Summer is a hot season for emergency room staff. Before the mother had time to turn away, lo and behold, the child had already fallen off the hill, fell off the swing, or he was bitten by a dog.

And this latter is often more dangerous than a classic fracture with displacement, because parents do not always pay attention to light scratches and barely noticeable dog bites ... and in vain.

The child was bitten by a dog - what to do?

The word "rabies" has long become a winged and firmly entered our speech, denoting excessive and sudden anger caused by an unpleasant event. However, the true meaning of this term is much more formidable. After all, rabies is the most dangerous viral disease, which after the incubation period becomes incurable and leads to death. Unfortunately, modern science has not learned how to overcome this ailment, which is still scientifically called Rabies, hydrophobia Lyssa (hydrophobia, hydrophobia).

Both animals and humans are ill with this acute viral infection. Remember that the duration of the incubation period in animals is from a week to several months (sometimes years), but already 5-10 days before the manifestation of the disease, the animal is infectious. The pathogen is transmitted by contact as a result of a bite or salivation of damaged mucous membranes or skin. The disease is characterized by progressive damage to the central nervous system. Edema, hemorrhages, degenerative and necrotic changes in the nerve cells of the brain and spinal cord are observed. There is only one way out - as soon as possible after a bite, see a doctor for rabies vaccinations.

Of course, the threat of a virus infection rabies Is not the only nuisance for a survivor of a dog attack. Some of the "man's friends" bite very painfully and can greatly scare the baby. In addition, a large animal is capable of inflicting a severe wound with damage to the deep subcutaneous and muscle layers. It happens that as a result of a bite, part of the tissue is lost. If the child is small, then he runs the risk of getting a bite in the face, head and neck, which is especially dangerous from an aesthetic and medical point of view. No less dangerous are bites in the hand, which can "get" to more adults, and, consequently, tall children - in this part of the body there are many nerve endings, which are usually "highways" for the spread of the virus. A large dog sometimes bites right through a child's cheek. With any bite, subcutaneous detachments may remain unrecognized if the victim has not been thoroughly examined in the hospital. Fortunately, with timely medical attention, the number of functional and aesthetic consequences does not exceed 3% of all dog bites.

Since particles of earth can get into the wound, there is a possibility of tetanus infection.

First aid for children with a dog bite

After a dog bite, the wounds should be washed as soon as possible with plenty of water and a solution of laundry soap. Desirable, the good old, still popularly called seventy percent. As a last resort, antibacterial is also suitable. Such an event will remove droplets of animal saliva from the wound and reduce the risk of "catching" an infection. After all, bites, as a rule, are strongly "flavored" with saliva, containing (in addition to the likelihood of the already described rabies) a wide variety of microbial flora, including staphylococci, streptococci and anaerobes. Between 30 and 60% of dogs are carriers of various strains of Pasteurella, a group of bacteria that can cause severe suppuration and even pneumonia. If the bleeding is not severe, you should not try to stop it immediately. A large number of harmful microorganisms are removed from the wound with blood.

After soap, the bite is poured with hydrogen peroxide, and abrasions and single marks from the teeth and the edges of the wound are smeared with iodine. Do not treat the wound itself with iodine, alcohol and brilliant green - this will burn the already damaged tissue. Before contacting a doctor, the site of injury can be wrapped with a sterile bandage or covered with a clean cloth. A delay of more than six hours from the time of the bite to the first local procedures significantly increases the risk of infectious complications.

If the baby is scared, the wound is serious and it hurts, it is not forbidden to give him analgin and a mild sedative.

Rabies vaccine

The next step is to get the victim to the nearest emergency room or hospital as soon as possible. The longer the time interval between the bite and the moment of going to the doctor, the higher the risk of disease rabies, tetanus and other infections.

The medical institution will first of all collect information about the incident. A wild or pet attacked the child. Does the dog have an owner? Was the attack provocative or spontaneous? Whether the dog has been aggressive before. If the dog is domestic, then what was its behavior in the previous days and whether it was carried out rabies vaccination? It is very important whether the incident occurred in an area with a high risk of rabies.

During a clinical examination, the doctor will determine the location of the injury and its connection with the neurovascular bundles, tendons and joints. Determine the severity of the injury depending on the aesthetic consequences (for example, a bite on the face or loss of tissue). Dislocation of the joint or the sheath of the flexor tendon is also dangerous.

The medical staff will additionally process and disinfect wounds, the edges of which, as a rule, are not additionally excised or sutured, because this increases the risk of spreading throughout the body rabies... Exceptions are cases when the intervention of a surgeon is necessary for health reasons: with extensive lesions, for cosmetic reasons and in order to stop profuse bleeding.

Appointments in most civilized countries of the world are determined by law. In our country, they are made free of charge, even if the applicant does not have a medical policy. Depending on what the doctor has learned from you, he or she will decide whether to prescribe rabies vaccinations. The doctor will not vaccinate the baby for single small bites of any part of the body, except for the head and hands in an area that is safe in terms of the incidence of the hydrophobic virus, if a vaccinated dog has bitten and there is a certificate from a veterinarian, in case of salivation and intact skin of the child, when the animal at the time of the attack was great (there is a certificate from the veterinarian).

Ideally, the bitten animal can be monitored for 10 days. Indeed, if during this period he shows signs of rabies, the child needs to immediately start the course rabies vaccinations... If you have dealt with healthy-looking animals that can be monitored for 10 days, the victim will be assigned conditional rate rabies vaccination for humans(2-4 injections), the dosage and duration of which are determined depending on the location and severity of the bites.

In case, alas, the animal has signs rabies and or they are confirmed by laboratory, in a situation where it is impossible to establish a diagnosis - the animal escaped or died, and the corpse disappeared, as well as with bites of wild animals and birds, a mandatory course of vaccinations is prescribed.

How is a child vaccinated against rabies?

do according to a special scheme on the zero, 3, 7, 14 and 28th day after the "event". This creates good immunity against the virus. WHO also recommends a 6th injection 90 days after the first.

Since we are talking about a child, he will most likely be admitted to the hospital for the first injection, especially if the baby suffers from allergic reactions. The vaccine consists of two components: rabies immunoglobulin (RIG) and dry inactivated concentrated purified cultured rabies vaccine (COCAV). The first is a preparation based on the blood serum of a horse previously immunized against rabies and allows the body to start fighting the virus immediately. The second is an inactive neutralized culture of the virus rabies and helps the body develop its own antibodies to the virus. In the hospital, the baby will also be vaccinated against tetanus and an antihistamine injection with a solution of suprastin or diphenhydramine. The injection is split into several injections and injected directly into the bite site, as well as into the muscles of the limbs affected by the bites or into the surface of the thigh.

The child is monitored and if, after an hour after the last injection, he does not have allergic and severe adverse reactions, he is discharged home with a referral to the local clinic to continue. rabies vaccinations according to the scheme.

Pain, swelling and lumps may occur at the injection site. Sometimes the temperature "jumps" up to 38 degrees and above, lymph nodes enlarge, arthritis and dyspeptic disorders occur. Headache and general malaise, chills, myalgia occur. All such manifestations should be immediately reported to the attending physician.

If your child has already been vaccinated against rabies according to the full scheme earlier and he has a sufficient level of protective proteins - antibodies (this is shown by a special analysis), he is vaccinated according to the "0-3" scheme (the first injection is administered on the day of treatment, the second - on the 3rd day) without the use of immunoglobulin.

Remember that the incubation period rabies in the body of an unvaccinated child it is about 30 days, in adults it reaches 90 days and a year. After vaccination, overheating, overwork, hypothermia should be avoided. It is clear that we are talking about children, but you should know that the intake of any kind of alcohol in the body during this period is prohibited. Timely vaccination (in the first 2-3 hours after the bite) prevents the occurrence of a fatal disease in 97-99% of cases!

Human rabies vaccinations also not prescribed for bites of cold-blooded animals (snakes, lizards, turtles), the use of thermally processed milk and meat of animals with rabies. For poultry bites, vaccinations are prescribed only if the bird is clearly ill with rabies.

Teach your children to behave with a dog

• never play with stray, courtyard and simply unfamiliar dogs, do not stroke them
• if you walk with your dog, always keep it on a leash
• never tease a dog, even a kind one
• do not disturb the animal when it is
• don't wake the sleeping dog
• do not pick up a sleeping dog until it wakes up.
• never run up to the dog from behind and do not scare him
• When strangers, such as the postman, come into the house, keep your dog at a safe distance.
• When punishing a dog, never spank it with your bare hand. She can bite you defensively.
• don't put your face close to the dog's face. This is permissible only if the dog is well acquainted and you have an excellent relationship with it, if it does not sleep or doze, and at the same time is completely healthy.
• If your dog gets into a fight with another dog before it gets bled, you should check to see if it has contracted rabies. Do not pet or play with your dog until you are sure it is healthy.

To compose the answers, the normative documentation of the Russian Federation and international recommendations were used.

Rabies prevention is not a topic for a correspondence consultation. The best solution is to contact a full-time specialist.

The basic requirements for the complex of organizational and sanitary-anti-epidemic (preventive) measures aimed at preventing the onset and spread of rabies diseases among the population of the Russian Federation are regulated in the Sanitary-Epidemiological Rules of SP 3.1.7. 2627 -10 "Prevention of rabies among humans":

When a person seeks medical help for an attack and bite of an animal or salivation of damaged skin or external mucous membranes, medical workers are required to determine the volume and provide medical assistance, prescribe and begin a course of preventive vaccinations, inform the victim about the need for preventive vaccinations and the possible consequences in case of violation of the course of vaccinations.

An animal with which a case suspicious of human rabies is associated must be isolated for 10 days or killed (in case of aggressive behavior). Material from the deceased animal must be delivered to a specialized laboratory by veterinary specialists.

Persons at risk of infection are referred to a trauma doctor who determines the scope of medical care and treatment, including post-exposure prophylaxis.

What is post-exposure prophylaxis against rabies in humans?

Post-exposure (after contact) prophylaxis consists of local wound care, administration of rabies immunoglobulin (if indicated) and immediate vaccination.

How and to whom is post-exposure prophylaxis of rabies carried out in humans?

Sanitary and Epidemiological Rules of the Joint Venture 3.1.7. 2627 -10 "Prevention of rabies among humans"

Section VIII. Post-exposure prophylaxis of rabies in humans

8.1. Specific anti-rabies treatment (post-exposure prophylaxis) for victims of the bites of persons suspected of rabies begins before the results of laboratory studies of animals are obtained.

8.2. Post-exposure prophylaxis is carried out with immunobiological preparations registered in the established order in accordance with the instructions for their use.

8.3. With a positive result of laboratory diagnostics of an animal examined for rabies, the initiated course of specific anti-rabies treatment continues, with a negative result, the course of vaccination is terminated.

8.4. If the animal has clinical manifestations suspicious of rabies, the course of antirabies treatment is continued, despite the negative result of laboratory diagnostics.

8.5. If the animal under observation did not fall ill (did not die) within 10 days from the moment of injury (salivation) to a person, then the course of anti-rabies treatment is terminated.

8.6. In cases of various violations of the course of anti-rabies vaccinations (failure to comply with the terms of vaccination, violation of the sequence of administration of the drug, etc.), the immune status of the vaccinated should be determined in order to further adjust the specific treatment.

8.7. Determination of the immune status is mandatory in individuals whose specific treatment is carried out while taking corticosteroids and immunosuppressants, as well as HIV-infected

8.8. At the end of the course of preventive and curative-prophylactic immunization, each victim must be issued a certificate of vaccination against rabies.

8.9. Rabies treatment includes topical wound care as soon as possible after a bite or injury, and the administration of a rabies vaccine. If indicated, a combined course of treatment is carried out: rabies immunoglobulin (RIG) for the purpose of passive immunization and rabies vaccine in accordance with the instructions for the use of rabies drugs.

What rabies vaccines and immunoglobulins are registered in the Russian Federation?

Doses and immunization schedules are the same for children and adults. The course of treatment with the vaccine is prescribed regardless of the period of the victim's request for help, even several months after contact with a patient suspected of rabies or an unknown animal (except for rabies immunoglobulin).

As a standard, the following scheme of post-exposure anti-rabies prophylaxis is used in the Russian Federation:

Day 0 is the day of the first vaccination (sometimes rabies immunoglobulin is administered in addition to the vaccine) - Day 3 - Day 7 - Day 14 - Day 30 - Day 90.

When is it possible to prematurely terminate the course of anti-rabies vaccinations?

Clause 8.5.

"If the animal under observation did not fall ill (did not die) within 10 days from the moment of injury (salivation) to a person, then the course of anti-rabies treatment is terminated."

What to do if the rabies immunization schedule is violated (the follow-up vaccination was not introduced or was not introduced on time)? Can vaccinations be given at other times that do not coincide with those indicated in the instructions?

The efficacy of the rabies vaccine has been investigated only when used within the terms indicated in the instructions. Violation of the timing of the introduction of the next anti-rabies vaccinations can lead to ineffectiveness of the vaccination course if the animal was rabies.

Sanitary and Epidemiological Rules of the Joint Venture 3.1.7. 2627 -10 "Prevention of rabies among humans" paragraph 8.6:

"In cases of various violations of the course of anti-rabies vaccinations (failure to comply with the terms of vaccination, violations of the sequence of administration of the drug, etc.), the immune status of the vaccinated should be determined in order to further adjust the specific treatment."

Is it possible to continue the rabies vaccination course in different cities if I have to travel?

If the situation with the trip is completely insurmountable, then you need to consult in person with the doctor of the medical facility where you are vaccinated against rabies (or with a specialized rabies doctor, see below), and decide how and where it is possible to continue vaccination on the trip.

If a person previously received a full course of rabies vaccinations and after a while was bitten again, is it necessary to repeat the vaccinations and how exactly?

The procedure for vaccination in such cases is indicated in the instructions for the COCAV vaccine:

“..For persons who have previously received a full course of preventive or prophylactic vaccinations, from the end of which no more than 1 year has passed, three injections of the vaccine, 1.0 ml each, at 0, 3 and 7 days are prescribed; if a year or more has passed, or an incomplete course of immunization was carried out, then - in accordance with the given "Scheme of therapeutic and prophylactic vaccinations with COCAV and anti-rabies immunoglobulin (RIG)".

Where can I get rabies medical care and advice on rabies and its prevention in humans?

Sanitary and Epidemiological Rules of the Joint Venture 3.1.7. 2627 -10 "Prevention of rabies among humans" clause 9.9.

“In each municipality, a center (office) for rabies care should be organized on a functional basis on the basis of one of the health care facilities that have a trauma center or a trauma department to provide rabies care to people who have suffered from animal bites. Specialists of the centers (offices) of anti-rabies care:

Decide on the amount of anti-rabies treatment in each specific case and decide on the cancellation of such treatment in accordance with the indications;

An analysis of the appealability, causes and circumstances of animal bites on humans is carried out;

Submit proposals to the bodies exercising state sanitary and epidemiological supervision on the necessary preventive measures;

Organize explanatory work with the population on the prevention of rabies. "

Who is a rabiologist and where can I find him?

A rabbiologist will usually see and advise patients, administer rabies vaccinations and follow-up.

Usually it can be located in territorial clinics or emergency rooms. The availability of such a doctor at your place of residence should be checked with the health department of your city (district).

Where can a healthcare professional get advice on rabies and its prevention in humans?

The Center for the Fight against Rabies (FSBI "Scientific Center for the Expertise of Medicinal Products") provides consultations to medical workers. In especially difficult cases, the Center conducts a determination of the immune status of persons who have suffered from bites by various types of animals, the treatment of which was carried out with various violations of the "Instructions for the use of antirabies drugs" in order to make adjustments to the ongoing or carried out vaccination course.

What is prophylactic (pre-exposure) rabies immunization?

Pre-exposure (pre-exposure) vaccination should be given in people at high risk of rabies. These can be both people of a certain profession (veterinarians, animal catchers, etc.), and travelers to rabies-endemic areas of the world, where they can come into contact with animals, and immediate access to adequate medical care is limited.

What contingents in the Russian Federation are subject to pre-exposure vaccination against rabies and where is it regulated?

Sanitary and Epidemiological Rules of the Joint Venture 3.1.7. 2627 -10 "Prevention of rabies among humans"

X. Prophylactic immunization against rabies

10.1. Preventive vaccinations against rabies are included in the national immunization schedule for epidemic indications.

10.2. For immunoprophylaxis, medical immunobiological preparations approved for use in the Russian Federation are used.

10.3. Storage and transportation of medical immunobiological preparations at all stages must be carried out in compliance with sanitary and epidemiological requirements.

10.4. Prophylactic vaccination against rabies is subject to:

10.4.1. Service workers carrying out the capture of animals (catchers, drivers, hunters, foresters and others.);

10.4.2. Workers of veterinary stations for combating animal diseases who have contact with animals (veterinarians, paramedics, laboratory assistants, junior staff);

10.4.3. Workers of research institutes and diagnostic laboratories conducting research on rabies;

10.4.4. Workers of vivariums and other institutions working with animals.

Which health care provider can receive pre-exposure prophylaxis against rabies?

Sanitary and Epidemiological Rules of the Joint Venture 3.1.7. 2627 -10 "Prevention of rabies among humans"

10.5. In medical and prophylactic institutions, only persons with a high risk of infection (pathologists, specialists involved in parenteral interventions for patients with rabies) are subject to prophylactic vaccination against rabies.

What are the side effects of rabies vaccination? Where to contact?

Side effects are likely to occur with any vaccine and are local or general. A list of possible adverse reactions to a specific vaccine can be found in its instructions for use.

Which anatomical area should you administer rabies vaccine to? Can it be injected into the gluteus muscle?

When can the introduction of rabies vaccine start, are there deadlines? Is the dosage of the vaccine different for children and adults?

The instructions for the COCAV vaccine indicate that “... Doses and immunization regimens are the same for children and adults. The course of treatment with the vaccine is prescribed regardless of the period of appeal of the victim for help, even several months after contact with a patient suspected of rabies or an unknown animal (except for rabies immunoglobulin). "

The first vaccination should be carried out as soon as possible.

Is it possible to refuse vaccinations with post-exposure (after exposure) vaccination against rabies?

In accordance with the Fundamentals of the Legislation of the Russian Federation on the Protection of Citizens' Health (Article 33) "A citizen or his legal representative has the right to refuse medical intervention or demand its termination."

It is your right to refuse medical care and vaccinations. Rabies is 100% fatal. If clinical symptoms of rabies develop (in humans, this disease is also called Hydrophobia), then it cannot be cured in any country in the world.

Can vaccinations be waived for prophylactic (pre-exposure) rabies prophylaxis?

In accordance with the Fundamentals of the Legislation of the Russian Federation on the Protection of Citizens' Health (Article 33) "A citizen or his legal representative has the right to refuse medical intervention or demand its termination ..".

In accordance with the Federal Law of September 17, 1998 N 157-FZ "On immunization of infectious diseases" Article 5. Rights and obligations of citizens in the implementation of immunization:

1. Citizens in the implementation of immunization have the right to:

Refusal of preventive vaccinations.

2. Lack of preventive vaccinations entails:

• a ban for citizens to travel to countries in which, in accordance with international medical and sanitary rules or international treaties of the Russian Federation, specific preventive vaccinations are required;
• temporary refusal to admit citizens to educational and health-improving institutions in the event of mass infectious diseases or the threat of epidemics;
• refusal to admit citizens to work or suspension of citizens from work, the performance of which is associated with a high risk of contracting infectious diseases.

Decree of the Government of the Russian Federation of July 15, 1999 N 825 approved a list of works, the performance of which is associated with a high risk of contracting infectious diseases and requires mandatory preventive vaccinations:

1. Agricultural, irrigation and drainage, construction and other work on excavation and movement of soil, procurement, field, geological, prospecting, expeditionary, deratization and disinsection work in areas unfavorable for infections common to humans and animals.

2. Work on logging, clearing and landscaping of forests, health improvement and recreation areas of the population in areas unfavorable for infections common to humans and animals.

3. Work in organizations for the procurement, storage, processing of raw materials and livestock products obtained from farms unfavorable for infections common to humans and animals.

4. Work on the procurement, storage and processing of agricultural products in areas unfavorable for infections common to humans and animals.

5. Work on the slaughter of livestock sick with infections common to humans and animals, the procurement and processing of meat and meat products obtained from it.

6. Work related to the care of animals and the maintenance of livestock facilities in livestock farms, unfavorable for infections common to humans and animals.

7. Work on the capture and maintenance of stray animals.

8. Works on maintenance of sewerage facilities, equipment and networks.

9. Work with patients with infectious diseases.

10. Work with live cultures of infectious diseases pathogens.

11. Work with human blood and body fluids.

12. Works in all types and types of educational institutions.

Thus, if a profession is associated with the need for prophylactic (prior to exposure) vaccination against rabies, then a person has the right to refuse vaccination, but then he does not have the right to work in this profession.

Bitten by a monkey (dog, cat, etc.) while vacationing in another country. They were vaccinated against rabies with a foreign-made vaccine. How can you continue to vaccinate against rabies when you return to Russia?

In Russia, for detailed cases, there are no official recommendations for switching from foreign manufacturers' anti-rabies vaccines to domestic vaccines.

In practice, regardless of the specific vaccine of which the course was started, then the vaccination scheme is continued with any anti-rabies vaccine registered in Russia. It is advisable to bring a certificate of vaccinations made abroad (date, dose, name) to the emergency room.

An updated WHO position paper on rabies vaccines was published on 9 July 2010 in the Weekly Epidemiological Record (WER) in Russian:

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5902a1.htm (in English).

In July 2009, the ACIP Committee voted to exclude the fifth dose of vaccine for post-exposure prophylaxis in previously unvaccinated individuals in the absence of immunosuppression. The decision is based on evidence that the immune response will not be reduced, the need for vaccines will decrease, and there will be benefits to both patient health and the economy from fewer medical visits and fewer doses. Updated guidelines for a four-dose schedule for post-exposure rabies prophylaxis were published in the MMWR on March 19, 2010.

Side effects of rabies vaccination in humans, its complications, allergic reactions are the topic of many discussions. Although this disease is a huge life-threatening condition, it is not safe to fight it either.

Contraindications to the administration of the vaccine

There is a risk of developing adverse events after taking any drug. Rabies vaccinations for humans also have contraindications.

Contraindications:

1. Pregnancy (at any time).
2. Exacerbation of any diseases (acute, chronic, non-infectious, infectious, tumors, immunodeficiency states, etc.). Sustained recovery, by the time of vaccination should last at least a month.
3. Allergic reactions of a systemic nature revealed after previously carried out prophylactic injections.
4. The presence of allergic reactions to drugs, antibiotic groups.

It should be borne in mind that this is true only with the prophylactic administration of the vaccine if it is prescribed before the bite of a suspicious animal (to people who may come into contact with rabid animals). Vaccinations are applied to persons whose profession involves the possibility of such contact (hunters, veterinarians, foresters, etc.). For prophylactic purposes, vaccination can also be carried out for residents of natural foci of the disease. After all, the danger of contracting rabies from wild animals is quite real today.

If a bite with damage to the skin or contact of an animal (fox, wolf, dog, cat, etc.) with saliva on the scratch site has already occurred, then there can be no question of the impossibility of prophylaxis. Pregnant women are vaccinated to save the mother's life. Since when symptoms of the disease appear, her death, and hence the death of the fetus, is inevitable. Vaccination is also done at the time of exacerbation in a bitten person with other life-threatening diseases (including neurological, oncological, etc.). This is because rabies is a particularly dangerous disease caused by a virus. If untreated, this disease leads to death in the vast majority of cases of clinical symptoms. The developing damage to the nervous system is so significant that it causes paralysis of the centers in the brain and respiratory arrest. Therefore, as epidemiologists say, "it is better to inject for three months than to remember all your life."

Rabies treatment

The pharmaceutical industry has found formulas that can successfully fight many formidable diseases: hypertension, the bird flu virus, and even some types of cancer. Unfortunately, there are no such achievements in the direction of rabies. There is no specific treatment. A person diagnosed with rabies is urgently hospitalized. The hospital is provided with a protective regime. Treatment is reduced to weakening the manifestations of the disease (its symptoms):

• With increased arousal, hypnotics, sedatives, anticonvulsants and pain relievers are administered.
• If fluid is lost, solutions are given intravenously.
• Nutrition is carried out by the introduction of glucose and proteins.

Rabies prevention

Due to the fact that the mortality rate from the disease is 100%, all actions to combat rabies are aimed at preventing it:

Extermination of sick animals. The introduction of a quarantine regime in the infected areas. Vaccinations for domestic and farm animals (cats, dogs, etc.).

Vaccination of humans:

• Before direct contact of the beast with a person.
• After a bite or contact with animal saliva on the mucous membranes.

The most effective is a combination of all activities.

What rabies vaccinations are there

After the bite of an unfamiliar, suspicious carriage of a virus or a sick animal, according to the recommendations of the WHO and the Ministry of Health of the Russian Federation, a vaccine is administered (KOKAV, Rabivak-Vnukovo, Rabipur, etc.). These drugs include an inactivated (killed) rabies pathogen. It cannot lead to infection. The purpose of the introduction of inactive viruses is the production of its own antibodies by the human body. After such inoculation, the synthesized substances prevent the virus from invading the human nervous system and moving to the spinal cord and brain, causing encephalitis. It is the latter that leads to the death of a person.
When to vaccinate against rabies

The choice of vaccination method will determine its effectiveness and human life. The schedule and timing of vaccine administration will vary depending on the depth of contact with the animal. Defeats are divided into groups:

• Local
• General

The first include changes in the skin at the injection site: itching, redness, induration, rash. These phenomena quickly disappear with the use of symptomatic agents (antihistamines, etc.).
The side effects of rabies vaccination in the second group are more dire. These include the phenomena of general malaise: a rise in body temperature, lethargy, headache. Neurological complications are fraught with great danger, although they are much less common. These include impaired sensitivity (more often in the limbs), autonomic disorders, paresis. It is recommended that such patients be treated in a hospital setting. Neurological manifestations can be observed in patients for up to 3 months. In contrast, gyneralized allergic reactions in the form of Quincke's edema are extremely rare. Despite their significant danger to life, they more quickly lead to stabilization of the condition with adequate treatment.

Complications from the administration of rabies immunoglobulin

Side effects of vaccination with inactivated virus only and with the introduction of a combination of AIH and vaccine will be different. The administration of rabies immunoglobulin may be painful. Pain at the injection site will be a common adverse reaction at a later date. Complications in the form of allergic reactions will be typical for the prevention of AIH. The time of development of local side effects will fluctuate within one to two days after the introduction of AIH. Anaphylactic shock can develop with lightning speed. Serum sickness, as an example of a common complication, from 6 to 9 days after vaccination.

No matter how dangerous and painful it is to carry out preventive measures, in this case, as infectious disease specialists say, it is "the only thing that can save a human life."

Discussion: 8 comments

I don’t understand there is a round wound on the back of my leg. Probably left from the summer when the mosquito bite combed (there was a cloud of them in the village). What if a stray dog ​​bites from behind? but I didn’t feel and didn’t notice ... and what should I do now or not?

If everything is so terrible, why not vaccinate everyone prophylactically? Children are vaccinated in dozens, they would add against rabies and live peacefully.

GUEST, because you need to get vaccinated against rabies every year, plus you shouldn't drink alcohol for the first month after vaccination. Also, for example, to be grafted into Flax. region and some other areas make no sense, because the area is safe for this disease. And in general, vaccination of domestic and wild animals, + control of the number of wild animals - the reservoir of the rabies virus has a much greater effect in the non-spread of this disease.

Sergei, if you had a wound from a dog infected with rabies since the summer, then now you would be gone. You don't have to be vaccinated.

The rabies vaccine is only valid for about a year. Vaccinate children every year? Plus, the vaccine is very difficult for the body, some destruction of the immune and near the immune mechanisms of the body occurs, up to the likelihood of the appearance of autoimmune reactions.

I was bitten by a yard dog, they gave me an injection against rabies, and today I feel lethargic and low blood pressure from the columnar. How can this be related to injections?

Lethargy, redness at the injection site of the anti-rabies vaccine, what should I do?

Mom was bitten by a neighbor, an unvaccinated dog. Mom was walking with her dog and he rushed at the dog first, and then at mom, as he tried to drag her aside. He bit his hand. The neighbor's dog feels great so far, there was no foam. The hospital treated the wound and said that it was too early to do the vaccine, you need to watch the neighbor's dog, but he is still fine. They also replied that there is no rabies in our area. The bite site healed quickly, but a bruise and hematoma remained. I am very afraid for my mother, her blood pressure is already jumping, and now it's just awful. How to determine that Neighbor is sick? Maybe I was just defending the territory?

Rabies is an infectious disease. The virus enters the human body in the presence of damage to the skin with the saliva of an infected animal. The most common mode of transmission of the disease is through a bite. In such a situation, a special vaccination is needed.

The incubation period in humans is 1-8 weeks. When an animal suffering from this ailment bites a person, his saliva gets into the resulting wound, as a result of which the pathogen is transmitted. The first step in a bite is to wash the wound for a long time with clean water and soap.
Then immediately contact a medical facility, where the necessary assistance will be provided, and most importantly, an injection is given.

It must be remembered that there is a chance of getting infected even from pets. Through an oversight of their owners, they can interact with "rabid" animals and catch the infection. The most common domestic carriers of rabies are dogs and cats.

Vaccination is necessary for people interacting with various animals at work: zoo workers, veterinary staff, gamekeepers, as well as representatives of other similar specialties.

The most dangerous thing is to be bitten without having rabies injections. Cases when, having received only a small wound and hoping for a positive outcome, a person forgets about it, also lead to serious consequences. But even an almost imperceptible wound is enough for the virus to enter the body. Children are at particular risk because they often simply do not tell adults about the attack.

The percentage of infected people ranges from 20 to 90 percent. The location, as well as the depth of damage, are very important for carrying out diagnostic measures. The most dangerous are lesions of the face and upper limbs.

How does the infection take place?

Angry dog ​​- increased threat

When a pathogen in saliva enters the wound. It doesn't matter if it is a bite or any other damage to the skin, such as an abrasion or a scratch. Mucous membranes (mouth, membrane of the eye, etc.) are also a suitable place for the penetration of a pathogenic agent into the body.

It should be noted here that to date, the possibility of transmission of the disease from people to people has not yet been proven, but you still need to take precautions in the process of communicating with infected people.

Signs

Understanding what kind of disease it is, you should dwell on its symptoms. A certain amount of time passes from the moment of infection until the onset of the initial symptoms. Basically, this period is from ten to sixty days. However, in certain cases, this period increases to one year or decreases to five days.

The vaccination cycle must be completed before symptoms appear!

1. primary symptomatology
2. the appearance of acute neurological pathologies
3. paralytic state

The duration of the phase of manifestation of the initial signs is several days. There is pain and itching in the affected area, a healed wound or a scar begins to become inflamed and redden again. The temperature rises, but not significantly.
Headaches, negative health, weakness, nausea, diarrhea, pain during swallowing, feeling of lack of air occur. The level of visual and auditory sensitivity increases. Sleep disorders appear in the form of insomnia or nightmares. At the same time, these signs sometimes act as symptoms of other diseases.
It often happens that an infected person is diagnosed with acute respiratory viral infections or the presence of an acute intestinal infection. Therefore, appropriate therapy is prescribed. In order for the symptoms to never appear, it is necessary to vaccinate in the first 12 days.
The phase of neurological pathologies is characterized by lesions of the nervous system. The condition becomes difficult, aggression appears instead of weakness. The patient is poorly oriented in reality, mental processes are disturbed, he can attack others, try to bite. Patients are in an agitated state, emotionally overly active, able to escape.

Then convulsions and hallucinations follow. A variety of phobias are manifested, provoked by gusts of wind, water, the thought of the elements, bright light, loud sounds.
During seizures, the face begins to distort, spasms of the muscles of the pharynx, larynx, vomiting, hiccups appear. The body temperature rises to forty degrees, which is typical. Between the differences in health, the patients behave quite calmly, adequately, are conscious.

The final phase occurs in a couple of days if the patient is healthy and has not died from prolonged spasms of the muscles of the respiratory system. During this phase, muscle paralysis increases. There is a split in the eyes, the function of the pelvic organs is disrupted, the face is distorted, the excitatory processes weaken. Patients become calmer, begin to eat, drink water, there are no convulsions. However, this well-being is false, and literally twenty hours later, death occurs - breathing and heart suddenly stop. You can learn more about the signs.

Vaccination - where and how much

The first anti-rabies drug was created at the end of the 19th century. It was invented by a French microbiologist Louis Pasteur. An injection in 1885 saved a nine-year-old boy. How many people were saved in the future can no longer be counted. It is a fact.
But the forty injections in the stomach known to almost everyone is a myth. There are only six of them: below the shoulder or in the gluteus muscle. The course completely eliminates the virus. The first is carried out immediately after the victim is admitted to the medical facility, the second - on the 3rd day, the third - on the 7th, the fourth - on the 14th, the fifth - on the 30th, the sixth - on the 90th day.

And this is the only way to defeat the infection. A full course of treatment is usually needed. However, if there is an opportunity to observe the bitten animal, and it has not died ten days later and feels great, it is permissible to stop the treatment.

Please note that the injection can only help in the absence of the first symptoms. In the case of their manifestation, the likelihood of death is very high. Most often, the victim is saved by the fact that the incubation period in homo sapiens lasts longer, and the time to the initial signs, respectively, is longer.

What are the guarantees

On average, one hundred percent cure is guaranteed. However, positive results may not be achieved in the presence of such signs:

• weakness of immunity due to congenital abnormalities;
• the duration of taking immunosuppressive and glucocorticoid drugs;
• late implementation of the beginning of the course of treatment;
• violation of the term and storage conditions, incorrect introduction;
• alcohol;
• skipping procedures.

It should be noted here that alcohol consumed by the patient usually reduces the treatment to zero.

Time spending

It is important to get help before the end of the incubation period. It has a significant duration - it can last for several weeks and even drag on for months. For this reason, vaccination must be performed without fail in every suspicious case.

Even with the shortest duration (ten days), a patient who timely applied for medical care will have time to receive 3 doses of the drug and immunoglobulin, which minimizes the chance of getting sick.

• The disease is not transmitted through the contact of a sick person with a healthy person, however, facts of infection during organ transplantation from an infected person in the incubation phase of the disease are known.
• In children, the development of the disease is not affected by the implementation of professional activities. It is they who are more in contact with various animals, but, as previously noted, they may be afraid to say about the bite.

The therapy, started in the incubation phase, helps the human body to produce certain antibodies that prevent the virus from entering the nerve cells and reaching the central nervous system, where it mainly causes the onset of encephalitis. The latter is fatal.

Do not forget that the duration of the incubation period largely depends on the localization of the site, for this reason, bites are distinguished:

1. With a dangerous localization - damage to areas of the head, face, neck, upper limbs.
2. With a non-hazardous localization - damage to other surfaces of the body.

The likelihood of getting infected depends largely on the source of the infection. Warm-blooded predators are mainly affected - foxes, wolves. In the event of an attack by a pet, vaccination is not necessary if there is accurate information about its vaccination and the possibility of constant monitoring.

Methods

The introduction is carried out in a dosage of one milliliter, exclusively in medical institutions. The dose contains 25 IU / ml of antigen and is the same for both children and adults.

There are cases when adverse reactions developed and immunization was ineffective.

The injection is relatively painless. However, it should be remembered that it is incompatible with alcohol. If the vaccinated person consumes alcohol, the vaccine will not give any effect.

Prophylaxis

To date, prophylaxis is carried out with the help of KOCAV lyophilisate (with the pathogen inactivated by ultraviolet light), suitable for both children and adults. If all the recommendations are followed, the risk of spreading the disease is minimized, however, with a significant likelihood of infection, an additional immunoglobulin should be administered.

The dose of the drug, the schedule, and the mode of administration are the same, regardless of age. Vaccination is part of the national immunization plan in accordance with current legislation. Therefore, when receiving emergency medical care, the question of its cost in a state institution should not bother the patient.

How many injections need to be delivered and what this number will depend on will be said by an exclusively highly qualified rabiologist who examines, analyzes and evaluates the number of wounds, their depth, location. He also determines the circumstances of the interaction, knowing the epidemiological characteristics of the disease in a particular locality.

With a favorable situation in a specific settlement, insignificant indicators of the probability of infection (there is a possibility of monitoring unvaccinated pets, or the possibility of their having an infection in accordance with the data of laboratory examinations is completely excluded), the vaccination schedule can be limited to 3.
Among certain categories of the population who, according to the specifics of their work, interact with probable carriers of the virus, preventive measures are being taken.

Features of primary prevention

Routine prevention involves the vaccination of groups of citizens at risk (dog handlers, veterinarians, trainers, etc.). Children under 16 are vaccinated only with a bite.

Preventive measures include the following:
The vaccine is given three times.

The second injection is given seven days after the first. The third - 21 (or 28) days after the 1st. Basically, they are placed on the top of the shoulder.

Every living thing develops antibodies in the blood serum.

Features of secondary prevention

If an unvaccinated child has been bitten by an animal, you must immediately determine whether it is healthy. If there is a risk of infection, the baby is prescribed immunoglobulin and a series of five anti-rabies drugs for twenty-eight days. In general, the temperature does not rise after the injection.

It is better to start treatment no later than two days after infection. It is necessary to process the bitten site as early as possible. Initially, it is necessary to clean the wound surface by washing it with soap and water for 10-15 minutes. Then, immunoglobulin should be injected into the wound site and adjacent tissues. Such actions will prevent the virus from entering the central nervous system. The dosage recommended by experts is 20 IU / kg. The remains are injected intramuscularly into any place remote from the damaged area.

Immunoglobulin is not injected where the vaccine is. The injection is performed once, due to which specific antibodies are generated in the blood, which act until the body itself is able to produce them in response. Repeated administration of immunoglobulin can lead to a disruption in the production of antibodies, as a result of which the disease can progress.

The scheme of therapy is as follows: the introduction of an anti-rabies immunomodulator is performed on the 3rd, 7th, 14th and 28th days, one milliliter after the first application. The initiated series of vaccinations can be stopped only when rabies is not found in the animal.

The question arises, how long does the injection last? In this case, no one will give a definite answer, it all depends on the vaccine itself. One will be valid for 3 years, the other for 2.

Contraindications

Before prescribing treatment, the doctor should identify contraindications. For example, if a child has a tumor, HIV / AIDS, side effects after a previous vaccination, the immunization should be done very carefully.

Primary prophylaxis is not carried out with weakened immunity.
If a hypersensitive reaction develops after immunization, treatment with antihistamines is carried out.

With a history of allergy to egg white, it is impossible to use antiviral drugs produced in chicken embryos. But in general, there are no significant contraindications.

The occurrence of side effects

There is evidence that at present, a large number of modern vaccines do not cause negative consequences, or those are extremely rare.

The likelihood of developing side effects increases with the number of doses used.
Among the main problems are intolerance to certain components of the drug.

Rabies vaccination is salvation for humans. Only vaccination can reliably protect against the virus and help save the life of the victim. Despite the possible adverse reactions from vaccination, all people bitten by sick animals, regardless of gender and age, should receive it.

What is rabies

Rabies is a very dangerous disease of viral origin. Infection of a person is carried out through the bite of an animal sick with rabies. The disease is quite serious, since, spreading through the damaged skin along the nervous system, it causes a fatal phenomenon for human life - inflammation of the cerebral cortex (encephalitis). Both pets and wild animals can transmit the rabies virus. Dogs are the most common sources of this deadly disease. Vaccination is currently the only way to prevent the development of the disease after contact with a sick animal.

Who needs to get vaccinated

Vaccination is required:

• In case of bites, scratches or salivation of the skin and mucous membranes by rabid animals.
• If the integrity of the skin is broken by objects marked with the saliva of rabid animals.
• In the case when a rabid animal has bitten a person through clothing and there are obvious skin disorders.
• In a situation, if the attacking animal died 5-7 days after the bite.
• For bites of wild animals.

Also, special attention to the issue of rabies vaccination should be given to people whose profession involves interaction with wild or sick animals. The following specialties are distinguished: forester, veterinarian, hunter.

Situations in which rabies vaccination is not given:

• If the vinegar has come through a dense layer of clothing and the skin has not been damaged.
• If, after 10 days after the bite, the animal that committed the attack remained healthy.
• If the animal is vaccinated against rabies.

Actions when bitten by sick animals

If a person has become a victim of a sick animal, the first thing to do is to try to calm down and get to the medical facility as soon as possible.

The saliva of a sick animal rapidly diverges through the blood vessels, penetrating into the brain. Therefore, it is impossible to hesitate with a trip to the doctor, every minute can cost your life.

First aid

Emergency help in case of an attack by a sick animal:

• Immediately after the bite, wash the wound with warm water and laundry soap. The alkali in the soap destroys the rabies virus that may have entered the wound. Also, the soap solution is excellent for washing out the animal's saliva and dirt.
• Be sure to treat damaged skin with an antiseptic. For these purposes, iodine, brilliant green or a solution of potassium permanganate is well suited.
• Apply an antibacterial ointment to the wound.
• After this careful treatment, cover the wound with a sterile gauze bandage.
• After receiving first aid, try to get to the doctor's office as soon as possible.

Signs of rabies

It is very important to know whether the attacked animal is sick with rabies or not? To determine this, you need to know some of the signs of rabies in animals:

• the animal is unnaturally calm or, on the contrary, shows signs of unmotivated aggression;
• the animal is huddled in dark corners;
• there is profuse salivation and the tongue falls out;
• the animal eats inedible items and categorically refuses to drink water;
• if the dog is mad, then it does not bark, but only howls or whines.

Vaccination instructions

The modern method of vaccination against rabies is simpler than it was ten years ago. There are several schemes for setting vaccinations, which are applied depending on the situation.

Rabies vaccines are not given in the abdomen. The graft is injected into the gluteus maximus or shoulder muscle.

Vaccination in the event of an attack

If a person is attacked by an animal infected with rabies, then the following vaccination schedule is used:

1. the vaccination is done immediately after the victim goes to the doctor;
2. another vaccination is given on the 3rd day;
3. at the end of the first week after the bite of a sick animal;
4. on the 14th day;
5. vaccination on the 30th day;
6. the latter is done on the 90th day after the bite.

This rabies vaccination scheme provides the most robust immunity.

Additional vaccination after an attack

A patient who received a rabies vaccination no more than 1 year ago, in the event of an attack by a sick animal, undergoes additional vaccination, carried out according to a slightly different schedule:

1. one vaccination on the day the animal was attacked;
2. vaccination on the 3rd day;
3. and another one after 7 days.

Preventive vaccination

Persons at risk (veterinarians, foresters) are recommended preventive vaccination, which is carried out according to a specially established schedule, regardless of whether there was an attack by a sick animal or not. The vaccination schedule is as follows:

• vaccination on the day of treatment;
• another one after 7 days;
• vaccination on the 30th day;
• a year later, the first revaccination is carried out;
• and then one shot every three years.

Vaccination has the maximum effect on the rabies virus, if the victim has not yet developed the first symptoms of the disease. This period (incubation) lasts from 10 to 90 days. Otherwise, the likelihood of death is very high.

Types of vaccines

When vaccinating against rabies, two types of vaccines are used:

1. CAV - cultural rabies vaccine (Rabivak). The drug is injected subcutaneously into the anterior wall of the abdominal cavity. One dose is 3 ml.
2. CoCAV is a concentrated cultural rabies vaccine (Rabipur). It is more effective. Purified, inactivated vaccine is intended not only for the treatment of rabies, but also for the prevention of the disease. The drug is available in the form of a dry powder for injections. The vaccine is administered intramuscularly only, and one dose is only 1 ml.

Interaction of the vaccine with other medicinal products

Certain drugs may have a negative effect on the production of antibodies against the rabies virus:

• Drugs, the action of which is aimed at strengthening the immune system.
• Chemotherapy drugs.
• Radiation therapy drugs.
• Glucocorticosteroids.

The decision to stop taking these drugs is made by the attending physician.

Contraindications

There is always a risk of side effects after the vaccine is administered. Therefore, it is not recommended to vaccinate against rabies in the case of:

• Pregnancy (regardless of timing).
• Exacerbation of chronic diseases.
• The presence of cancer in the patient.
• Identification of allergic reactions to previous vaccinations.
• Individual intolerance to individual components of the vaccine.

Contraindications are mainly related to preventive vaccinations. In the event of an attack by a rabid animal, refusal to vaccinate will most likely cost the person his life.

Possible side effects

A shot of a vaccine can lead to a number of reactions of a diverse nature. The most common are:

• Itching of the skin.
• Significant swelling at the injection site.
• Swollen lymph nodes.
• Increase in body temperature up to 38.0 ° C.
• General weakness
• Headaches and muscle pains.

Also, the side effects of rabies vaccination can be more severe:

• There is aches in the joints.
• A febrile condition is present.
• Hives appear on the skin.
• Especially severe cases can be accompanied by disorders of the autonomic system.
• Quincke's edema.

The most dangerous consequence of the rabies vaccine is anaphylactic shock. This instant allergic reaction can lead to the death of a person.

The negative effects of rabies vaccine should disappear after ninety days.

Rules of conduct after vaccination

After a person is vaccinated against rabies, it is very important to adhere to certain rules and requirements:

• Drinking alcohol is categorically unacceptable. Ignoring this rule can lead to nervous seizures, the emergence of special sensitivity to various external stimuli, possible seizures of epilepsy.
• You cannot overheat or, on the contrary, overcool.
• Do not stay in direct sunlight for a long time.
• It is strictly forbidden to wet the vaccine injection site.

On the first day after vaccination, do not contact with water at all. Under the influence of moisture, the risk of allergic reactions increases significantly. Contact with water, on the first day after the injection of the vaccine, can provoke an increase in body temperature, the occurrence of general weakness and chills.

The importance of rabies vaccination and its possible consequences in the video.

Vaccination against rabies after an animal bite is a very important event that can protect a person from this serious fatal ailment. If the spread of the virus is not prevented in a timely manner, a person dies within ten days.