About rabies vaccination

Vaccination: Under normal circumstances, the antibody level in the body can be maintained for at least 1 year after being fully vaccinated against rabies. If re-exposure occurs during the vaccination process, continue to complete the full course of vaccination according to the original procedure without increasing the dose; those who are re-exposed within six months after the full course of immunization generally do not need to be re-immunized; those who are re-exposed within half a year to one year after the full course of immunization , one dose of vaccine should be received on days 0 and 3; those who are exposed again within 1-3 years should receive one dose of vaccine on days 0, 3, and 7; those who have been exposed for more than 3 years should be fully vaccinated.

Attachment: Working Standards for Prevention and Treatment of Rabies Exposure

Article 1: Rabies exposure refers to being bitten, scratched, or licked by a rabies dog, a suspected rabies dog, or a rabies host animal that cannot be determined to be healthy. Mucous membranes or damaged skin, or open wounds or mucous membranes coming into contact with animal saliva or tissues that may be infected with rabies virus.

Article 2: Rabies exposure is divided into three levels according to the mode of contact and degree of exposure.

Contacting or feeding animals, or having intact skin licked is Level I.

Bites on exposed skin, or minor scratches or abrasions without bleeding are Level II.

Single or multiple penetrating skin bites or scratches, or broken skin being licked, or open wounds or mucous membranes being contaminated are Level III.

Article 3: After determining the level of exposure, doctors in the rabies prevention and treatment clinic must immediately perform wound treatment as necessary; after informing the exposed person of the dangers of rabies and the treatment measures that should be taken, and obtaining informed consent, take Corresponding disposal measures.

Article 4: Those judged to be Level I exposed do not need to be treated.

Article 5 Those who are determined to be exposed to Level II should have their wounds treated immediately and receive rabies vaccination. Those who are confirmed to be Level II exposed and have low immune function, or when Level II exposure is located on the head and face and the injured animal cannot be determined to be healthy, should be treated according to Level III exposure.

Article 6 Those who are determined to be exposed to Level III should immediately treat their wounds and inject rabies passive immunity preparations, followed by rabies vaccination.

Article 7 Wound treatment includes thorough washing and disinfection. The sooner the local wound is treated, the better. If the wound has scabbed or healed at the time of treatment, wound treatment is not recommended. If the pain is severe during cleaning or disinfection, local anesthesia can be given.

Wound washing: Use 20% soapy water (or other weakly alkaline detergent) and a certain pressure of running water to thoroughly clean and rinse all bites and scratches for at least 15 minutes. Then wash the wound with normal saline (you can also use clean water instead), and finally use sterile absorbent cotton to absorb the remaining fluid in the wound to avoid leaving soapy water or detergent on the wound. When rinsing a deep wound, use a syringe or high-voltage pulse instrument to penetrate deep into the wound to perform perfusion and cleaning thoroughly.

Disinfection treatment: Rinse thoroughly and apply 2-3% iodine (iodophor) or 75% alcohol to the wound. If there is a lot of broken tissue in the wound, it should be removed first.

Article 8 If the wound condition permits, suturing should be avoided as much as possible. Wound closure and antibiotic prophylaxis should be differentiated based on consideration of the type of animal exposed, wound size and location, and the time interval since exposure.

When the wound is minor, it does not need to be sutured or bandaged. The wound can be covered with a breathable dressing.

When the wound is large or the face is severely injured and affects the appearance or function, if suturing is really needed, after debridement and disinfection are completed, anti-rabies serum or rabies patient immunoglobulin should be used as an infiltration injection around the wound. Allow antibodies to infiltrate into tissues to neutralize the virus. Suture and bandage again after a few hours (not less than 2 hours); if the wound is deep and large, a drainage strip should be placed to facilitate the discharge of wound contaminants and secretions.

For those with deep wounds and serious contamination, anti-tetanus treatment and antibiotics may be used as appropriate to control infections other than rabies virus.

Article 9 Wound treatment of special parts.

Eye: When treating wounds involving the eyes, flush them with sterile saline and generally do not use any disinfectant.

Oral cavity: It is best to treat oral wounds with the assistance of a dental professional. When rinsing, be sure to keep your head down to avoid irrigating fluid from flowing into the throat and causing suffocation.

External genital or anal mucosa: The wound treatment and flushing methods are the same as those for the skin. Note that the flushing direction should be outward to avoid contamination of the deep mucosa.

When the wounds in the above special parts are large, it is recommended to use primary suturing (suturing the wound immediately after surgery or within the allowed time after trauma) to facilitate functional recovery.

Article 10: Rabies vaccination after first exposure should be administered as early as possible.

Vaccination procedure: Generally, bite victims will receive one dose of rabies vaccine on days 0 (the day of injection), 3, 7, 14 and 28 days. The rabies vaccine is administered in one dose per injection, regardless of weight or age.

Injection site: Intramuscular injection into the deltoid muscle of the upper arm. Infants under 2 years old can be injected intramuscularly on the anterolateral thigh. Buttock injections are prohibited.

If the health status of the exposed rabies host animal cannot be determined, those who have been exposed for several months and have not been vaccinated against rabies should also be vaccinated according to the vaccination procedures.

Article 11 Children who are undergoing planned immunization can be vaccinated against rabies according to the normal immunization program. During the rabies vaccination period, other vaccines can also be vaccinated according to the normal immunization schedule, but the rabies vaccine is given priority.

Article 12 The full course of rabies vaccination should be completed on time. Correct vaccination according to the procedure is very important for the body to develop immunity against rabies. When a certain injection is delayed by one or several days, subsequent injections will be delayed. The vaccination time will be postponed according to the delayed interval of the original immunization program.

Article 13 The same brand of rabies vaccine should be used as much as possible to complete the entire vaccination course. If this is not possible, qualified rabies vaccines of different brands should continue to be fully vaccinated according to the original procedure. In principle, medical patients are not allowed to bring rabies vaccines to other places for injection.

Article 14 The case fatality rate of rabies reaches 100%, and there are no contraindications to rabies vaccination after exposure. A few people may experience local redness, swelling, induration, etc. after vaccination. Generally, no special treatment is required. A few individuals may have severe reactions and should seek medical attention promptly. When it is found that the vaccinator has a serious adverse reaction to the rabies vaccine being used, another rabies vaccine can be replaced and the original procedure can be continued.

Article 15 Freeze-dried rabies vaccine diluent should be used strictly in accordance with the instructions.

Article 16 The dosage of passive immune preparations should be calculated strictly based on body weight, and a sufficient amount should be injected at one time. Rabies immune globulin is calculated at 20 international units per kilogram of body weight (20IU/kg), and anti-rabies serum is calculated at 40 international units per kilogram of body weight (40IU/kg). If the calculated dose is not enough to infiltrate and inject all the wounds, the passive immune preparation can be appropriately diluted to a sufficient volume with physiological saline and then infiltrated and injected.

Article 17 If the anatomical structure of the injection site is feasible, all passive immune preparations should be infiltrated and injected around the wound according to the calculated dose. All wounds, regardless of size, should be infiltrated and injected. When there is remaining passive immune preparation after infiltration injection of all wounds, it should be injected into the muscle away from the vaccine injection site. When the exposed site is located on the head, face, upper limbs, and trunk above the chest, the remaining passive immune preparation can be injected into the back muscles (such as trapezius) on the same side of the exposed site, and the rabies vaccine can be inoculated on the opposite side. When the exposed site is located on the lower limbs and trunk below the chest, the remaining passive immune preparation can be injected into the lateral thigh muscles on the same side as the exposed site.

Article 18 If the passive immunization preparation cannot be used on the day of vaccination, the passive immunization preparation can still be injected within 7 days (inclusive) of the first dose of rabies vaccine. Passive immunity preparations and rabies vaccines must not be injected into the same site; it is prohibited to use the same syringe to inject rabies vaccines and passive immunity preparations.

Article 19: For those with mucosal exposure, passive immune preparations should be dropped/coated on the mucosa. Local infiltration injections may also be performed if the anatomy permits. The remaining passive immune preparations were injected intramuscularly according to the aforementioned method.

Article 20 Before injecting anti-rabies serum, an allergy test must be conducted strictly in accordance with the product instructions.

Article 21 Disposal after re-exposure.

Wound treatment: Wound treatment should be carried out first, promptly and thoroughly after any exposure.

Passive immune preparation injection: Those who have completed the full course of rabies vaccine (cell culture vaccine) according to the pre-exposure (post-exposure) procedures no longer need to use passive immune preparations.

Article 22: After a full course of immunization using a qualified vaccine obtained through formal channels, there is generally no need to test the immune effect. If you need to detect antibody levels, you should use a neutralizing antibody test, including rapid fluorescent focus inhibition test (RFFIT) and mouse brain neutralization test.

Article 23 Adverse reactions should be handled in accordance with the "Vaccination Work Standards" (Health Disease Control and Prevention [2005] No. 373).

Article 24 People with high risk of exposure to rabies should undergo pre-exposure immunization, including laboratory workers engaged in rabies research, personnel in contact with rabies patients, veterinarians, etc.

Article 25 The basic pre-exposure vaccination program is to inoculate 1 dose of rabies vaccine on days 0, 7, and 21 (or 28). For those who are continuously exposed to the risk of rabies, after completing the pre-exposure basic vaccination, if there is no animal injury, a booster dose will be given after 1 year, and then every 3-5 years.

Article 26 Pre-exposure immunization may be postponed as appropriate for pregnant women, those suffering from acute febrile diseases, allergic constitutions, and those using steroids and immunosuppressants. Pre-exposure immunization is not recommended for patients with immunodeficiency. If they are at high risk of exposure, pre-exposure immunization can be performed, but neutralizing antibody testing is required after completing the immunization program.

If you are allergic to one vaccine, you can switch to another vaccine and continue the original procedure.

Article 27: Local health administrative departments at or above the county level shall make a reasonable layout of rabies exposure prevention and treatment clinics within their jurisdiction. Physicians engaged in rabies exposure prevention and treatment must pass the training and assessment by the local health administrative department at or above the county level before they can take up their posts.

Article 28: Rabies exposure prevention and treatment clinics should have necessary wound washing, cold chain and other equipment and emergency rescue drugs.

Article 29: Rabies exposure prevention and treatment clinics should establish and improve corresponding management systems. It mainly includes cold chain management, informed consent, vaccination registration, adverse reaction registration report, etc.

Article 30 If the contents of the pharmacopoeia or product instructions are changed, the relevant contents of this specification shall prevail.

Attachment: Informed consent form for the use of rabies vaccine and anti-rabies serum/rabies patient immune globulin

Attachment

Rabies vaccine and anti-rabies serum/rabies patient immunity Globulin

Informed Consent for Use

Rabies is an acute infectious disease caused by rabies virus, mainly caused by bites of dogs, cats and other animals carrying rabies virus. When a person is bitten, scratched or licked by an animal infected with the rabies virus, the wound or mucous membrane will be infected. The virus contained in the saliva will enter the human body through the wound or mucous membrane. Once it causes disease, the fatality rate will reach 100%.

After being bitten by a suspicious animal, the risk of disease can be greatly reduced by treating the wound immediately and correctly, injecting anti-rabies serum/rabies immune globulin as needed, and strictly following the requirements for full rabies vaccination. Anti-rabies serum/rabies immune globulin can specifically neutralize the rabies virus and take effect immediately. Rabies vaccination can stimulate the body to produce protective antibodies against the rabies virus. In order to use rabies vaccine and anti-rabies serum/rabies immune globulin safely and effectively, we will inform you of the relevant information before you use it, and you can decide whether to use it according to your specific situation.

Graded contact exposure

Extent of physician recommendation

(Tick the corresponding column) Signature of patient/guardian

Level I compliance One of the following situations:

1. Contact or feeding animals

2. Intact skin is licked. No treatment is required if the contact method is reliable. Agree ( ) Disagree ( ) < /p>

Level II meets one of the following conditions:

1. Bite on bare skin

2. Minor scratches or abrasions without bleeding 1. Treat wounds

2. Vaccination against rabies

Agree ( ) Disagree ( )

Level III meets one of the following conditions:

1. Single or multiple penetrating skin bites or scratches

2. Licking of broken skin

3. Open wounds or mucous membranes that are seriously contaminated 1. Treat the wound

2. Inject rabies passive immune preparation (anti-rabies serum/rabies immune globulin)

3. Inject rabies vaccine

Agree ( ) No Agree ( )

Agree ( ) Disagree ( )

Adverse reactions

Rabies vaccine: Individual people may have varying degrees of adverse reactions after vaccination. For example: local reactions at the injection site (pain, redness, swelling, induration, etc.); allergic reactions such as rashes and urticaria; systemic reactions such as fever or general malaise.

Anti-rabies serum: Some individuals may experience abnormal reactions such as serum sickness, rash, urticaria, and even anaphylactic shock after injection.

Rabies immune globulin: Generally there are no adverse reactions. A few people experience redness, swelling and pain, and they can recover on their own without special treatment.

Notes: Rabies vaccine and anti-rabies serum/rabies immune globulin are voluntary vaccinations for citizens at their own expense. Observe for 30 minutes after vaccination. If there is a slight reaction, no special treatment is generally required. In special circumstances, you can call the vaccination unit and go to the hospital for diagnosis and treatment if necessary.

Rabies vaccination card*

1st shot

(0 days) 2nd shot

(3 days) 3rd shot Shot

(7 days) 4th shot (14 days) 5th shot (28 days)

Programmed vaccination date

Actual vaccination date

Remarks

*Please get vaccinated on time according to the time specified above.

I have read the above information in detail and agree with the doctor’s advice.

Signature of the recipient (or guardian): Contact number:

Physician’s signature: