"Fear of water, fear of wind, pharyngeal muscle spasm , progressive paralysis..." After being caught by a cat at home, Xiao Liu fell into rabies anxiety.
Looking at the message about rabies on the phone, "the fatality rate is 100%" and "rabies is beyond cure", she began to imagine the most extreme results. When suspicion began to arise, panic spread like wildfire, she even felt that she began to fear light and her throat began to twitch.
In China, there are not a small number of people who are extremely panicked about rabies. Some people immediately get vaccinated with rabies because their pet sneezes, while others also get vaccinated with rabies after being bitten by mosquitoes.
September 28, 2022 is the 16th " World Rabies Day ". Rabies expert Yan Jiaxin believes that the strong tension in China about rabies is partly due to the high mortality rate of the disease and partly due to panic caused by a little understanding of the virus.
As a well-known virologist, Professor Yan Jiaxin has served as a researcher and doctoral supervisor in the Genetic Engineering Department of the Wuhan Institute of Biological Products. According to his estimate, the number of madness-phobic patients in China is at least hundreds of thousands, ranking first in the world.
In an interview with 9pai News , he said that at least one-third of rabies vaccines in China are abused, and many vaccinated people have no risk of infection at all, and they can be vaccinated without or less. "I have been exposed to related cases. Some people have received more than 100 rabies vaccines in a few years. Every time they are caught or licked by a dog, they will get a box of five-dose vaccines... Some people are very afraid of rabies and have been worried that they will get rabies for many years after being bitten by a dog. This is completely unnecessary. If you are really worried, three preventable vaccination can ensure that all rabies risks in the past can be eliminated."
World Health Organization once proposed that human beings are expected to achieve the goal of basically eliminating rabies worldwide by 2030. In 2021, about 150 people in China still died of rabies. In Yan Jiaxin's view, according to the experience of relevant countries, solving the rabies problem mainly depends on veterinary vaccines rather than human vaccines. "Sustained and effective immunization of 70% of dogs in a certain area. If you persist for several years, you can basically eliminate rabies in dogs and humans."
Rabies virus concept map. Photo/Visual China
Dialogue with Yan Jiaxin
[1] Understand the rabies virus: the mortality rate is almost 100%, and the incubation period is no more than 1 year
Jiupai News: What are the characteristics of rabies?
Yan Jiaxin: Rabies is a zoonotic disease, an acute encephalitis caused by the rabies virus, which kills 55,000 lives around the world every year. The mortality rate after rabies is almost 100%, and so far, only three unvaccinated people still survive after the onset of the disease.
Jiupai News: Which animals spread rabies?
Yan Jiaxin: The main storage host is the carnivorous and pteryx in the mammals class, including dogs, cats, foxes, jackals, wolfs, raccoons, skunks, raccoons, , mongoose and bat , etc. In nature, other mammals other than the storage hosts mentioned above, such as mice and rabbits, are only likely to be infected under extremely accidental circumstances and can be collectively referred to as accidental hosts, which generally do not constitute the source of infection for the virus.
Therefore, in most cases, especially in non-key epidemic areas, if you are bitten by rats and rabbits, you are extremely unlikely to get rabies and usually you don’t need to get rabies vaccination.
In addition, birds (such as chickens, ducks, geese), reptiles (such as lizards, turtles and snakes), fish and insects will not suffer from rabies, and therefore it is impossible to spread rabies. In fact, 99% of rabies are caused by bites or scratches by sick dogs (a few are cats).
Jiupai News: How long is the incubation period of rabies?
Yan Jiaxin: The World Health Organization has clearly confirmed that the incubation period of rabies shall not exceed one year.
The current mainstream view on the "incubation period" of human rabies is: the incubation period of most cases is 1-3 months, and the incubation period of a few severe head and face bites may be as short as 7 days.Therefore, if you have been bitten by a dog or cat for more than a year, you usually don’t have to get a supplementary rabies vaccine, and the possibility of recurrence is negligible.
Some people are very afraid of rabies and worry about rabies for many years after being bitten by a dog. This is completely unnecessary. If you are really worried, you can get 3 preventive vaccination, which can ensure that all rabies risks in the past are written off.
【2】Risk and treatment: After the risk of infection, it should be treated in graded. Correct rinsing of the wound can reduce the incidence by 50%
Jiupai News: Under what circumstances will you get infected with rabies?
Yan Jiaxin: The transmission route of rabies is relatively single, mainly through scratches or bites of sick animals, among which cats and dogs are the main sources of infection. The risk of rabies infection after bitten by a sick animal is 5% to 80%, and the incidence of infection caused by licking or scratching is 0.1% to 1%.
Contacting the blood or feces of sick animals will not cause infection, and there is no evidence that humans will suffer from rabies from eating dairy or cooked meat. However, it is strongly recommended not to consume meat or milk from rabies animals. In many countries, dog slaughtering is also one of the ways of transmission, and dogs with seemingly healthy appearance also have rabies viruses in the brains of dogs, which makes slaughterers susceptible to rabies.
However, eating dog meat itself will not cause rabies, but the entire process before consumption, including capture, disposal, and slaughter, will increase the risk of transmission.
Jiupai News: What should we do after we are bitten and scratched by cats, dogs and other animals?
Yan Jiaxin: The World Health Organization clearly stipulates that prevention after exposure is managed at three levels.
For level I exposure, i.e., contact or feeding an animal, or the animal licks the whole skin, no precautions are required.
If bites and scratches are caused, corresponding measures should be taken. First, wound treatment should be carried out. It is recommended to rinse and clean the wound immediately with soapy water, detergent, disinfectant or other solutions that can kill rabies virus for more than 15 minutes.
Correct wound rinsing can reduce the incidence by more than 50%, and there is one of the most typical examples. The earliest recorded rabies in Europe occurred in Lyon, France in 900 AD. After a bear went crazy, it bit 20 people at one time and then fled to the other side of a small river. Among the bitten people, 14 people swam across the river to chase the bears. Perhaps the river water naturally washed away the virus in the wound. None of these 14 people were infected with rabies. The six people who did not chase and kill the bear and therefore did not clean the wounds later died of rabies. After
is caught and bitten, we should also conduct full vaccination in a timely manner. If the patient is severely exposed, an appropriate amount of rabies virus immunoglobulin should be injected locally infiltrated into all wounds while receiving the first shot of the vaccine.
Picture: Visual China
Jiupai News: How to judge whether you are likely to be infected with rabies?
Yan Jiaxin: I will list some simple and practical judgment criteria: First, the incubation period of human rabies shall not exceed 1 year in principle. Therefore, no rabies vaccine is needed for any exposure for more than one year.
Second, healthy dogs do not spread rabies. After being bitten by a dog, you should use the " ten-day observation method ". The World Health Organization has determined: "If the dog (or cat) remains healthy during the 10-day observation period, treatment can be terminated."
The third point is that as long as the immunization procedure is completed, the disease will not occur again. There is no need to blindly receive vaccines or test antibodies. Moreover, after the entire vaccination, a certain degree of immune protection may last for decades.
Fourth, rats, rabbits, birds, and reptiles do not spread rabies, so there is no need to worry after being bitten.
Because the incubation period of rabies virus is relatively long, even if the patient has never been vaccinated before, it can still prevent the emergence of clinical diseases after exposure to the virus.
[3] Vaccination: Follow the "ten-day observation method", humans are expected to completely eliminate rabies
Jiupai News: What are the precautions during vaccination?
Yan Jiaxin: Eating spicy foods such as irritating foods will not affect the vaccine's immunity effect, but may worsen the adverse reactions.
China's rabies vaccine 30 years ago was produced with animal brain tissue. It must be given 14-21 shots within half a month, and 2ml of crude brain tissue will be vaccinated each time. The side effects are great. Drinking alcohol and strenuous exercise may increase side effects. Therefore, the vaccine instructions at that time stipulated that you should not drink alcohol, drink strong tea or eat irritating foods. You should avoid catching a cold or strenuous exercise or labor. In recent years, rabies vaccines have been produced by cell culture. After concentration and purification, they have only been given 5 injections or 4 injections, and the side effects are extremely small. But many domestic vaccine instructions are still copied 30 years ago.
Jiupai News: What is the current status of domestic vaccination?
Yan Jiaxin: Domestic rabies prevention and control should avoid vaccine abuse. At least one-third of rabies vaccines in China are abused. These vaccinated people have no risk of infection at all and can be completely eliminated or vaccinated.
I have been exposed to related cases. Someone has received more than 100 rabies vaccines in several years. Every time he is caught or licked by a dog, he will get a box of five shots of vaccines. This situation is a lot, which leads to great abuse of the vaccine. Unlike infectious diseases transmitted from human to human, vaccination of people can reduce the source of infection. For rabies, its main transmission vector is dogs. There are almost no cases of rabies caused by human infection in China. Therefore, the more you get the better the dogs, and the more you get the right ones, and the more you get the right ones. Only those who are indeed likely to be infected should be beaten, otherwise it would be a pure waste and would not be able to reduce the source of infection at all.
Jiupai News: What is the "ten-day observation method"?
Yan Jiaxin: Rabies is divided into incubation period and infectious period. The incubation period of dogs or cats is usually within 10 days to 6 months. The incubation period does not transmit rabies. It is only 3 to 5 days before the onset, plus the 3 to 7 days from onset to death (the total is no more than 2 weeks). This period is called the infectious period. When a dog is contagious, a large number of rabies viruses have been reproduced in the brain. As the virus in the brain further reproduces, it will inevitably develop the disease and die a few days later. This is the theoretical basis of the "Ten Day Observation Method".
In other words, healthy dogs will not spread rabies, so how do you judge whether the dog is healthy? In addition to the laboratory taking brain tissue for testing, the common practice is the "ten-day observation method". The World Health Organization stipulates that if the animal is a dog or a cat and remains healthy within the observation period 10 days after the exposure occurs, post-exposure prevention can be terminated, that is, if the cat and dog do not die within ten days after being caught and bitten, there is no need to worry about rabies.
In the epidemic area where rabies is prevalent, people who have not been vaccinated before should start post-exposure prevention immediately while starting the "ten-day observation method", and then determine whether the subsequent 2 or 3 shots of the vaccine can be saved based on the observation results.
Jiupai News: There is a risk of exposure again after being vaccinated. How should I get vaccinated?
Yan Jiaxin : Anyone who has received 3 (or more) vaccination in the past can be given 1-2 shots after being exposed again. Moreover, anyone who has received 3 (or more) vaccines before will never need to receive rabies immunoglobulin again in the future.
After receiving 3 shots of rabies vaccine, the titer of antibody is far higher than the minimum suitable titer within half a year, and it is usually not necessary to detect antibodies; after strengthening vaccination, the effective protection period is at least 3 years.
Jiupai News: Is humans expected to completely eliminate rabies?
Yan Jiaxin: The World Health Organization clearly confirms that "rabies can be eliminated". At present, rabies has been effectively controlled in all developed countries and some developing countries in and (or regions), and many developed countries have zero rabies cases over the years. The World Health Organization has also proposed to achieve the goal of basically eliminating rabies worldwide by 2030.
About 150 people in China still die of rabies in 2021, and we still have a way to go. Experience in relevant countries has proved that solving the problem of rabies mainly depends on veterinary vaccines rather than human vaccines. Continuous and effective immunization of 70% of dogs in a certain area. If you persist for several years, you can basically eliminate rabies in dogs and humans. This should be the direction we will strive for in the future.
Jiupai News Reporter Chen Wei
[Revelation] Please contact the reporter WeChat: linghaojizhe
[Source: Jiupai News]
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