Is taking rabies vaccine 100% effective? as in the once infected person won't need a booster shot in the future?

Submitted by DetectiveSherlocky t3_yhchrs in askscience

Suppose a patient is given the treatment for rabies after getting bitten and then gets cured after a while. Are there any chances the infection might still stay active somewhere in the body for years?

Are the booster doses needed? Is there any scenario where the cured person still has a possibility to get infected after many years from the past supposedly cured infection if booster shot isn't taken?

Can the infection stay passive in the patient even after the treatment?

There's a lot of conflicting information out there. I would appreciate some explanation on this.

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TheGnarWall t1_iudiob1 wrote

You're supposed to get a titer every couple years to check your levels of protection and if those levels drop you would require a booster. I have friends that work with bats and other wildlife and haven't heard of them needing boosters over many years but I'm sure it happens.

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Alwayssunnyinarizona t1_iudlfhk wrote

Typically every 2yrs for titers.

The only problem? No one knows what titers specifically are protective; the "less than" level requiring a booster is somewhat arbitrary.

For obvious reasons, the experiments necessary to determine the appropriate level - exposing people with varying antibody titers to rabies - have never been done :)

Source - I've gone through full post-exposure prophylaxis. There's no concern for developing rabies further down the road and boosters are only necessary for those who continue to be at high risk for exposure.

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chronicallylaconic t1_iudrd7m wrote

May I ask whether PEP is as painful as I've heard? If it's not a goddamn horror story it'll be unlike everything else associated with rabies.

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Squester t1_iuexpnx wrote

You're probably thinking the big needle in the stomach but they don't need that anymore. The vaccine itself is just a series of 4 normal shots for post exposure, but the painful part is the immunoglobulin because it's very thick so it needs a big needle at the site of exposure. In my case, my forehead

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Sir-Simon-Spamalot t1_iugqmub wrote

How did you get bitten in the forehead, if I may ask?

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Squester t1_iugqtcf wrote

I very rudely ripped a poor little bat's house off the wall of our garage while he was sleeping (did not know it was his house). He was understandably very upset and my face was right there! Since it was outside we couldn't catch it to test it for rabies so I got to get the vaccine

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[deleted] t1_iudvyf5 wrote

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TheLurkingMenace t1_iudxfhf wrote

I always thought the "big needle right in your stomach" was just what they told kids so they wouldn't play with wild animals. Never would have guessed there was some truth behind it.

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tonniecat t1_iuee8ro wrote

A bat bit me in a couple fingertips - the bites didnt hurt, but the needles in the fingertips was pretty painful.

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Insight42 t1_iug0df3 wrote

It's not.

I hate needles. I've passed out from vaccinations before, even if they're not painful - I even had to sit for a half hour after a flu shot once.

Rabies PEP consists of 4 visits. The first is 4 shots of vaccine in the arm and immunoglobulin injected as close to the wound as they can get. The 4 vaccine doses were almost entirely painless - the immunoglobulin is not. It's thick and you get a lot of it.

The other three visits - at day 3, day 7, and day 14, if memory serves - are each just one injection of a dose of vaccine, and aren't any more painful than a flu shot. Generally you're a bit wiped for the rest of the day, but nothing terrible and no soreness the next day.

Unfortunately, the only place they have this is the ER. That can mean a long wait and some nasty bills. Better than rabies though.

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xallanthia t1_iugj3uw wrote

Anyone else going through this—you can get doses 3, 7, and 14 through urgent care to save some on the bill. I just had to do the series myself.

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[deleted] t1_iufvhri wrote

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Emu1981 t1_iugxfg7 wrote

>the COVID vaccine was a 5

I found that the COVID vaccine highly depended on who actually gave you the injection. I had Pfizer for my first two doses and Moderna for my two boosters. My first dose of Pfizer was barely noticeable other than the mild fever and ache of my arm afterwards. My second dose, which was done by a different nurse but same vaccine at the same centre, was painful AF but the fever and arm ache was way more mild. Third and fourth were done at my local chemist and neither really did much of anything regarding pain or aching beyond a really mild arm arche (barely noticeable) and a very mild fever - I literally feel hotter now due to the combination of heat from my computer (just played around 45 minutes of BF2042) and the high humidity.

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BigNorseWolf t1_iugggmp wrote

The pre exposure was just a regular shot. No side effects for me (got it in africa for the peace corps. But they wouldn't give me a dog tag...)

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brucebay t1_iugpgwf wrote

I never heard pre-exposure for rabbies. If you have it, will it protect you like a regular vaccine, or do you still need additional shots if you are bitten?

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BigNorseWolf t1_iugrphf wrote

Its just like for dogs, but for people.

If you get bitten while vaccinated you get two shots.

If you get bitten and not its 4.

I don't think we know how often those two extra shots are NECESSARY but we do not want to find out.

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4077007 t1_iugpe35 wrote

I’ve given it in the ER a handful of times, and it’s easily one of the cruelest things I have ever done to another human. Definitely better than rabies, but not better than much else… People don’t tend to get bitten in large, low innervation areas. It tends to be in the sensitive, low-fat, low muscle areas which makes the injections so so painful. I’ve given them in a shin, palm of the hand, and thumb.

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Kraz_I t1_iuipics wrote

Can you at least numb the area with local anesthetic first?

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4077007 t1_iuj3zsc wrote

Lidocaine is very painful going in at first. It’s great for longer procedures, but you’re just about as good bearing through the rabies shots as you would be getting the lidocaine shots and then having to get stabbed more times in areas that may or may not have gotten sufficient lidocaine to numb you completely.

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AquaDoctor t1_iufhixf wrote

If you have a bite or a suspected bite, you get two things on the first day. You get your first dose of vaccine as well as a weight based Immunoglobulin (Ig). Vaccines take time to work, and so to keep you from death the Ig is basically premade antibodies that will work to fight rabies immediately.

So Day 0 you get those and then you typically get boosters on Days 3, 7, and 14.

As others commented I think there has been like 1 rabies infected person who lived without treatment. That’s why bite or suspected bite or even remote possibility of exposure, get Ig and vaccine. If you wake up to a bat in your room, assume exposure.

By then you should be protected for about 3 years. If you work around bats you’ll get boosters after that point to help ensure you have circulating antibodies.

Source: I’m a doctor and I woke up to a bat in my room two years ago so I assumed exposure. And I’m alive still.

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Quick_Turnover t1_iug18dd wrote

How the heck are these bats getting into peoples rooms!?

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Bu22ard t1_iug8hsk wrote

You don’t have bats in your room to wake you up?

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frustrated-brain t1_iughg4y wrote

I wonder how many doses does batman have to take with all those bat's around him

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Bu22ard t1_iuhl1fu wrote

He might be that one case of getting infected and surviving without treatment.

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urahonky t1_iuhishv wrote

Yeah I'm confused... How tf are other people waking up in the mornings?

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sonicthehedgehog16 t1_iuhvw1a wrote

In some areas they roost in attics and then escape into other parts of the house

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_Oman t1_iufxih4 wrote

Hello Mr. Dr.

Had wildlife worker friend who encountered the wonderful world of rabid raccoons much too often. He was told the Ig was to get an immediate immune response using foreign antibodies so that the virus could not replicate well enough to move into the nerve cells. For some reason if the virus does reach the long nerves, the body can't make an effective defense and the virus will kill you.

Does that seem correct?

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Xion407 t1_iuhzn1y wrote

Basically yes this is true, the antibody injection will fight the virus to give your body time to create its own antibodies in response to the vaccine. Rabies must be kept out of the central nervous system because once it reaches there then it’s already too late and the odds of survival are almost zero. It takes our body a week or two to start creating its own antibodies and that’s why you have to receive several doses while your body is ramping up production.

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kai58 t1_iuhbsog wrote

Iirc the one who survived wasn’t even without treatment, there was only a single person who survived after showing symptoms.

I’m too lazy to look for the copypasta about it but basically if you get bitten with rabies and show symptoms you’re already doomed.

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Psychological_Dish75 t1_iuhh75i wrote

Can I have a follow up from someone who know nothing of biology. Is rabies from different animal different, or is that vaccine can target all of them ?

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marker_dinova t1_iuj5d96 wrote

Woah. A friend of mine told me a squirrel bit him a while back (a few years ago). When I asked him if he got rabies shots he dismissed them and said the squirrel looked fine and nothing has happened to him since. Might he be in the clear?

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APG_20 t1_iudmqpt wrote

Post exposure prophylaxis is almost 100% effective (see WHO position paper: https://www.who.int/publications/i/item/who-wer9316). It takes advantage of the relatively long latency period of the virus (usually weeks/months, but in rare cases years), so when administered before symptoms show, it is almost always effective. In this case, the virus is gone and there is no risk of it re-emerging.

This doesn't mean you can't get rabies again if reinfected. As another post mentioned, the rabies vaccine is usually topped up with a booster (frequency depends on risk areas). Post exposure treatment is always recommended regardless of whether a person is vaccinated or not.

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StinkyBrittches t1_iudrigf wrote

And just to be clear, typical post exposure prophylaxis isn't just one shot, it's a series, with boosters at days 3, 7, and 14.

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uh_buh t1_iufedw8 wrote

This is besides the point but rabies doesn’t really ever get “cured” it’s fatal in 99% of cases (once symptoms begin). However because the rabies virus is dormant for a little bit (has a long latent period), you can get the vaccine after you are bit, and while you are infected. During this dormancy period, before your symptoms start, if you get the vaccine, your immune system will create antibodies to destroy the latent pathogen.

TLDR: your immune system can forget the response if the virus mutates too much since your last vaccine but since you get the vaccine even after the virus begins infection, most of the time you just need to get a shot immediately after getting bitten, kinda like tetanus shots.

Hope this helps a bit

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AndarianDequer t1_iufy77u wrote

I went to college for veterinary technology, one of my professors, a veterinarian, was vaccinated when he was 20. When I was in school he was something around 60 and had a tighter and it showed he was well within the value of being immune still. So his vaccine lasted for him over 40 years. But who knows?

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Emu1981 t1_iugxna5 wrote

>So his vaccine lasted for him over 40 years.

Given that rabies has a mortality rate approaching 100% once symptoms appear, would you risk relying on your old vaccinations?

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cl174 t1_iugbn8y wrote

The real answer is probably that this has likely never been studied due to the rarity of rabies exposure in general. And since we will likely never have a huge outbreak of rabies, I suspect that if you got exposed to rabies as like a child, completed a post exposure prophylaxis round and survived, and then 40 years later were exposed again, they would do the same post exposure prophylaxis again. Because it would be crazy to risk it.

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Radical_MD t1_iuei02n wrote

This needs more info.

“Once infected patient” does this mean the patient was really infected? If indeed it was already a diagnosis of Rabies then there is no turning back. There are documented sucess in treating Rabies but the cure rate is low, that is why it is recommended to get a pre- and/or post-exposure prophylaxis.

Latent infection - yes this happens when the virus travels somwhere in the nervous system and be dormant, then wakes up one day due to a trigger factor. This is caused by insufficient doses of the vaccine given, or no vaccine was given at all. So better get all the shots recommended for post-exposure prophylaxis. Especially important to note is one has to get both the passive and active vaccines to prevent latent infection.

Booster doses - from where I am (PH), booster doses after the initial doses are not really required, as evidenced by local and international journals. The full post-exposure prophylaxis is sufficient. However, if you are highly exposed to animals (eg. You live in a farm, have many mammalian pets, you are a hunter or is involved in any activity that may cause you to get bitten like a vet, etc), pre-exposure prophylaxis is recommended.

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Latitude22 t1_iuh6k6x wrote

There is a difference between the vaccine given before a bite and a vaccine given afterwards. I was given the rabies vaccine, along with immune globulin shots post dog bite in 1988. It was a series of immune globulin shots around the wound and then a several shots in the arm spanning over a few weeks. I will never need any more shots. I believe dog catchers etc are given shots pre dog bite that work a little differently, I do not know if they require a booster, but I am pretty sure they do.

At the time that I was given the vaccine in Washington state no one really knew how to give it since it was so uncommon. they consulted doctors in other states and even a veterinarian lol

Edit:spelling

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bobgom t1_iui3zn3 wrote

In this study, out of 201 cases of rabies only one of them had received the fully recommended PEP of immunization + immunoglobin, which was a young child that was seriously bitten. 15 others had initial vaccinations but didn't complete their doses, and one other had all their vaccine doses but no immunoglobin.

https://www.ijidonline.com/article/S1201-9712(15)00180-0/fulltext

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Electronic_Health22 t1_iujhwp7 wrote

Rabies doesn't typically stay latent in your body for years. When it's treated, it's treated.

All immunity wanes over time. If you've been treated with rabies immune globulin and vaccine after you were exposed, the immunities generated last, in general, for several years. There isn't any good long-term data on this since it's so rare but I would think that over time, antibody titers go down and upon re-exposure, we would just treat the patient the same way as if they were initially exposed. Some studies here:

https://pubmed.ncbi.nlm.nih.gov/7410895/

https://pubmed.ncbi.nlm.nih.gov/27997343/

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metagravedom t1_iugv39p wrote

So from what I've heard is that sometimes very rarely the vaccine doesn't actually work as intended for a number of reasons. Could be that the person had multiple infections and the vaccine got bombarded too quickly etc. I've even heard of an instance where the vaccine was accidentally administered into a tumor and the person died later because of the mistake. Anyways I think the booster itself is mainly just to make sure everything is good. Its basically like antibiotics, doc wants to make sure you took them all so you don't come in later with something more serious that they can't fix. Last thing anyone wants is a lab result coming back showing you have massive holes in your brain, lock jaw and a very painful last few months to live. But your medical treatment is entirely up to you so if your fine with not getting it that's entirely your choice.

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[deleted] t1_iudvb5w wrote

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778899456 t1_iuex7k5 wrote

That's interesting. When I had the pre shot they just told me it would buy me more time to get the post shot if I got bitten. I had 5 post bite.

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[deleted] t1_iudr9ch wrote

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