3-year-old girl dies after rabies vaccination? You can't believe the truth behind it!

Recently, a "3-year-old girl died the next day after receiving rabies vaccination" news in major media and circles of friends.

Source: The Paper

Weibo spread wildly.

Let's briefly review what happened.

The girl's name is Yanyan (pseudonym), 3 years old, living in Lianyungang City, the little finger of her right hand was scratched by a classmate's pet dog.

At 4 p.m. the next day, Yeon-yeon received her first rabies vaccine at the local hospital.

Yeon-yeon's vaccination records and medical history records:

At 10 p.m. on the first day, the fever reached 38.4 °C. The body temperature dropped to 36.7 ° C 1 hour after taking antipyretic drugs.

At 2 a.m. the next day, I had a fever again, convulsions, and vomiting. His family sent him to the District People's Hospital.

But at this point he began to be unconscious. At 6:32 a.m., he was transferred to the First Hospital of Lianyungang City.

At 7:20, he was transferred to PICU (Pediatric Intensive Care Unit).

At 16:25, the heart rate drops and the stimuli do not respond. Rescue is ineffective and dies.

If you look at this incident roughly and think of the negative events in the field of vaccines on the mainland in recent years, it is easy to link the death of the girl with the quality of rabies vaccines, and even directly conclude that "rabies vaccine has caused another accident" and "rabies vaccine has led to death".

But is that really the case? In this issue, we have invited Dr. V Taurina, the Vaccine Science Popularization University, to sort out a few key issues for us, which may help to understand this incident.

Do girls need rabies vaccination?

Yes, and must be vaccinated.

According to the news description, the girl was bitten by the puppy and broke the finger, and the picture below has been classified as a level III exposure.

If they have never been vaccinated against rabies in their entirety, they should be vaccinated promptly and inject rabies immunoglobulins locally in the wound.

Technical Guidelines for the Prevention and Control of Rabies (2016 Edition) Source: Chinese Center for Disease Control and Prevention

Given that the case fatality rate of rabies is close to 100% (once onset, it is almost certain to die), anyone who achieves a grade II or grade III exposure must be vaccinated against rabies. Don't take any chances!

Does I get fever after getting the rabies vaccine?

Yes, and it's very common.

According to domestic and foreign monitoring data, after vaccination against rabies, about 35% to 45% of people will have a transient slight rash, pain and/or redness at the vaccination site; 5% to 15% will have mild systemic adverse reactions such as fever, headache, dizziness, gastrointestinal symptoms and so on.

However, most of the above adverse reactions will disappear within 3 days without special treatment.

Did the girl die of rabies?

Unlikely.

On the one hand, the typical symptoms of rabies (water phobia, fear of wind, difficulty breathing, difficulty swallowing, etc.) have never occurred in girls from the onset of illness to death.

On the other hand, the incubation period of rabies is usually 1-3 months, and the onset of the disease is not until 4-5 days after infection. Onset and death the day after the bite is difficult to explain in both medical mechanisms and practical reports.

Image stock: Emoji

Is there a quality problem with the rabies vaccine?

Not possible.

Rabies vaccines are inactivated vaccines that do not contain living microorganisms and do not cause rabies infection in vaccinated people.

After preliminary investigation, the outpatient clinic where the girl was vaccinated against rabies has rabies exposure prevention and treatment qualifications, the vaccination behavior also meets the requirements of the work specification, the vaccination doctor has the qualification of the vaccination personnel, and the informed consent of the family and the vaccination are recorded.

The batch of rabies vaccine has a certificate of conformity issued by the state batch, and during the validity period, the transportation and storage also meet the specifications. Since the same batch of vaccine has been used since March 11, 2019, no abnormal vaccination reactions have been reported by other vaccinators, indicating that the safety of this batch of rabies vaccine is good.

Could it be a drug cause?

According to online information, the girl was treated clinically after being admitted to the hospital with fever on the same day, and the drugs used included "diazepam, cefuroxime, dexamethasone, thermotoxine, aminopyrine, etc."

After treatment and during rescue, the girl developed sudden shock, coma, DIC, metabolic intoxication, liver function damage, myocardial damage, pulmonary hemorrhage, etc., and there was a high suspicion of hemorrhagic shock and the possibility of encephalopathy syndrome.

Looking at the drug itself, thermotoxin and aminopyrine are both contraindicated in infants and young children, and children should use drugs with caution, and both may have anaphylactic shock. In addition, the use of all of the above drugs may also have the possibility of life-threatening adverse drug reactions.

Will there be other reasons?

Considering the rapid progression of the course of the disease after the girl's admission to the hospital, combined with the diagnosis of "severe infection", it is not possible to exclude the cause of infection, such as rapid "viral encephalitis".

If there is a recent infection with another pathogen, and the onset of the disease happens after the dog bite (after vaccination), it is a coupling reaction, which is completely unrelated to the vaccine, but also requires an autopsy to reach a conclusion.

Judging from the current news, the parents agreed to cooperate with the autopsy, which is very commendable.

Children are an important group of rabies injuries!

According to statistics, rabies can cause nearly 60,000 deaths worldwide every year. The WHO noted in 2018 that 40% of victims of injuries to suspected rabies animals were children under the age of 15.

On the mainland, the estimated number of rabies exposures per year is 40 million. In contrast, children are more vulnerable to attacks by suspected rabies animals, and often do not dare to tell their parents after being injured and do not have the financial ability to afford it, and cannot carry out post-exposure prevention and treatment in a timely manner, resulting in the occurrence of rabies onset tragedies from time to time.

After an injury, the first step in wound management is very important

Standardized wound management includes thorough irrigation, disinfection and surgical disposal. The earlier the wound is treated, the better.

(1) Wound irrigation: Alternately wash and rinse all bites and scratches with soapy water (or other weak alkaline cleaners) and a certain pressure of running water for at least 15 minutes.

(2) Disinfection treatment: after thorough rinsing, disinfect and apply or disinfect the inside of the wound with 2-3% iodine wine (iodophor), 75% alcohol or other skin and mucous membrane disinfectant with virus inactivation effect.

(3) Surgical disposal: After the wound is cleaned and disinfected, follow-up surgical treatment is carried out as needed.

How to get the rabies vaccine?

1. Pre-exposure prophylaxis

Receive 3 injections, one on days 0, 7, and 21 (or 28).

2. Post-exposure prevention

There are "four-stitch method" and "five-stitch method".

Four-stitch (2-1-1) procedure

On day 0, 1 injection (2 shots in total) was given to the deltoid muscles of the left and right upper arms, followed by another injection on day 7 and 21.

Five-stitch procedure

One injection is given on day 0, day 3, day 7, day 14, and day 28.

There is no difference in the protective effect of the two procedures, and sufficient antibodies can be produced.

The time to produce sufficient antibodies in the four-stitch method is faster. Note that once vaccination is required, the sooner you are vaccinated, the better. If the first shot is not given within 24 hours for various reasons, it is also necessary to get enough immunity by vaccinating as soon as possible, and it is really too late to get sick!

3. Re-exposure prevention

If you have previously received a full rabies vaccine (regardless of pre-exposure or post-exposure procedures), no matter how long the interval is, no immunoglobulin is required for re-exposure, as long as 2 injections are given at 3 days intervals.

How to choose a rabies vaccine?

At present, there are more than 20 rabies vaccine manufacturers in the national market. In terms of process, it can be roughly divided into four categories:

In general, the products of the first two are more common. The study believes that there is no essential difference in the protective effect of the two, and sufficient antibodies can be produced throughout the vaccination. Theoretically, the vaccine of the "human diploid cell" process has a lower probability of adverse reactions after vaccination, but the price is also the most expensive.

Which animals transmit the rabies virus?

Globally, more than 99% of human rabies cases are caused by dogs and rabid cats, with a very small proportion caused by wild animals such as foxes, jackals, wolves, bats, raccoons, skunks and mongooses. If you are bitten or scratched by these animals, it is recommended to get vaccinated against rabies in time.

Various mammals, such as pigs, cattle, monkeys, horses, sheep, donkeys, and deer, may themselves be infected with rabies, but the probability of sustained transmission of the rabies virus is extremely low.

Rodents, such as rats, hamsters, rabbits, etc., are rarely infected with rabies, and no evidence of rabies in humans has been found.

All kinds of birds, fish, insects, lizards, turtles, snakes, etc. will not infect and spread rabies. Bitten or scratched by these animals does not require rabies vaccination.

The spread of rabies from person to person through bites and scratches has never been proven (occasionally transplantation of organs or tissue donated by rabies patients). Therefore, if someone bites or scratches, there is no need to worry about getting the rabies virus and no need to get rabies vaccine.

Can pregnant or lactating women get rabies vaccine?

OK.

There are no contraindications to post-exposure vaccination of rabies vaccine. Lactating, pregnant women, infants, children, the elderly or people with diseases should be vaccinated promptly.

Standardized, correct and full vaccination is very critical to the body's rabies immunity. There is currently no scientific evidence that a rabies vaccine can cause health damage to pregnant women and fetuses.

Can I get other vaccines during rabies vaccination?

OK. Rabies vaccine is an inactivated vaccine, and other vaccines can be given normally during and before and after rabies vaccination, and will not affect each other.

If there is a conflict with other vaccinations, rabies vaccination is preferred.

How is the "Ten-Day Observation Method" used?

What the World Health Organization and the U.S. Centers for Disease Control and Prevention call the "ten-day observation method" is a requirement for timely vaccinations after injuries, while at the same time observing the health of cats and dogs. If the animal survives for 10 days, it can be confirmed that the animal was not poisoned when it was injured, and the person can also interrupt the subsequent vaccination procedure (that is, the remaining 1 or 2 doses of the vaccine do not need to be re-vaccinated).

However, in practice, we still recommend the completion of the whole process of vaccination, otherwise once exposed again in the future, it still needs to be disposed of according to the first exposure, and some of the gains are not worth the losses.

Do I need to avoid rabies vaccination after vaccination?

No, you don't.

In some rabies vaccine instructions, it is clearly mentioned that "avoid alcohol, strong tea and other irritating foods and strenuous exercise." But this sentence is the original text of the mainland biological product code more than 50 years ago, and it has not been modified so far.

At that time, the vaccine production process was backward, there were more adverse reactions after vaccination, and irritating diet and exercise may aggravate these adverse reactions, so such a clause was set at that time.

At present, the production process of rabies vaccine is very mature, and the safety of the vaccine is not substantially different from the vaccine routinely given by children, and there are no more adverse reactions because it prevents fatal rabies. Therefore, there is no need for any contraindications after rabies vaccination.

Source: Stand Cool Helo

bibliography

[1] WHO Position Paper: Rabies Vaccine (April 2018).

[2] Technical Guidelines for the Prevention and Control of Rabies (2016 Edition). Chinese Center for Disease Control and Prevention.

[3] Norms for the Prevention and Treatment of Rabies Exposure (2009 Edition). National Health and Family Planning Commission

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