First, the incubation period of rabies is usually 1-3 months, and the incubation period of a few severe head and face bites may be as short as 7 days, and only 1% of the total may be longer than one year.
Second, healthy dogs will not spread rabies. The simple and practical identification method is "ten-day observation method". According to WHO, if the dog (or cat) stays healthy within the observation period 10 days after the injury, the injured person will not be infected.
Thirdly, if you have not been vaccinated before in an epidemic area where rabies is prevalent, you should immediately inject the vaccine (you can't wait for 10 days, if the observed animal really dies within 10 days, it will be green) at the same time of starting the "10 day observation method", and then determine whether it is necessary to take a few more shots according to the observation results.
Fourth, there is no strict scientific evidence to prove that mice and rabbits will be infected with rabies. Birds, reptiles, fish and insects will not be infected with rabies.
Fifth, correct wound irrigation can reduce the incidence rate by more than 50%.
Assuming that rabies virus has entered the central nervous system, the vaccine may still be effective. After rabies virus enters the central nervous system, it will either be cleared or become ill within 3-5 days. Under any circumstances, it is impossible for rabies virus to lurk in the central nervous system (including the brain and spinal cord) for a long time.
Once rabies breaks out, people will die within ten days. Some people have long suspected that they have rabies symptoms, and they must not be rabies.
Eight, as long as the whole process of vaccination before the onset produces effective antibodies (note: immune failure does not count), rabies virus can not be "latent" in the body, and it will not happen again.
Nine, if the whole process is immunized with 3-5 needles, the protection can last for decades. If you get bitten again, 2 stitches will be enough. This view is far below the standards of the Ministry of Health.
X. Compared with WHO, our current national standard is obviously vaccine abuse. This is not only a serious waste of resources, but also the official caliber has guided the "phobia" of the whole people.
These summaries are still too professional. Let me put it more bluntly: if you are bitten and scratched by a cat or dog, you should wash it at the first time and be immunized throughout the whole process (3-5 stitches for the first time, and then you are accidentally bitten, and up to 2 stitches will be strengthened); 2, observe the little guy who caused the accident 10 days. You're fine if you're fine, and you don't need an injection in your back; 3. If you can't follow up the situation of the little guy and complete the steps 1 at most 1 year, you will definitely be fine (there will be no terrorist rumors lurking for decades); 4. If the little guy really hangs up within 10 days, you will have a chance to win by completing step 1 the first time; See a doctor at once, don't let it break out.
To put it bluntly, what I really want to express is that cats and dogs are generally healthy. After being bitten, we should face it with a scientific attitude and simply deal with it with a scientific method. We can't ignore it, but we don't need to exaggerate or panic. Mania, dog phobia, neighborhood disputes, social contradictions and long-term misleading public opinion are hard to blame. It is the interests that mislead the public, and it is ignorance that leads to the unique spectacle that China people's attitudes towards cats and dogs are divided into two camps: love and hate. The lives of cats and dogs, under the gorgeous and legal banner of public health and safety, have become the most pitiful victims of some interest groups.
Appendix: Who should be vaccinated against rabies? "Rabies phobia" and vaccine abuse
Rabies phobia is a unique phenomenon in China. No country in the world attaches so much importance to rabies as China. The general prejudice and fallacy against rabies is one of the important reasons for the massive abuse of rabies vaccine in China.
At present, China people are most afraid of infectious diseases, except AIDS, which is rabies. Rabies phobia, referred to as "phobia", has now become a very popular psychological disease that can almost keep pace with "phobia".
Recently, the abuse of rabies vaccine in China has aroused widespread concern. The annual consumption of rabies vaccine in China reaches150,000 people, exceeding 80% of the global total. If vaccines are not used at all, 30,000 people will die of rabies every year in China. This means that 99.8% of the vaccinators can not be vaccinated theoretically, and at least 1/3 of them may be abused. So, what circumstances may belong to abuse? How to avoid abuse?
The most common manifestation of phobia is the abuse of rabies vaccine. Even after repeated vaccination, people still have a lingering fear. The prevalence of phobia is obviously one of the important reasons for the abuse of rabies vaccine in China.
Rabies is an infectious disease with the highest mortality and the lowest incidence, and it is easy for people to overreact. At present, unscientific remarks about rabies are rampant on the Internet or in real life, and all kinds of strange opinions are quite common among "experts" and the public, which makes some people who have contacted cats and dogs (even those who have never contacted them at all) stay in fear for a long time, and even develop into obsessive-compulsive disorder or hysteria. Some people have been vaccinated many times, but they still travel thousands of miles to Wuhan for antibody testing every month, fearing that "once the antibody is lowered, rabies will break out." Some people think that the virus has infiltrated their brains, and they will die, lose their jobs, look up information on the Internet all day, and be at a loss in all kinds of contradictory information. Some people suspect that the vaccine is fake, some people suspect that there is a live virus in the vaccine, some people suspect that rabies virus can spread through the air, and some people suspect that nurses and experts are struggling with endless troubles all day.
When it comes to rabies, we must first clarify the most basic fact: the risk of rabies is not the same as that of AIDS (there is no effective vaccine for the latter at present, and the relevant basic immune mechanism is still unclear). The prevention and treatment of rabies has been basically solved in medicine for a long time. Rabies has been effectively controlled in all developed countries and some developing countries in the world, and the number of rabies deaths has remained at or near zero every year for many years. Rabies 100% can be prevented: no matter how serious the exposure is, 100% can be avoided as long as it is treated according to the plan approved by the World Health Organization (WHO).
In this article, the author will list some representative cases and explain how to avoid the abuse of rabies vaccine. The author will provide several simple and practical standards to help phobia patients get out of the shadows as soon as possible.
How long is the incubation period?
The incubation period of rabies may be as long as forty years? Fifty years? Even for life. Is China going to set the Guinness Book of Records again? In some professional magazines and even textbooks in China, the incubation period of rabies is often described as decades.
Are these "cases" in China really rabies? Because there is no laboratory diagnosis basis, or it is impossible to prove that no new infection has occurred recently (for example, through some special or rare ways), these "cases" have not been recognized by international academic circles, and even passed down as jokes internationally, as an example of the low level of related science in China.
Domestic and foreign data show that the incubation period of rabies is usually 1-3 months, and the incubation period of a few serious head and face bites may be as short as 7 days, and the incubation period of a few cases (less than 1% of the total) may exceed one year.
At present, the longest incubation period of rabies recognized by the international mainstream scientific community is 6 years. American scholar 199 1 reported the case in a professional magazine. The deceased was a Filipino immigrant who never left the United States after immigrating to the United States. Because the probability of rabies infection in the United States is extremely small, and the results of partial gene sequence analysis prove that the rabies virus isolated from the brain of the deceased is the same as the strain prevalent in the country of origin of the deceased, this report proves with the most convincing evidence so far that the incubation period of rabies may be as long as 6 years.
Due to the small number of similar cases and the incomplete evidence chain, the relevant academic circles still have objections to the case report. For example, many French scholars believe that cases with incubation period of more than one year, if any, are very few, and the possibility of recurrence after one year is slim. They all laughed at the idea of extending the incubation period.
Too many people have been bitten by dogs in China for decades. If the incubation period of rabies is really that long and so many people have to be vaccinated, then the annual vaccination amount of rabies in China will increase by a considerable amount. Many phobia patients are scared silly by the legend that rabies has a long incubation period.
Popularize the "ten-day observation method"
We must firmly believe that healthy dogs will not spread rabies! Based on the results of field investigation in China, Chinese and American experts jointly wrote relevant papers, which were published in the third issue of American Journal of Vector-borne Diseases between People and Animals in 2008. But physical health is not equal to real health, which must be tested by experiments or identified by "ten-day observation". After a person is bitten by a dog, if the dog can be killed immediately and the brain tissue is taken for testing, it can be determined whether the bitten person needs vaccination according to the test results (whether there is virus or not). If animals are killed unconditionally on the spot for experiments, the "ten-day observation method" recognized by WHO can be applied: "If dogs (or cats) remain healthy during the observation period of 10, ... the treatment can be terminated."
In recent ten years, our laboratory has not found enough evidence to deny the "ten-day observation method" at home and abroad. This method is a simple and practical method to judge whether dogs (or cats) are contagious, and it is also suitable for China.
It should be noted that in the epidemic areas where rabies is prevalent, people who have not been vaccinated before should immediately start post-exposure prevention while starting the "10-day observation method", and then determine whether they can keep the next 2 or 3 shots of vaccine according to the observation results.
At present, the vast majority of dogs or cats kept in cities are pets, and they usually have little contact with the outside world, so it is convenient to implement the "ten-day observation method". If the "ten-day observation method" is popularized in China, it can not only greatly reduce the dose of vaccine (which may be half of the total dose), but also liberate the vast majority of phobia patients more quickly.
What should I do if I am bitten by a mouse or rabbit?
The relevant report of WHO pointed out: "The inspection of thousands of rodents in the wild and residential areas of North America and Europe shows that few rodents are infected with rabies, indicating that these animals are not the storage hosts of the disease." "After exposure to rodents such as rabbits and hares, there is little need for special anti-rabies post-exposure prevention."
There are occasional statistical reports of rabies cases transmitted by rats in China literature, but the identification of injured animals depends entirely on the oral memories of patients or their families, which has limited scientific value and a small total.
According to the author's years of data collection and research, it is considered that the above viewpoints of WHO are basically applicable to China. Especially in non-key epidemic areas, if bitten by rats or rabbits, the possibility of rabies is extremely small, and rabies vaccine is usually not needed.
There are many opportunities for people to be bitten by rats-3% of all animal injuries-10%. If you don't vaccinate in this case, you can save up to 65,438+0/65,438+00 per year.
Regarding the disposal of rats after biting, China's Ministry of Health has not yet issued relevant work norms. It is suggested that patients should weigh whether they need to be vaccinated with rabies vaccine while objectively publicizing that the probability of rabies caused by rat bites is extremely small.
In addition, birds (such as chickens, ducks and geese), reptiles (such as lizards, turtles and snakes), fish and insects have never suffered from rabies, so it is impossible to be infected with rabies.
Correctly treat "indirect communication"
The source and transmission route of rabies are relatively simple, mainly through being scratched or bitten by dogs or cats. Who clearly stipulates that post-exposure prevention is divided into three levels of management. For class I exposure, that is, touching or feeding animals, or licking the whole skin of animals, no preventive measures need to be taken. The so-called "indirect transmission" mode that many other phobia patients are worried about is actually very unlikely, so it can usually be ignored. If some people have a particularly heavy psychological burden and seriously affect their daily work and study, they can also be vaccinated with 3 needles. After vaccination, you can basically sit back and relax-neutralizing antibodies may last for years or even decades, during which they are sufficiently resistant to so-called "indirect transmission".
We should fully understand the important role of wound cleaning. Correct wound irrigation can reduce the incidence by more than 50%. For many specious "indirect transmission" or slight exposure in non-epidemic areas, wound cleaning is actually enough to completely rule out the possibility of a minimal infection, and there is no need to insist on vaccination.
Regarding the important role of wound management, there is a typical example: the earliest recorded rabies in Europe occurred in Lyon, France in 900 AD: a bear went crazy, bit 20 people at a time, and then fled to the other side of a small river. Among the bitten people, 14 people swam across the river to hunt bears, probably because the river naturally washed away the virus in the wound, and none of these 14 people was infected with rabies virus; Those six people who didn't chase the bear (and therefore didn't clean the wound) all died of rabies later (it seems that brave people have good results).
Viruses in the central nervous system
Many patients with "phobia" like to ask such a question: after rabies virus enters nerve cells, does the antibody triggered by the vaccine not work? Can antibodies kill viruses in the central nervous system (CNS)?
A large number of original and newly discovered evidences show that rabies virus antibodies can not only neutralize viruses in peripheral nerve cells, but also completely eliminate viruses in the central nervous system under certain conditions. After rabies virus enters the central nervous system, it will either be cleared or become ill within 3-5 days. Under any circumstances, it is impossible for rabies virus to lurk in the central nervous system (including the brain and spinal cord) for a long time.
Once rabies breaks out, people will die within ten days. Therefore, if any symptom is suspected to be related to rabies, ten days later, the patient will definitely die of rabies (at least he has been admitted to the intensive care unit for rescue). If this is not the case, the symptoms are definitely not related to rabies (it should be transferred to other specialties as soon as possible). Some phobia patients firmly believe that they have rabies, claiming that the typical rabies performance has lasted for several months or even longer. I hope no one will make fun of themselves like this again.
A large number of examples have proved that it may be effective to treat the virus after exposure for several days or even months, indicating that antibodies may also remove rabies virus from the central nervous system.
Some patients who have been actively rescued by modern life support system for a long time have found that the rabies virus in the whole body (including the central nervous system) has been completely removed after autopsy, which can indirectly prove that antibodies can enter the central nervous system and remove the virus in the central nervous system.
In fact, most vaccination failures occurred within 20 days after the first injection, mainly in patients with severe head and face bites. If you don't get sick this time, the possibility of getting sick again is almost nonexistent.
Rabies virus does not cause morphological changes of brain cells. The whereabouts of rabies virus in human body can not be detected before the onset, and whether brain function is damaged can only be judged according to symptoms. High enough antibodies were detected before the onset, which proved that his brain function was not damaged, at least not seriously damaged, and he would not get sick again in the future.
In short, as long as the rabies virus is vaccinated before the onset and antibodies are produced, it is impossible to "lurk" in the body (including the central nervous system) and it will not happen again. Searching the relevant literature at home and abroad, no cases violating this standard were found. This is another simple and practical criterion, which helps to liberate patients with "phobia" from their blind fear of rabies.
What should I do after re-exposure?
Some clinical trials published recently show that those who have received 3-5 doses of rabies initial vaccine can have a certain degree of immune protection for decades. Whether this person has detectable antibodies or not, two injections after re-exposure are enough to trigger a good immune recall response (immunoglobulin is not needed under any circumstances after re-exposure).
Germany had a related survival case a few years ago. An organ donor was diagnosed with rabies before, and her liver, pancreas and two kidneys were transplanted to four people respectively. Of these four people, only one survived after liver transplantation, and the other three died of rabies within a few weeks after transplantation. Further investigation showed that the surviving liver transplant recipients were vaccinated with rabies vaccine in childhood. This case can prove the persistence of rabies vaccine.
The latest WHO regulation is that no matter how long you have been vaccinated, you only need 2 injections after re-exposure.
In 2009, the regulations of the Ministry of Health of our country on the disposal after re-exposure were: 1-3 injections within three years, and 5 injections after three years.
Compared with the regulations of WHO, it can be seen that strengthening vaccination with more than 2 injections belongs to the category of abuse. Therefore, the norms of the Ministry of Health should be revised.
At present, the packaging of rabies vaccine in China is 5 needles in a box, which cannot be sold separately. There are quite a number of rabies clinics, and all those who come for vaccination, including re-exposure, are indiscriminate, and each person takes 5 shots. Results It is not uncommon for a person to get 10 or 20 stitches a year. Even professional dog owners get more than 50 stitches a year because they are often bitten by dogs. This is the most obvious abuse of vaccines.
Phobia is a unique phenomenon in China. No country in the world attaches so much importance to rabies as China. China is currently the largest producer and user of rabies vaccine in the world. If the relevant administrative departments and all walks of life can work together, make full use of the knowledge and experience of countries around the world in rabies prevention and control, and resolutely put an end to the abuse of rabies vaccine, it is estimated that the annual use of rabies vaccine in China may be reduced by more than half at the current level, and the number of rabies deaths will not increase.