

    The one-year and three-year vaccines are virtually identical medically – but not under the law. A one-year shot must be followed by re-vaccination a year later.

    Note: the one-year shot is not safer than the three-year (except that it may contain fewer adjuvants).

    6. Vaccinate at the safest time

    Vaccinate in the morning, early in the week, and don’t leave the area for at least an hour if possible. Watch for reactions for at least the next 48 hours. Reactions occurring when the closest vet’s office is closed can prove disastrous, even fatal.

    7. Tell your vet you want a Thimerosol-free vaccine

    Thimerosol (mercury) in vaccines has been linked to adverse reactions.

    Merial, for one, makes one- and three-year thimersol-free rabies vaccines: IMRAB® 1 TF and IMRAB® 3 TF. Make sure you see “TF” on the label. (If your vet doesn’t carry the vaccine, you may have to vet shop to find the vaccine you want. You might also ask why the vet why he/she doesn’t carry it.)

    8. Find a vet trained in homeopathy to vaccinate your dog

    Certain homeopathic remedies given before, during and after vaccinating can lessen the chance of ill effects from vaccination. Click the link to find vet referral lists.

    9. Report all vaccine reactions to your vet

    …and make sure they’re recorded in your pet’s file.

    Have the vet sign relevant pages, get copies and put them in a safe place. (Vets lose records, retire and move away.) Also report the reaction to the drug’s manufacturer. (You’ll need the vaccine lot number.) Vets are notoriously bad at reporting reactions, but exemptions to rabies vaccination and drug safety require documentation.

    10. Don’t vaccinate within a week of travel

    Pets experiencing reactions on route can die for lack of immediate medical assistance.

    11. Keep copies of vaccination records and titer tests in your car

    .. and license tags on your dog’s collar or harness. Otherwise, you may be forced to re-vaccinate if your pet bites someone, runs away and is taken to a shelter or if you have to board your pet unexpectedly.

    12. Do not administer a rabies vaccine yourself

    It will not satisfy legal requirements and you’ll have to have a vet vaccinate again. You will also be unprepared to deal with a potentially life-threatening reaction. Similarly, a vet’s office may likely be a safer place to get the vaccine than a mobile clinic.

    Before the next notice from Animal Control arrives, do your homework. A little time spent learning about the rabies vaccine can mean the difference between your dog’s wellness and serious illness.

    Rabies virus can cause a nearly 100% fatal illness in humans and other mammals. The virus is present in some wildlife in Florida and can spread to unvaccinated pets, which then pose a high risk to the pet owner and their family. The main wildlife sources of rabies in Florida are raccoons and bats. Infected raccoons and bats can expose people, pets, livestock and other wildlife to rabies, typically through bites. Outside cats are by far the most common domestic animal found to have rabies in the state of Florida largely because they are often not kept up-to-date on rabies vaccinations. Dogs, cats and ferrets are required by law to be vaccinated against rabies in the state of Florida.

    Some actions people and their families can take to prevent from being exposed to rabies include avoiding direct contact with wildlife, not feeding wildlife, consulting with a veterinarian to ensure pets are up-to-date on rabies vaccinations, and supervising pets and young children while outside. If you believe you may have been exposed to rabies, contact your health care provider and your county health department right away. If an exposure occurred, there is effective treatment that can prevent infections in people if administered in a timely manner.

    • RABIES PREVENTION
    • Frequently Asked Questions
    • RABIES IN BATS
    • WORLD RABIES DAY – SEPTEMBER 28

    1. Avoid direct human and domestic animal contact with wild animals.

    2. Have your veterinarian vaccinate pets and at-risk livestock, make sure you follow your veterinarian’s instructions for revaccination.

    3. Do not allow your pets to run free. Follow leash laws by keeping pets and livestock secured on your property.

    4. Never feed wild or stray animals-avoid attracting them with outdoors food sources. Feed your pets indoors.

    5. If your animal is attacked by a wild, stray or unvaccinated animal, DO NOT examine your pet for injuries without wearing gloves. DO wash your pet with soap and water to remove saliva from the attacking animal. DO NOT let your animal come into contact with other animals or people until the situation can be handled by animal control or county health department staff.

    6. Educate the public to reduce contact with stray and feral animals.

    7. Support animal control in efforts to reduce feral and stray animal populations.

    8. Provide pre-exposure prophylaxis for people in high-risk professions, such as animal control and veterinary personnel, laboratory workers, and those working with wildlife.

    9. Bat-proof homes.

    How is rabies spread?

    When an animal is sick with rabies, the virus is shed in the saliva and can be passed to another animal or a person, usually through a bite. Transmission may also occur if this saliva or the animal’s nervous tissue enters open wounds, the mouth, nose or eyes of another animal or person.

    What do rabid animals look like?

    Animals with rabies may show strange behavior — they can be aggressive, attacking for no apparent  reason, or act very tame (especially wild animals). They may not be able to eat, drink or swallow. They may drool because they cannot swallow their saliva. They may stagger or become paralyzed. Eventually they will die.

    Lots of breeders and regular pet owners give their own vaccines as a way to save on multi-pet care. Many of them do research on the vaccines, ask their vets for advice, buy the vaccines online, store them properly, administer them carefully and keep excellent records.

    I have no problem with this approach as long as self-vaccinators don’t skip steps and get all sloppy about it. After all, vaccination detail is not something to be undertaken lightly. That’s why so many pet owners ask their vets to manage this for them carefully.

    But when it comes to vaccines that require regulatory oversight, vets are required to administer them or provide “direct supervision” whenever they are. (“Direct supervision” in this case means that vets must be in the facility at the time vaccines are administered but a technician is allowed to give the shots out of the doctor’s sight).

    Vaccines that require this kind of oversight include those for zoonotic diseases (diseases transmissible to humans) such as rabies and brucellosis as well as for those required for regulatory health certificates.

    But not all vets seem to understand this. Case in point:

    I’m in this email group run by the FVMA where vets discuss the pros and cons of various issues affecting the profession and how regulatory concerns affect our patients’ care. This week’s big brouhaha concerned the issue of who is legally allowed to administer a rabies vaccine.

    It seems some breeders in Florida are trying to administer their own rabies vaccines then get the vets to issue licenses and/or certificates of administration. Some vets think this is OK. They say the vaccine is no more likely to cause a problem (nor is the disease’s risk higher) if the shot’s administered by a non-veterinarian.

    Others, however, are raising a red flag to such shenanigans. Guess which group I’m in? Here’s my reasoning:

    • If I’m required by law to administer a vaccine then I’m going to follow the law.
    • If I’m going to sign my name to paperwork attesting to the vaccine’s administration then I’m going to give the vaccine.
    • If my child is bitten by a dog, guess whose rabies vaccine records I’m going to have to trust?

    It seems that some vets don’t get the problem of rabies. “Rabies hasn’t been seen in dogs and cats in this county for over 25 years,” they say. “Why can’t I offer my multi-pet clients a break on this one? I didn’t go to vet school to push vaccines, anyway.”

    Here’s my rejoinder:

    When I was a kid I was bitten by a neighbor’s white shepherd while riding my bicycle on the street near her house. Rabies? “Oh, I gave it myself. I grew up on a farm where we gave all our own shots. Here’s my receipt for the vaccine.”

    Needless to say, this creepy woman’s records were not going to convince my mother. The dog was quarantined and I was very nearly subjected to a series of painful intraperitoneal injections (those “belly shots” required for rabies post-exposure back in the day). I know I didn’t sleep for many nights out of fear for my abdomen. The bite? Incidental. It healed fine.

    So when it comes to you, your pets or your human children being bitten, whose records would YOU trust? Do you blame me for protecting my profession’s right to be the sole provider of vaccines in this case?

    Rabies is a serious illness typically transmitted through the saliva of animals. Its symptoms include increased fever, salvation, madness and other abnormal behaviors, convulsions, paralysis, and it can even cause death.

    This virus affects dogs, cats, other mammals, and even humans. It is transmittable through the bite of an infected animal. Once infected, symptoms usually appear within one to three months. However, it can be as little as one week to as much as one year.

    Before the start of symptoms, infected people have been cured by using the rabies vaccine and sometimes rabies immunoglobulin. Rabies causes tens of thousands of deaths worldwide. Most of the human deaths occur in Asia and Africa though. The only continent that rabies is not present on is Antarctica.

    Symptoms of Rabies

    Fever and headache are usually the first signs of rabies in humans. Inflammation of the brain comes on next and can bring on such symptoms as partial paralysis, confusion, anxiety, agitation, paranoia, hallucinations, terror, and abnormal behavior. These symptoms then lead to delirium and coma. A fear of water is also often a symptom.

    What/Who Can Develop Rabies?

    All mammals can develop rabies. Birds, however, are largely asymptomatic and recover. They can also develop antibodies when they eat rabies-infected flesh. Larger animals present the biggest threat to humans.

    Small animals, such as rabbits, rodents like chipmunks, rats, and squirrels almost never contract the virus and have not been known to spread it to humans.

    Transmission between humans is very infrequent. The only known transmission between humans was through transplant surgeries wherein people received infected organs.

    Arizona Rabies Vaccination Law

    Since larger animals are the biggest threat to humans when it comes to rabies, most states have laws governing the vaccination of pets. Arizona rabies vaccination law states that dogs and cats should be vaccinated, and they should first be immunized at 3 months of age.

    The following year the animal is required to receive another vaccination. After taking their second vaccination the animal is required to receive a booster shot every three years. Arizona rabies vaccination law doesn’t pertain to dogs and cats only.

    Ferrets, horses, and cattle must also be vaccinated and their vaccinations must be annual. Ferrets should first be vaccinated at 3-4 months of age.

    The law also states that any animal with an unknown vaccination history should be immunized right away and again within a year. In order to assess the current vaccination status of an animal, the following must be true:

    • A product that’s approved for use was used in the vaccination process
    • The vaccine was in the Compendium of Animal Rabies Prevention and Control
    • The vaccine was given by a licensed veterinarian who signed the certificate
    • The recommended schedule was followed
    • At least 28 days had passed since the first immunization

    Rabies Quarantine Protocol

    Arizona rabies vaccination law has a quarantine protocol for any animal that bites a person. It must be confined and observed for ten days. The animal must be tested for rabies if it develops signs of the illness or if it dies within those ten days.

    Rabid Animal Bites a Person

    At the first signs of illness, a veterinarian must examine the animal. If the dog or cat has been vaccinated for rabies, a home quarantine may be permitted at the discretion of animal control.

    The owner will be given instruction on what to look for as far as signs of rabies are concerned.

    The quarantine will be done at an animal control office or a vet’s office if the animal has not been vaccinated or if the vaccination status is unknown.

    Pet Bit by Wild Rabid Animal

    There is also a protocol for if your pet gets bitten by a wild animal. If the wild animal is caught and available for testing, then bring it in. If it isn’t caught, assume it is positive for rabies, after which notify animal control.

    Take the dog or cat to the vet for a booster rabies shot. If the animal has had a rabies vaccine, home quarantine may be permissible.

    The animal should be kept in a secure, enclosed place and only taken out on a leash for 45 days. If the cat or dog has never been vaccinated, you may want to consider euthanasia of your pet to avoid causing it pain.

    Otherwise animal control will quarantine it for 120 days in an approved facility where it will most likely go through immense amounts of pain and eventually die. The owner will be responsible for all costs incurred.

    Read more about dog-related injuries:

    Rabies Vaccinations are Vital

    Rabies can infect just about any large mammal. It is a dangerous and deadly virus that results in madness and death. Arizona has taken precautions against transmitting this virus to humans by requiring that pets get vaccinated.

    This helps in the prevention of transmission to humans. Arizona rabies vaccination law states that cats and dogs must be vaccinated and has laws about vaccinating your ferrets and livestock as well. In addition, there are protocols to follow when your animal gets bitten by a wild animal or if your animal bites a human.

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    It is essential that anyone who has potentially been exposed to rabies virus or Australian bat lyssavirus (ABLV) be protected against these diseases through the appropriate use of rabies vaccine and human rabies immunoglobulin (HRIG). Potential exposure occurs when people are bitten or scratched by animals that may be infected, or when animals that may be infected lick a person’s broken skin or mucous membranes (eyes, nose or mouth).

    If you have had this type of contact with:

    • bats in Australia or anywhere else in the world, OR
    • any land dwelling mammal in any country where rabies is known to be a risk, you should clean the point of contact as described below and seek immediate medical attention.

    Thoroughly clean the wound site with soap and water for 5 minutes. If available, an antiseptic that kills viruses such as povidone-iodine, iodine tincture, aqueous iodine solution or alcohol (ethanol) should be applied after washing. If exposed, mucous membranes such as eyes, nose or mouth should be flushed well with water. It is important to follow these processes with appropriate treatment with rabies vaccine and HRIG.

    What is the difference between rabies vaccine and HRIG?

    A course of rabies vaccines (given into the shoulder muscle) works to develop long term immunity, but this may take seven days to begin providing protection. For this reason, HRIG is usually given into the wound or site of injury to provide immediate short term protection while the rabies vaccines start to work. Long term protection is essential as rabies infection can take a long time to develop. Not everyone potentially exposed to rabies or ABLV will be advised to have HRIG. For example, HRIG is generally not required for people who have been previously vaccinated against rabies. When recommended, it is important to have the HRIG as well as the vaccine to ensure complete protection against rabies or ABLV.

    How many doses of rabies vaccine are needed following a bite or scratch by a potentially infected animal?

    A course of four doses is generally needed over a period of one month (0, 3, 7, 14 days). However, an additional fifth dose is needed at 30 days for anyone who has a weakened immune system. The injections are given in the muscle of the upper arm.

    Are there any side effects?

    All medicines and vaccines have side effects. For this vaccine, about 20% of people complain of redness at the injection site or a sore arm. Other side effects include fever (8%), headache (5%), stomach upset (5%), muscle aches and pains (5%) and a rash (5%).

    A very small minority of people (1 in 10,000) can suffer a severe allergic reaction, with symptoms that might include difficulty breathing and swelling of the throat. This is exactly the same reaction that occurs in some people who are allergic to bee stings or peanuts. Your doctor will ask you to stay in the clinic for about 20 minutes after the rabies vaccination to ensure you are not one of those very few people who are allergic to the rabies vaccine. If this reaction occurs, it is usually easily treated at the clinic.

    Throughout the world, five cases of inflammation of the brain have been reported among the millions of people who have been given rabies vaccine. These cases have not been linked with certainty to the vaccine.

    Should the vaccinations be stopped if there are side effects?

    The disease caused by rabies and ABLV is lethal and the recommended vaccination schedule should be continued unless there is a severe allergic reaction. If a severe allergic reaction occurs, specialist advice should be sought and the risk of developing infection must be carefully considered before deciding to discontinue the vaccinations.

    Are there any people who should not have the vaccine for medical reasons?

    No. The disease caused by rabies and ABLV infection is lethal, so all people bitten or scratched by a potentially infected animal should have the vaccine. If your doctor thinks there is a risk of a severe allergic reaction, then specialist advice should be sought.

    What about women who are pregnant or breast feeding?

    There is no evidence that the vaccine can harm unborn babies. Follow up of 200 pregnant women in Thailand found that the vaccine was safe. It is not known if the vaccine is secreted in human milk, but any vaccine present in breast milk should not have harmful effects.

    What should you do if you experience vaccine side effects?

    For mild side effects such as headache, muscle soreness or fever, paracetamol may be taken every four hours up to a maximum for adults of eight 500 mg tablets in 24 hours. If fever persists or you are concerned about your condition consult your doctor.

    When and where is human rabies immunoglobulin (HRIG) given?

    When recommended, HRIG is usually given with the first dose of the vaccine. It provides immunity until the vaccine starts to protect at about day 7. It is preferable that as much as possible of the HRIG is injected in and around the wound site.

    It is prepared from the plasma of donated human blood.

    Are there any side effects of HRIG?

    Pain and discomfort can occur at the injection site. Fever and chills sometimes occur. As with all medicines, acute severe allergic reactions occur very rarely. Because HRIG is prepared from human blood, the risk of transmitting blood-borne infections cannot be absolutely excluded. This risk also applies to as yet unknown diseases. The risk of spreading known diseases is reduced during the production of HRIG by screening blood donors, by screening all donated blood for HIV, hepatitis B and hepatitis C, and by further processing of the blood to extract the immunoglobulins. There have been no reports in Australia of transmission of any blood borne disease in people who have received HRIG.

    Are there any other adverse effects of HRIG?

    Administration of immunoglobulin may interfere with the effectiveness of some vaccines (eg. measles, mumps, rubella and chickenpox vaccines). You should tell your doctor if you have had one of these vaccinations in the two weeks before the HRIG injection. It may be necessary for you to be re-vaccinated (with measles, mumps, rubella or chickenpox vaccines) four months after the dose of HRIG.

    You should wait four months after the immunoglobulin before having certain vaccines (eg. measles, mumps, rubella and chickenpox). Otherwise these vaccines may not work.

    Help and Assistance

    For further information, please contact your local doctor or nearest public health unit or the 13HEALTH information line (13 432584).

    At the 2017 American Veterinary Medical Association Convention in Indianapolis, Indiana, Richard Ford, DVM, MS, DACVIM, spoke about must-know issues related to rabies vaccination. The audience-participation lecture touched on legal issues regarding rabies vaccination that affect veterinarians, owners, the public and, of course, animals.

    Much about rabies law is confusing and conflicting, Dr. Ford noted. Not understanding it or misinterpreting it can lead to legal liability for humans and quarantine or euthanasia for animals.

    Laws regarding rabies vaccination of animals are not consistent throughout the United States. Some states, such as New Jersey, mandate rabies vaccinations for dogs but not for cats. Minnesota, Kansas, and Ohio have no state law requiring pets to be vaccinated for rabies. Many states allow vaccination of hybrid animals, such as wolf hybrids, coydogs, or ocicats, but they don’t recognize the vaccination. “If a pet ocicat or wolf hybrid is exposed, it is subject to euthanasia,” Dr. Ford said.

    Exposure and Euthanasia

    The definition of the term exposure varies widely from state to state. It’s important to understand the state’s definition and the factors that define rabies exposure. It’s also important to know that the state public health authority makes the final determination, not the veterinarian.

    If a dog or cat is determined to have been exposed to rabies, most state laws dictate a 45-day home quarantine. What are the consequences of exposure for a pet who is exposed but unvaccinated? Most state laws today follow the 2016 revised rabies compendium guidelines, which call for a 4-month strict quarantine. Animals must usually be vaccinated at the time of entry into quarantine and often must be vaccinated within 96 hours of exposure.

    Euthanasia and testing are not required if a currently unvaccinated dog bites a person. Some veterinarians assume this is required, but it’s not. The dog is subject to a 10-day home quarantine with revaccination on release. That is the law in the majority of states.

    Euthanasia can, however, be required in certain instances. Dr. Ford cited the case of a dog 2 months past due for a rabies booster. The dog bit the child next door, and the child’s parent insisted that the dog be euthanized and tested rather than waiting for the 10-day home quarantine period. The state public health authority agreed. The dog was not infected with rabies.

    Rabies Vaccination Requirements

    This raises the question of when an animal is considered to be “currently vaccinated.” A dog is not considered to be vaccinated until 28 days after the initial inoculation. Rabies vaccinations are considered outdated 1 day beyond the 1-year or 3-year anniversary of the vaccination. (Generally, the only difference between the 1-year rabies vaccine and the 3-year rabies vaccine is how it’s labeled.) On revaccination, the pet is considered immunized immediately.

    It’s also important to know who is authorized to administer a rabies vaccine. Usually, the answer is a licensed veterinarian. Some states require that a licensed and accredited veterinarian administer the vaccination, while others permit vaccines to be given by a licensed veterinary technician working under the direct supervision of a licensed veterinarian. Two states, Kentucky being one of them, entitle owners to give a rabies vaccine, but they must first take a course. In North Carolina, several counties are not served by a veterinarian. The state has identified “certificated rabies vaccinators” who are permitted to administer vaccines.

    In Michigan, statutes specify who is entitled to deliver a vaccine to which species. A licensed veterinarian may vaccinate ferrets, for instance, but a licensed and accredited veterinarian is required to vaccinate dogs. A licensed veterinarian or a veterinary technician under the supervision of a veterinarian may vaccinate cats. Owners are permitted to administer vaccinations to livestock such as cattle, horses and sheep.

    Each state’s department of public health determines the requirements, following the guidelines of the Compendium of Animal Rabies Prevention and Control. The rabies compendium is written and updated periodically by members of the National Association of State Public Health Veterinarians.