Today is World Rabies Day, and to promote this important issue I’ve decided to share with you a not-very-hypothetical scenario, along with three different outcomes. Which one would you choose for your precious child?
The Scenario: A 5-year old expat girl gets scratched on the leg by the new family cat. The cat was bought at a local pound which claims she was born there, to a stray cat, and has her rabies vaccine documented. Mom brings her to the ER and it’s decided, after a long consult with our local vet experts, that we simply cannot rely on this pound’s vaccination records nor their rabies vaccine quality, and we must assume she could potentially have exposure to rabies.
Outcome 1. This 5 year old already has her 3 rabies pre-exposure vaccines, so she now only needs one booster vaccine, and another in a week. She gets a Spongebob sticker afterwards and merrily goes home.
Outcome 2. The girl had no pre-exposure rabies vaccines because the parents had decided the risk was low and didn’t vaccinate the family earlier. She now starts a 5-vaccine series, today getting one in each shoulder, plus an extremely painful and expensive immunoglobulin injection (fortunately in stock) at the site of the scratch. Mom and dad cajole, bribe and eventually straddle her down onto the table as the doctor tries to inject the medicine into her wildly kicking leg. Afterwards, she gets my entire sheet of Spongebob stickers as well as a set of panda stickers for extra comfort.
Outcome 3. The girl gets scratched by her cat and doesn’t tell her parents about it. Why would she? Kids get cat scratches all the time. Half a year later, she develops symptoms of rabies, and is dead within another month.
So which outcome would parents prefer? Because the scary truth is that if your children are infected with rabies, they are certain to die — rabies is 100% fatal with no cure. In China, thousands of people die every year of rabies, and a large percentage of deaths are in children. This is something we simply don’t have to think about in places like the US, where maybe 1-3 people die every year of rabies, usually not from dogs but from wildlife like bats.
So, please, parents, please consider getting the 3-shot rabies vaccine now, before it’s too late. Outcome 2 above is an all-too-real scenario that we see very often in clinic, and it’s so much less traumatic to deal with animal bites if the child is already pre-vaccinated (as well as the animal, of course — from a reputable center).
And yes, expats have died from rabies, as Beijing’s International Center for Veterinary Services co-founder Mary Peng mentions in her extremely useful slideshow below, which I highly recommend you all view. In fact, Mary mentions an expat that died from his pet dog who didn’t even have symptoms; and the man wasn’t even bitten! He probably got infected from normal playing (who doesn’t occasionally have their dog lick their face?).
For more information, you can see Mary’s slide show below, plus the entire FAQ from Mary and her ICVS group:
Rabies Awareness and Prevention in China
It is very important for all individuals to understand the seriousness and prevalence of rabies in China and to understand how testing for rabies is handled locally. Rabies pre-exposure and post-exposure vaccinations are considered essential for anyone living and traveling in China:
• Rabies is a virus that is transmitted from the saliva of an infected animal to a human or other mammal through bites or by licking a cut or open wound on the body or the mucous membranes (e.g., lips, nostrils, eyes, etc.). Rabies is one of the leading fatal, infectious diseases among humans in China today. According to the Ministry of Health, more than 3,380 persons in China died of confirmed rabies infections in 2007. Dogs accounted for more than 95% of these rabies cases in China
• Rabies testing is strictly controlled in the PRC. Doctors and hospitals and pet owners cannot send animal remains or saliva samples to laboratories for rabies testing as may be done in other countries. Rabies is an extremely dangerous zoonotic disease that is uniformly fatal once symptoms develop. Zoonotic diseases are diseases that can be transmitted from animals to humans. Every suspected case of rabies must be reported in line with legal regulations and handled by the China Centers for Animal Disease Control and Prevention (CCADC)
• Only the CCADC is authorized to send animal remains or saliva samples for rabies testing at government designated laboratories. An individual must first report the suspected animal to a legally registered animal hospital that must then go through the official channels to report and work with the CCADC on these suspected cases.The time that it takes to report the case and to have the animal tested at the official government designated facilities may take several weeks or longer. A delay of this length may jeopardize the health of the human patient especially in cases where the vaccination or health history of the animal is unknown or unclear.
In line with WHO, USA CDC and China CADC recommendations, it is strongly advised that vaccine therapy with human rabies immunoglobulin (HRIG) be given to rabies-exposed patients that have never been previously vaccinated against rabies. The incidence of rabies vaccinations among dogs in China is less than 10% and is nearly zero in cats and other small companion animals. Compounding this situation is the risk that the animal may have been improperly vaccinated at an unauthorized facility. Unauthorized facilities are not permitted to purchase legally registered, imported vaccines that are only distributed through the Agricultural Bureau, and so are likely to procure vaccines through unsecured illegal channels. Vaccines from unsecured illegal channels may be counterfeit, expired or improperly stored (e.g., non-refrigerated) and therefore ineffective. Unauthorized facilities include pet shops, animal markets, grooming salons, kennels, breeders, small animal clinics and even large animal hospitals that are not officially designated as animal rabies vaccination hospitals.
The International Center for Veterinary Services (ICVS) is a legally registered full-service animal hospital and officially designated animal vaccination hospital in the PRC. Please see this link below for more information on officially designated animal vaccination facilities:
http://www.icvsasia.com/index.php?option=com_content&view=article&id=51&Itemid=72&lang=en
The pre-exposure rabies vaccinations are recommended for all travelers and residents in China, especially children. Children are most likely to engage in provocative behavior with animals and to not tell their parents or other adults about an exposure. The pre-exposure rabies vaccine is a course of 3 vaccinations given over the course of 21- or 28-days (e.g., on days 0, 7 and 21 or 28). The pre-exposure rabies vaccination protocol DOES NOT REQUIRE THE ADMINISTRATION OF THE HUMAN RABIES IMMUNOGLOBULIN. The post-exposure rabies vaccination protocol most widely adopted in China requires the administration of 5 rabies vaccinations over the course of 28-days (e.g., on days 0, 3, 7, 14 and 28) with the human rabies immunoglobulin given on the same day as the first rabies vaccination. This is the protocol for persons that have NEVER been previously vaccinated for rabies and have been exposed to a potentially infected animal.
If you were already rabies vaccinated and then found yourself exposed to a potentially infected animal (e.g., bitten, scratched, licked on wounds or mucous membranes, etc.), you should then receive another 2 injections of the rabies vaccination (e.g., on days 0 and 3) with the first injection scheduled as soon as possible after the exposure. You are unlikely to need the human rabies immunoglobulin if you were previously rabies vaccinated. This is an extremely important point as human rabies immunoglobulin is in short supply worldwide and is expensive. If you are traveling outside of the major cities in China, it is UNLIKELY THAT THE LOCAL CLINICS AND HOSPITALS WILL HAVE IMMUNOGLOBULIN IN STOCK.
In all cases of exposure (e.g., bites, licks on cut/broken skin or scratches, etc.), the wound areas should be washed and flushed thoroughly with soap and water for at least 15-minutes and then disinfected with iodine or ethanol. Medical treatment and post-exposure rabies vaccinations should be sought immediately.
Rabies vaccinations are considered to be effective for at least 2-years or more. While it may be common to test for rabies antibody titres in other countries, this test is not a standard test offered at most medical facilities in China. Please consult with your medical doctor about rabies vaccinations for all members of your family.
You are welcome to contact the International Center for Veterinary Services (ICVS) with any questions:
International Center for Veterinary Services
No. 29 Liang Ma Qiao Lu, An Jia Lou
Chaoyang District, Beijing, PRC 100125
Tel: (8610) 8456-1939/1940/1941
Fax: (8610) 6433-2301
E-mail: ICVS_CHINA@yahoo.com
Web site: www.ICVSASIA.com
Open Daily: Monday to Saturday, 8AM-8PM; Sunday, 10AM-7PM
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Photography: www.richardsaintcyr.com
My daughter was bitten by a cat with uncertain history. According to National Chinese policy, once bitten by any animal, immediate rabies vaccination is required. And after reading extensively about rabies in China, I agree with this requirement. But, please read on, there is a better alternative! Preventional treatment.
If rabies vaccination has NOT been given prophylactically, immunoglobulin and a series of rabies vaccinations are required if bitten, or possibly even scratched. Immunoglobulin is in short supply in China. It is apparently difficult to obtain, expensive, not to mention painful. It is injected into the wound site, and additionally in some cases above the wound site (preventing the virus travelling to the brain). The victim, once bitten and having received immunoglobulin, needs to be given a series of five rabies shots at varying times.
If a patient is given rabies shots prophylactically, then a schedule of three rabies shots is required. These shots are inexpensive, easy to obtain, and prevent the need for immunoglobulin if bitten by an animal or exposed to rabies. These shots are also virtually painless! This is a cheaper, easier to obtain, and non emergency way to prevent rabies. It is very difficult to avoid animal exposure living in Beijing, and challenging to know the history of any animal.