The saliva of infected animals can transmit the fatal virus known as rabies to humans. 99% of cases are brought on by infected canines, and it targets the central nervous system. Despite a general decline in deaths over the past few decades, a new study published in the Lancet found that 5,726 human rabies deaths occur annually.
Because of this, getting medical help right once after a dog bite or scratch is crucial. Although many people believe that the rabies vaccine is sufficient on its own, doctors emphasize that in some situations, rabies immunoglobulin (RIG) is also required to stop the virus from spreading.
IMMEDIATE MEDICAL HELP IS CRUCIAL
Dr. Mohammed Hussain, popularly known as The cancerdoctor, highlighted the severity of rabies in an X post: "Rabies has a 100% death rate. So never hesitate to visit your doctor after a dog bite. Don't take chances."
A potentially rabid animal must be treated right away for even a little scratch. Rabies immunoglobulin (RIG) is essential for providing prompt protection in severe instances, according to Dr. Neha Rastogi Panda, Consultant-Infectious Diseases at Fortis Memorial Research Institute, Gurugram.
HOW THE VACCINE FOR RABIES WORKS
Antibodies against the rabies virus are produced by the immune system in response to stimulation by the Anti-Rabies Vaccine (ARV). If exposed, the body will be better able to identify and combat the virus since it contains an inactivated (dead) form of it.
Rabies Vaccination Types:
Pre-exposure prophylaxis, or PrEP, is a medication that helps those at high risk—such as veterinarians, animal handlers, and tourists visiting rabies-endemic regions—develop immunity beforehand.
After a bite or scratch, post-exposure prophylaxis (PEP) is administered to stop the virus from entering the nervous system. PEP consists of several doses of the vaccine plus, in some situations, RIG.
The necessity of rabies immunoglobulin (RIG)
Following an animal bite, an injection known as Rabies Immunoglobulin (RIG) provides instant protection against rabies. The rabies virus is neutralized at the wound site by the pre-made antibodies it carries.
The illness is kept from spreading to the neurological system by it. As the body's immune system reacts, immunoglobulin offers "immediate protection for people who have not been immunised against rabies" in the past, according to Dr. Sanket Mankad, Infectious Diseases Consultant at Shalby Hospitals in Ahmedabad.
Many people believe that receiving a rabies vaccination following a dog bite is enough, but in extreme situations, rabies immunoglobulin (RIG) is essential because it produces antibodies right away to neutralize the virus at the site of exposure.
According to Dr. Neha Rastogi Panda, if RIG is not given, the virus has a window of opportunity to propagate because the vaccination itself takes 7–14 days to boost the body's immune response.
Without RIG, there is a greater chance that the virus will infect the central nervous system before the vaccine takes action, which could result in rabies deaths.
AFTER A DOG BITE, WHAT IS THE STANDARD TREATMENT PROTOCOL?
The following actions should be taken right away following a dog bite, according to World health Organization (WHO) guidelines:
Quick Care for Wounds
Spend at least fifteen minutes thoroughly cleaning the wound with soap and running water. Use antiseptics such as 70% alcohol or iodine to lessen the virus load.
Seek Medical Attention Right Away
Visit a medical facility to determine whether RIG and vaccine are necessary.
Sort the Exposure into Different Categories
Category I: Licks on undamaged skin, touching or feeding animals; no medical intervention is required.
Category II: Small scrapes or nibbling on intact skin; vaccination is necessary.
Category III: Immunoglobulin and vaccination are necessary for deep bites, wounds, or mucous membrane contamination.
Schedule for Rabies Vaccination
The WHO suggests a 4-dose intramuscular regimen for post-exposure prophylaxis (PEP) on days 0, 3, 7, and 14 (with a fifth dose on day 28 for immunocompromised patients).
RIG is not necessary and just two doses (Day 0 and Day 3) are required if the individual got pre-exposure prophylaxis (PrEP) earlier.
Administration of Rabies Immunoglobulin (RIG)
For best results, RIG should be injected directly into and around the wound.
Timetable for the Administration of RIG
RIG works best seven days after the initial dose of the rabies vaccine. RIG is no longer required after this time because the vaccine itself generates adequate antibodies.
If there is a delay in RIG:
Within 7 days: It is still effective and ought to be given right away. After 7 days: Since the vaccine has begun to act, it is usually not necessary. After seven days without RIG, there is a greater chance that the virus may enter the nervous system and cause rabies to be lethal.
Is it difficult to get rabies immunoglobulin in India?
In India, getting rabies immunoglobulin (RIG) is still difficult, particularly in rural regions. As Dr. Panda said, "RIG is costly and frequently unavailable, even while rabies immunizations are available. Equine rabies immunoglobulin (ERIG) is less expensive than human rabies immunoglobulin (HRIG), yet it is still more challenging to get.
An immunoglobulin injection costs between Rs 4,000 and Rs 6,000, whereas a standard rabies vaccine costs between Rs 300 and Rs 400.
"Many healthcare workers are not fully trained in WHO-recommended post-exposure prophylaxis (PEP) protocols, and cold chain logistics for proper storage and transportation of RIG are challenging in remote areas," stated Dr. Panda.
Public education programs about wound care, vaccination, and the importance of RIG are essential to raising awareness and expanding access to it.
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