Not long ago, a woman was bitten by a dog on the street in Xi'an, then she immediately went to the hospital for treatment, has been injected with rabies vaccine four times, unfortunately, the woman still died the following month due to rabies seizure rescue. We feel sorry for its death at the same time, can not help but ask: not already shot rabies vaccine, how still have a seizure?

First of all, rabies is an infectious disease, transmitted by the rabies virus, which is typically characterized by "fear of water", "fear of light", etc., and the attack manifests itself in extreme excitement, general paralysis, and ultimately respiratory failure and death. At present, rabies is still a dreadful disease and can only be prevented by rabies vaccination. Once an attack occurs, the mortality rate is 100%.

The main reasons why rabies attacks can't be avoided even though rabies vaccine has been administered are as follows:

1. Failure to adequately flush the wound in time and irregular treatment: Immediately after being bitten, the wound should be thoroughly flushed with running water or soapy water and then sterilized with alcohol.

2. Failure to vaccinate in time or to complete the vaccination on time, missing the optimal time: it is best to vaccinate against rabies within 24h of the bite, the earlier the better, and the rabies vaccine must be administered on the day of the bite, on the 3rd day, on the 7th day, on the 14th day and on the 28th day.

3. Failure to inject immunoglobulin: In severe cases, in addition to vaccination, human rabies immunoglobulin should be injected by subcutaneous infiltration around the wound.

4. The quality of the vaccinated vaccine is not up to standard: vaccination should be carried out in regular medical institutions.

5. Individual differences in the immunity of the patient's body: the patient is immunocompromised or has immunodeficiency diseases.

6. Direct invasion of the virus: the virus has invaded the nervous system before antibodies are produced after vaccination.

Respondent: Na Zhang, M.S.

Welcome to Apricot Island for more interesting health facts!

Dr. Springer to answer that question.

(Image from the Internet)

Long's death is regrettable, and what we need to learn and figure out from this incident is how to correctly respond to being bitten by woofers, how to scientifically inject rabies vaccine, as well as the prevention of rabies, to enjoy the woofers to bring us unlimited happiness at the same time, to protect their own lives and health.

So far, rabies attacks have a 100% mortality rate

To date, rabies is still a disease with a 100% mortality rate, and there is no medication available to treat patients with rabies attacks, relying only on rabies vaccinations to prevent its occurrence.

Infection with the rabies virus usually results in an incubation period of as little as a week to as long as a year, during which time there are no symptoms, and once the disease develops, death from cardiopulmonary failure can occur after just a few days.

Therefore.The ability to administer rabies vaccine in a timely and effective manner is absolutely critical to the ability to save the life of a person infected with the rabies virus.

However, after being bitten, the vaccine alone is not necessarily the best thing to do

First, remember to treat the wound at the first opportunity.

The State Food and Drug Administration (CFDA) states that "after a person has been bitten or scratched by a host animal such as a dog or cat, theWhere it cannot be determined that the injured animal is healthy, the injured area should be thoroughly cleaned and disinfected immediately. The sooner the local wound is treated, the better, and the wound should be thoroughly rinsed with soapy water or water for at least 15 minutes.Thoroughly rinse and rub the wound with 2%-3% iodophor (wine) or 75% alcohol."

After that, immediately go to your local Rabies Post-Exposure Disposal Clinic, where your doctor will give you wound care and immunizations depending on the circumstances of the bite.

(Source: Official website of the World Health Organization)

CFDA notes:

For Class II exposures, treat wounds and immunize against rabies immediately.

Procedure for rabies vaccination after first exposure: Generally, bites are injected with 1 dose of rabies vaccine on days 0 (the day of injection), 3, 7, 14 and 28. Injection site: intramuscular injection in the deltoid muscle of the upper arm; infants and young children under 2 years old can be injected in the anterolateral thigh muscle. Buttock injection is prohibited.

For Class III exposures and immunocompromised individuals with Class II exposures, immediate wound treatment and infiltration injection of anti-rabies serum or rabies human immunoglobulin around the wound at the same time as vaccination can neutralize the rabies virus locally infecting the wound and reduce the possibility of rabies.

Timely and standardized post-exposure treatment after being bitten and a full course of vaccination can effectively prevent the occurrence of rabies.

Going to a regular facility to ensure that you don't get an invalid vaccine

Some netizens mentioned that could Long have been injected with fake vaccines? A fraudulent vaccine? Failed vaccine? Expired vaccine?

First, the hospital that treated the patient's wounds and injected him with the rabies vaccine was the Xi'an Central Hospital - a general tertiary hospital - and the likelihood of using a shady vaccine of unknown origin is extremely low.

The greatest risk of vaccine failure comes from the failure to stimulate the body to produce an effective immune response. After vaccination, the body does not produce antibodies, and there is no protection. In the case of rabies, the lack of protection means that the patient will die.

In order to ensure a safe and effective vaccination, you should try to choose a regular, large-scale medical institution or vaccination center. You can ask to see the package, instruction manual, manufacturer, batch number, expiration date and other information of the vaccine injected, and keep it if possible.

As a final reminder, in addition to dogs, bites from these animals also require rabies vaccination

In addition to dogs, cats, mice, rabbits, wolves, squirrels, foxes, raccoons, and others can also transmit the rabies virus. It is only extremely rare for humans to become infected with rabies after coming into contact with foxes, raccoons, skunks, jackrabbits, mongooses, and other carnivorous wild hosts and die as a result.

I hope Dr. Chunyu's answer can help you, you can pay attention to the headline number [Dr. Chunyu] to get more health science knowledge yo.

Title image source: 123rf.com.cn gallery

References:

General Knowledge of Rabies Vaccine, State Food and Drug Administration http://www.sda.gov.cn/WS01/CL0619/43766.htm

World Health Organization Rabies Fact Sheet http://www.who.int/mediacentre/factsheets/fs099/zh/

Guidelines for Rabies Prevention and Control (2016 Edition)

Writer/Lao Bai

Copyright: This article is the original manuscript of Dr. Chunyu, the copyright belongs to Dr. Chunyu, unauthorized reproduction is prohibited, 授权与合作事宜请联系reading@chunyu.me

Dr. Clove is here to answer that question.

The news story "Dog Bitten and Died of Rabies Despite Four Vaccinations" is actually pretty scary. Some things really can not say 100%, but rabies prevention is still very effective, at least the United States has not occurred after exposure to vaccination failure cases. From the news, the person was bitten also took the standardized disposal method, why still failed and died, it is worth to pursue. Summer is more likely to have rabies risk, hope this incident is really just an accident.

For this incident, Dr. Clove hopes that people will not lose confidence in the rabies vaccine or be too afraid of rabies because of it, and still go to a regular hospital for rabies vaccination when bitten by animals such as cats and dogs.

Shocked and saddened to see this news! Should get those dog lovers over to see it, I wonder what they think?

Two days ago in Nanjing, because a pet dog bit a two-year-old baby, the dog owner did not squeak, the child's father took a look at the very angry, encouraged by alcohol, the dog fell dead.

After the incident, both sides recognized their own mistakes, understood each other and did not hold each other responsible. But a college student, but also a member of the dog lovers, in the online article to denounce the child's father, there are some dog lovers out of the voice of intimidation, personal threats, scared the child's father to let the store move away.

Gossip is far from the truth! This happened in Xi'an, 32-year-old woman was bitten by a dog on the street, although timely injection of rabies vaccine, but still died. Turning to the infectious disease bulletin published by the provinces, deaths due to rabies are at the top of the list every month, which means that rabies, whether dog lovers admit it or not, is objective!

Hate those who keep dogs without a leash, and not for the dog vaccination of those people, in their eyes only the dog, but not see the people, until the dog bites a person, they have two hands a spread, this matter has nothing to do with me ......

Nothing is foolproof, and due to individual differences, the treatment and measures in place, the quality of the vaccine, whether the injection was given in time, the location of the bite, etc., all affect the final outcome.

Finally, I hope that people who love dogs really do love dogs, tie the leash, epidemic prevention, accidentally bitten people timely treatment, the sooner the better!

Woman dies of rabies attack even after 4 shots after dog bite, why would she still die after vaccination? Will! Because there is still a certain probability of death after vaccination that makes it impossible to prevent.

Before we answer that question, let's go over some of the basics of rabies.

I. What is rabies

Rabies is an acute infectious disease caused by rabies virus, and is a common disease between humans and animals, mostly seen in dogs, wolves, cats and other carnivorous animals, and people are mostly infected by bites of diseased animals. Clinical manifestations of the characteristic fear of water, fear of wind, pharyngeal muscle spasms, progressive paralysis, etc., also known as hydrophobia, the death rate is close to 100%.

China's rabies is mainly transmitted by dogs, domestic dogs can become asymptomatic carriers, especially puppies, because of their own lack of immunity, so the rate of poison is higher, can be through the saliva and so on to the outside of the poison, so it seems that the "healthy" dog in fact, a great danger to the health of people.

II. Mode of transmission of rabies

1. Infection of the skin by bites, scratches or contamination of the mucous membranes of the human body by the saliva of dogs, cats and other animals. The rabies virus invades the nerves through wounds and mucous membranes and develops, which is the main mode of transmission.

2. Human beings are infected when their skin is inadvertently injured in the process of slaughtering animals.

3. It is also possible for a person to be infected through the mucous membranes of the digestive tract by eating an unseasoned rabies-carrying animal; the probability of this is very small, and the probability of this is not true for well-cooked meat.

III. Emergency treatment

1. After the skin is bitten or scratched by an animal, wash the wound repeatedly with 20% soapy water. Deeper wounds need to go to the hospital with a catheter into the soapy water to continue to irrigate, and strive to remove the dog saliva, squeeze out the blood. Generally do not sew the wound bandage, if necessary, the use of antibacterial drugs, wounds deep also use tetanus antitoxin.

2. After the wound treatment, according to the level of rabies exposure injection of human rabies vaccine or rabies high immunity serum, the sooner the better, never more than 24 hours, so that the possibility of contracting rabies is very small.

Knowing some of the basics of rabies, we can analyze in depth why some people who have been vaccinated against rabies still can't escape death, the main reasons are：

1. The dose of rabies vaccine is divided into 4-6 injections, which are usually finished within one month, and it takes 7-10 days after the completion of all the injections for the body of the vaccinated person to produce antibodies in accordance with the national standard, so that the body has an "immune gap" period. If the virus has invaded at this time, the body will not be able to produce antibodies to fight against it, people will be infected.

2. If the animal that bites has a large number of rabies viruses in its body, which are highly pathogenic; if the bite wound is deep and the wound treatment is not thorough enough; and if the rabies virus has already begun to spread along the nerves before the vaccination is administered, causing damage to the central nervous system and respiratory failure, etc., the patient can only go to his death.

3. It is also related to human immunity. People with low immunity cannot resist the fierce attack of the virus, which triggers rabies and eventually cannot escape the call of death.

Special Tip:

1. Rabies is a preventable but not a curable disease, so post-exposure treatment is essential! The first is emergency wound treatment; the second is rabies vaccination; the third is the use of rabies passive immunization preparations when needed. These "three steps" are not interchangeable, and failure to handle one of them properly may result in failure of prevention.

2. "Cauliflower yellow, dog crazy." After the spring, the animal enters the rut, the character is violent, more aggressive, hurt people also most. We have to strengthen the precautionary, after the dog around not teasing, not running, not barking, keep calm, and do a good job of emergency disposal.

3. During the vaccination period, do not drink alcohol, prohibit strong tea and coffee, and do not eat stimulating foods, such as chili peppers, green onions, garlic, etc., and avoid cold and flu, strenuous exercise or excessive fatigue.

Finally, it is better for people not to keep dogs, and sick dogs found should also be dealt with strictly, especially those suffering from rabies should be shot immediately.

Although the dog is a good friend of mankind, but unfortunately in an accident, we have to timely treatment, seriously dispose of the "three steps", each link is sloppy, irreplaceable. Life is precious, we must not take themselves to risk!

What's your opinion on this question? There will be a mysterious prize for one of the wonderful comments!

I do not know much about medical issues and dare not speak too much, but I analyze the problem from another angle. The woman was bitten by a stray dog and died of the disease despite the vaccination, which is why I have always advocated the need to fight stray dogs.

A dog is a good friend to mankind, and this dog should be tame and able to be a friend only, while some stray dogs may themselves be carriers of the rabies virus, and being bitten by a stray dog can be dangerous.

One of the prerequisites for us to have a pet dog nowadays is to get vaccinated, which is also a protection for ourselves and others, otherwise rabies does not recognize people, it doesn't matter if it is the owner or a stranger, there is no good in getting the disease.

According to news reports: the deceased Long on June 20, in the middle of the road, was bitten by a dog, the left leg outer ankle and inner ankle were bitten. The dog that bit the man was about 60 centimeters long dog, similar to a pug, no one holding.

Long then received a timely injection of rabies vaccine. Thereafter, Long in accordance with medical advice, and then injected three rabies vaccine, but by July 13, she felt numbness in the left leg, the back of the spine a little acid, while the symptoms of frequent urination and urinary urgency, July 17, Long went to a hospital, the hospital Neurology and Infectious Diseases together with the consultation, the preliminary diagnosis of rabies.

On the evening of the 17th, she was transferred to the Eighth Hospital of Xi'an for rescue, and by 4:00 a.m. on the 18th, the coma worsened. At about 6:50 a.m., Long died as a result of failure to rescue.

We sometimes call for fighting stray dogs, not because of cold-bloodedness, but in the face of human rights and dog rights, we choose human rights, and the interests of human beings are above all else.

For dogs, if they do not bite, do not stray and coexist peacefully with people, this is of course fine, but it is preferred that there are a lot of stray dogs, those abandoned by their owners, for other reasons, and so on. This is what we are against. If a dog lover is really caring, you pick up the stray dogs, vaccinate them and show them love, this is great love. Unfortunately, a lot of dog lovers only love his family's dogs, not the dogs, and there is a big difference here.

I'm a college animal medicine teacher and a licensed veterinarian, so let me explain. In my judgment, the quality of the vaccine cannot be ruled out.

The rabies virus is excreted from the saliva and infects through the wound. The virus enters the wound and travels up the nerves until it enters the brain, at which point it is irredeemable. Vaccination is the expectation that you will have developed antibodies that will intercept the virus before it reaches the brain.

The longer the distance of the bite from the brain, the longer the incubation period. If the bite is on the head and face, then it is too late to vaccinate anyway. You should get an immune serum blocker. Vaccination is for you to produce your own antibodies, which takes time. To put it bluntly, it's a race between the speed at which you produce antibodies and the speed at which the virus is traveling upstream. The immune serum contains the antibodies directly and works immediately.

Rabies incubation period is also related to the size and depth of the wound, virus content and virulence. Long a situation, the wound is larger, the content of the virus and virulence are higher, can make the incubation period shorter, but the bite site is far away, there is still a chance. The possible causes of the tragedy are as follows:

1, the wound treatment is not timely. This is very important, the bite should be the first time to squeeze out the blood with force, and it should be flushed with water to prevent the blood from coagulating. In the case of Long, it is best to use a band to tie it tightly above the wound to prevent the virus from traveling upward, and then squeeze out the blood while flushing with water for a long time. This allows a large amount of virus to be expelled from the wound. The soap and water rinsing and alcohol application at the back are instead secondary and far less useful than the water rinsing and blood squeezing.

2, vaccine quality problems. You must have heard of cases of fake vaccines and expired DE vaccines, and it is also possible that preservation problems have reduced the effectiveness of vaccines.

3, Long's own immunity may be low.

4, hospital disposal problem. According to Long's bite site is not necessary to hit the immune serum, but due to the wound is large, the ownerless dog turned back to take the initiative to bite, etc., you can consider using immune serum blocking. If used, it must be all right. But I'm afraid there are hospital regulations on the use of immune serum, so I don't dare to comment. However, I know that there are cases of allergy and accidents when using immune serum, so it is restricted for hospitals to let go of the use of immune serum. However, I would like to advise all of you to sign for the immunization serum if the bite is close to the brain.

5, now the epidemic control department of rabies emergency treatment norms are very chaotic, a moment said to play five shots, a moment said three shots enough. A moment to two months to play, a moment to a month to play, a moment to the upper body bite to play the immune serum, a moment and do not play. One moment, how to give domestic vaccines, and the other moment, how to give imported vaccines. A moment after playing the bite within six months do not need to play, a moment within a year do not need to play, a moment and all the re-play ...... I suspect that you do not know how to deal with it! Just know that the injection to collect money.

I have a moment on the hand was bitten a small wound, their own local treatment finished, go to the hospital when the wound has long been dry, he also want to give me a fake fake with soap and water to symbolize the rinse, this item charges 30.

I'm really sorry, I'm not a researcher and can't answer this question!

I only know, I grew up like to play with the dog, also was bitten by the dog a few times, and did not vaccinate, I did not care. Once last year, more bleeding a little more, I was ambushed with green peppers in the wound, squeeze down the chili juice with force, very painful, and the fingers are swollen for three days, did not take the vaccine, I'm still alive and well, maybe I'm the life of a cheap!

Thanks for the invitation!

Woman was bitten by a dog died a really unfortunate thing, but also to the majority of pet lovers profound lesson, keep pets must be careful, do not be paralyzed, in case of bites in time on the health epidemiological department to play rabies vaccine, as for the woman played the vaccine, but still the disease died may be: a more than twenty-four hours; second is the vaccine whether the expiration date; third is the hospital into the fake drugs. Under normal circumstances, the dog bite timely vaccination, there will be no rabies death.

Recently, Hangzhou city police beat dogs with sticks in a row, coupled with the previous problematic vaccine incident, the emergency surgery clinic often after being bitten by dogs and cats patients to the clinic questioned whether to vaccinate? After the vaccine is sure that you will not get rabies? And so on many questions.

The question mentioned in the "Xi'an woman was bitten by a dog after four shots of vaccine rabies attack and death", the previous many doctors have analyzed the possible causes very thoroughly. However, after this incident, people have some questions about the vaccine, the author would like to explain to you in this article:

First of all, should I get a rabies shot or not?

In general, when patients bitten by dogs and cats come to the hospital, most of them will directly ask for vaccination: doctor, I was bitten by a dog, come to get vaccinated. Normal reception will first check the wound, because only the first and second level wounds can play rabies vaccine, while the third level wounds are required to be injected with serum or protein, and at the same time injected with the full vaccine. Is there a difference between the serum protein and the vaccine mentioned here? The common saying is that the serum and protein itself is a kind of antibody, but the rabies vaccine is a kind of antigen, hit the human body to stimulate the human body to produce antibodies, so the former works faster. Then there are people who wonder why they don't just hit the serum protein so they can fight the virus faster. This is because the rabies virus can multiply in the body for a long time, while the serum and protein will be metabolized quickly in the body, the rabies vaccine can be a long period of time to stimulate the body to produce antibodies against the virus.

So, the rabies vaccine is not something you can get just because you want it, it depends on the wound. At the same time, rabies vaccine is not a cure-all; it's not like you won't get rabies 100% of the time if you get the vaccine.

Generally speaking, it takes a period of time from the injection of the vaccine to the production of sufficient concentration of antibodies, and whether or not the disease develops during this period of time, I remember that there is a very graphic description that goes like this: "The virus and the antibodies are in a race, and whether or not the antibodies can kill the virus before it reaches the central nervous system is the key to whether or not the disease develops." In addition, there is a period of time between the injection and the production of antibodies, if the bite is delayed for a long time, not timely vaccination, then the chances of getting sick will be even greater; and then there is the timely disinfection of wounds, wound treatment is not appropriate, not in time will increase the chance of infection; in addition, during the vaccination period, whether to pay attention to the requirements of rest, prohibition of alcohol, eat a light diet, etc., which may also cause the onset of the disease. So it's not just a vaccination, first of all, after being bitten and licked by dogs and cats, we should consult a doctor in a timely manner, under the guidance of the doctor in accordance with the requirements of the full immunization.

PsA first- or second-degree wound is defined as 1) contact with or feeding of an animal; 2) licking of intact skin; 3) contact of intact skin with secretions or feces from a rabid animal or human rabies case. 4) a light bite to bare skin; and 4) a minor scratch or abrasion that does not bleed.

Tertiary wounds are defined as 1) single or multiple bites or scratches through the skin; 2) licking of broken skin; 3) contamination of mucous membranes with animal saliva; and 4) exposure to bats.

Text: Jiao Weiwei Master's student / Wang Chuanhang Chief Physician