Dog bites are the main transmission method of rabies virus, and the mortality rate of rabies is almost 100%. All dog bites require rabies exposure risk assessment, and appropriate immunoprevention treatment plans are selected based on exposure grading.
The specific methods are as follows:
In short: If the bitten skin is not damaged, local cleaning is enough; if the skin is damaged but there is no bleeding, actively treat the wound and receive rabies vaccine at the same time; if the skin is damaged and bleeding, it is necessary to actively debride the wound, and inject rabies immunoglobulin locally into the wound and receive rabies vaccine at the same time.
02How to treat wounds?
Local thorough and effective rinsing of wounds is very critical. More than 99% of patients can survive by effective wound cleaning and immediate rabies vaccination and post-exposure prevention and molding.
1. Wound rinsing and cleaning:
① Use soapy water (or other weakly alkaline cleaning agent) and flowing water to alternately clean all bites for about 15 minutes;
② Use sterile gauze or degreased cotton to absorb the residual liquid in the wound;
③ Use normal saline to rinse the wound to avoid residual soapy water or other cleaning agents in the wound.
2. Disinfection treatment: After thorough rinsing, apply or clean the inside of the wound with dilute iodine or other medical preparations with inactivated viruses.
3. Seek medical treatment: If the wound is serious, go to the hospital for debridement and expansion immediately.
Prevention of rabies
How to prevent rabies? Methods include active immunity and passive immunity. Let me introduce it to you below:
1. Active immunization: that is, rabies vaccines are vaccinated with rabies. Currently, the rabies vaccines used in my country are concentrated and purified cell culture vaccines. For first-time exposed people, select the "5-point method" or "2-1-1" procedure to complete the full immunization procedure. 5-article method: that is, Essen method, inject one dose intramuscularly on days 0, 3, 7, 14 and 28 respectively. 4-injection method: Zagreb method, 2-1-1 immunization procedure, 2 doses, 1 dose, and 1 dose were injected intramuscularly on days 0, 7 and 21 respectively.
2. Passive immunization: that is, local infiltration of the wound is injected to inject immune preparations to neutralize the remaining virus after the wound is cleaned and disinfected, and produces a local immune protection effect. In fact, it is local injection of rabies immunoglobulin in the wound. It is mainly aimed at rabies level III patients who have not been vaccinated with rabies, gradual exposure patients with severe immune function defects, and areas with dense wound distribution (head, face, perineum, hands, etc.).
Some students will ask, if you have already been injected with rabies vaccine, do you still need to inject rabies immunoglobulin horses? Before entering the neural tissue, rabies viruses usually slowly replicate in local muscle cells for a period of time. The human body cannot produce high levels of protective antibodies within one week after the first injection of the rabies vaccine. Therefore, for patients with exposed grades of Level III, rabies passive immune preparations should be injected as soon as possible within 7 days after the first dose of the vaccine. Rabies immunoglobulins in my country include: human rabies immunoglobulin (rabies patient immunoglobulin) (no skin test required) and equine rabies F (ab’) 2 fragment preparation (anti-rabies serum) (requires skin test).