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Thread: A NPE Story - Rabies and the Hospital

  1. #21
    Site Supporter misanthropist's Avatar
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    Quote Originally Posted by Sensei View Post
    The idea behind a rabies vaccine is to give a person killed/inactivated virus so that their body produces antibodies to the live virus that will protect against infection. Anyone who is at high risk for rabies exposure (animal Control workers, rabies virologists, etc.) should get this series of vaccine shots. However, it takes a couple weeks for your immune system to produce sufficient antibodies to protect against rabies infection. As you can imagine that 2 week window is no bueno if you just got bit by a rabid animal and the incubation can be as short as 1 week. Thus, we give people an additional medication called rabies immunoglobulin (RIG) which are preformed antibodies that will bind-up as much virus as possible while we wait for your immune system to respond to the vaccine with your own antibodies. That one time dose of RIG is given in/around the bite to bind-up as much virus as possible which is concentrated at the bite for the first week. For big people who get a lot of RIG, we give about half at the bite site and the rest upstream but away from the vaccine so that it does not bind up the vaccine.
    Thanks very much for that! I had no idea there was even a hope of post-exposure inoculation. Over in my "on the island" thread I'll get into the story of my interest in this.

  2. #22
    Member Aisin Gioro's Avatar
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    Quote Originally Posted by misanthropist View Post
    Thanks very much for that! I had no idea there was even a hope of post-exposure inoculation. Over in my "on the island" thread I'll get into the story of my interest in this.
    The "good" thing about rabies vaccination/RIG is that it also gives you very long-lasting degree of partial immunity, so if you have future exposures, you can generally just get a booster of the vaccine and won't have to go through the whole RIG protocol again. As the WHO says, "The immune response to subsequent rabies vaccine boosters such as Post-Exposure Prophylaxis [PEP] when exposed, can be recalled very effectively even decades after Pre-Exposure Prophylaxis [PrEP]." In more developed settings, they like to titre and get a working estimate of immune response when deciding on whether to booster, but realistically, in a lot of the places where rabies is a concern, this is just not practical or maybe even available, so they go ahead with the booster. The other good news is that the current (post-1970s era) RIG/vaccination protocol has is pretty faultless when given in a First World setting. For reasons related to poor infrastructure and questionable practices, there have been a few instances in undeveloped or developing places where things like a lack of proper refrigeration have compromised the RIG and/or vaccine, but that's really not an issue most need to worry about. A friend of mine in China just had to go through the process last year, and she subsequently received a notice from the hospital that there "may be reduced long-term effectiveness" in the PEP she got, but of course they didn't say why, or even that it was related to any problems. Hmmm, could it have something to do with this?

    "Chinese maker of faulty rabies vaccines fined billions of yuan"

    https://www.nature.com/articles/d41586-018-07136-z

    "The company was caught selling ineffective medicines in July [2018]. The regulator determined that when the company created several batches of faulty rabies vaccine, it broke multiple laws, including: using expired products to make the vaccine; not testing the potency of vaccines according to prescribed methods; and destroying evidence to cover up its actions."

    I've had the RIG/initial vaccine series plus one booster session (not in China, thankfully), and while the RIG is not especially fun, it's really nothing more than a set of two large (20 to 40IU/kg of body weight, depending on the type), slow injections, one being as much as possible at the wound site and the rest someplace intramuscular ("gluteal region preferred", as they say). The vaccine portion is nothing, 1mL or 0.5mL each depending on the vaccine, and feels about like getting a flu shot each time. That said, where you need the wound-infiltrating portion of the RIG can make a difference on how uncomfortable it is. I knew someone who needed to get it in the tissue of the ear...ouch!

  3. #23
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    The friend of a former labmate was walking by a trash bin on campus one day and pitched a piece of trash into the bin. Unfortunately a squirrel digging around in the bin interpreted this piece of trash as a threat of grave bodily injury, sprang out of the bin, and in a brave act of self defence, bit the guy on the face before retreating up into the trees. The poor guy had to get the Ig injections in his face.

    I teach about half a lecture on rabies, and every year I think about getting the vaccine just because.

  4. #24
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    I just want to know where you all live that the hospitals have metal detectors???

  5. #25
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    A NPE Story - Rabies and the Hospital

    Quote Originally Posted by ChaseN View Post
    I just want to know where you all live that the hospitals have metal detectors???
    Around here, the emergency rooms in the urban hospitals have them. Other parts of the hospital do not. Suburban hospitals do not have them at all.

    The last time I had to enter an emergency room that had them, at least one of the security people was wearing his gun in a Serpa holster.




    Sent from my iPhone using Tapatalk
    Last edited by BillSWPA; 06-21-2019 at 10:48 PM.

  6. #26
    Member Aisin Gioro's Avatar
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    Quote Originally Posted by pangloss View Post
    The friend of a former labmate was walking by a trash bin on campus one day and pitched a piece of trash into the bin. Unfortunately a squirrel digging around in the bin interpreted this piece of trash as a threat of grave bodily injury, sprang out of the bin, and in a brave act of self defence, bit the guy on the face before retreating up into the trees. The poor guy had to get the Ig injections in his face.

    I teach about half a lecture on rabies, and every year I think about getting the vaccine just because.
    I cringe for the friend, but you have to respect that little squirrel.

  7. #27
    Hobbyist JAD's Avatar
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    Quote Originally Posted by pangloss View Post
    Unfortunately a squirrel digging around in the bin interpreted this piece of trash as a threat of grave bodily injury, sprang out of the bin, and in a brave act of self defence, bit the guy on the face.
    https://youtu.be/T_AHCm0urak

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