Lina Zhang/@央广网
Recently, a 3-year-old boy in Nanyang, Henan Province was bitten by a dog and unfortunately passed away 18 days later, causing heated discussions on the Internet. The Nanyang Municipal Center for Disease Control and Prevention, the Nanyang Xinye County Center for Disease Control and Prevention, and the Nanyang Wolong District Center for Disease Control and Prevention have all completed a preliminary investigation into the matter, and no abnormalities have been found in the management of rabies vaccines and passive immunization preparations (rabies immunoglobulin, anti-rabies serum or monoclonal antibodies), rabies exposure treatment and medical treatment, and neither immunoglobulin nor vaccines can ensure 100% blocking of viral infection.
Proof of diagnosis
The rabies vaccine stock in primary outpatient clinics is good, but the coverage of passive immunization agents is not the same
On April 21, Ms. Fan took her child to the Hanhua Community Health Service Center in Xinye County, where the child was vaccinated against rabies. In the face of online doubts, the staff of the Hanhua Community Health Service Center said that the reason why the child was recommended to go to the superior dog injury treatment clinic for treatment was because the injured person had multiple lacerations on the head and face, and the injuries were serious, which had exceeded the capacity of the outpatient treatment (wound irrigation after anesthesia and infiltration injection of rabies immunoglobulin at the wound site), not that there was no reserve of rabies immunoglobulin as rumored on the Internet. After many interviews, the reporter learned that the situation of the reserve of immune globulin for rabies patients in township health centers in Henan is not the same. The staff of the Xincai County Epidemic Prevention Station in Zhumadian City said, "Every township will reserve rabies vaccine, but rabies immune globulin is only available at the Xincai County Epidemic Prevention Station." Liu Ruitao, deputy director of the Center for Disease Control and Prevention of Xinye County, Nanyang City, told reporters that every township street in Xinye County has a vaccination clinic, and in terms of rabies prevention and control, each vaccination clinic is equipped with rabies vaccine, but for rabies immunoglobulin, generally larger towns and towns will purchase according to actual needs and service capabilities. Wang Tingzhu, head of the immunization prevention and planning section of the Nanyang Municipal Center for Disease Control and Prevention, also said that the canine injury treatment clinics in townships and towns can declare the procurement needs of rabies vaccines and passive immunization preparations to the county-level CDC according to the actual situation, but the injection of rabies immunoglobulin requires a professional doctor's certificate. The development of various health centers is uneven, and some health centers will not purchase rabies immune globulin if they do not have the capacity.
Neither immunoglobulins nor vaccines can guarantee 100% blocking of viral infection
According to the "Rabies Exposure Prevention and Treatment Work Specification (2023 Edition)", the case fatality rate of rabies is almost 100%. Those who are judged to be grade III exposed should have their wounds treated and given passive rabies immunization agents and rabies vaccination. The reporter visited the vaccination clinic involved in the incident and learned that the boy's dog injury was a grade III exposure, so it was necessary to timely treat the wound, inject vaccines and passive immunization preparations. Is the quality of the vaccine guaranteed? Wang Tingzhu said, "We have conducted an investigation on vaccine management and found no abnormalities, and the distribution, transportation and storage of vaccines and passive immunization preparations are safe and controllable. The rabies vaccine and passive immunization preparations of each vaccination unit in Nanyang are from the CDC in the jurisdiction, and the vaccination units cannot transfer vaccines to each other. In the process of vaccine distribution, transportation and preservation, the whole cold chain must be ensured, and the manufacturer has given each vaccine an 18-digit traceability code, and each vaccine is included in the automatic temperature control traceability system from the factory to the grassroots vaccination clinic. The reporter further learned from the Xinye County Center for Disease Control and Prevention and the Wolong District Center for Disease Control and Prevention, and said that the investigation had been preliminarily completed, and no abnormalities were found in the management of rabies vaccine and passive immunization preparations (procurement, transportation and storage of drugs), rabies exposure disposal (wound disposal, injection of rabies vaccine and passive immunization preparations) and medical treatment. So, can rabies infection be completely avoided with rabies vaccination and passive immunization preparations? Wang Tingzhu said, "According to the existing case analysis, if rabies is diagnosed, the immune failure is the result of multiple factors, which may be related to the proximity of the head and facial wounds to the central nervous system, the severity of the canine injury and the large amount of virus entering the body. ”
The place where the boy was bitten by a dog is located on Xincheng Avenue near Zhaogang Village, Shanggang Township, Xinye County, Nanyang City (Photo by CCTV reporter Zhang Lina)
How to deal with similar situations
On May 17, the reporter called the Henan Provincial Center for Disease Control and Prevention, and the staff said that the canine patients must be vaccinated as soon as possible. The staff of the epidemic prevention station of Xincai County, Zhumadian City, said that all township health centers have rabies vaccines, and in the case of level III exposure and particularly large wound area, it is necessary to give anti-rabies serum or rabies immunoglobulin as soon as possible. Wang Tingzhu said that if it is uncertain whether the injured dog carries the rabies virus, the dog injury patient should seek medical attention in time, thoroughly rinse, debride, disinfect and inject rabies vaccine, which will generally produce protective antibodies 7 days after vaccination. If the dog injury is judged to be grade III by a professional physician after exposure, passive immunization preparations should be injected as soon as possible within 7 days to quickly neutralize the rabies virus. At present, the Xinye County Public Security Bureau is actively investigating the tragic death of a 3-year-old boy in Nanyang, Henan Province, who was bitten by a dog. Deng Qianqiu, a lawyer at Beijing Zhongwen Law Firm, said that according to the provisions of the Civil Code of the People's Republic of China, if a dog bites a person and causes harm, the dog keeper or manager shall bear tort liability; If it is a stray dog, the owner or manager of the dog before it is in a state of stray shall bear the tort liability. In view of the serious consequences of the death of a bitten child, the keeper or manager of the dog may be suspected of a criminal offence in addition to civil liability. It is recommended that the public security organs investigate and decide whether to pursue criminal responsibility based on whether the dog is a fierce dog and the subjective state of its owner or manager.
This issue is edited by Xing Tan