Can anyone tell me whether the presence of the virus can be detected after a rabid dog dies a long time ago, and whether it can be confirmed whether it died of rabies.

Rabies phobia is a phenomenon unique to China. There is no other country in the world that takes rabies as seriously as China. Prejudices and fallacies about rabies are so widely spread, which is one of the important reasons for the current massive abuse of rabies vaccines in China.

The infectious disease that people are most afraid of in China, besides AIDS, is rabies. Rabies phobia, referred to as "rabies phobia", has now become a very popular mental illness that is almost as popular as "AIDS phobia".

Recently, the issue of misuse of rabies vaccines in China has attracted widespread attention. The use of rabies vaccine in China reaches 15 million people every year, accounting for more than 80% of the global total. If vaccines are not used at all, 30,000 people will die from rabies in China every year. This means that 99.8% of vaccinators could theoretically not have been vaccinated, and at least 1/3 of them may have been abused. So, what situations might qualify as abuse? How to avoid abuse?

The most common manifestation of rabies phobia is the misuse of rabies vaccines, taking the vaccine when it is obvious that it should not be vaccinated, and even being worried after repeated vaccinations. The prevalence of rabies phobia is obviously one of the important reasons for the current massive abuse of rabies vaccines in China.

Rabies is an infectious disease with the highest case fatality rate but a low incidence rate. People can easily overreact. At present, unscientific remarks about rabies are rampant on the Internet or in real life, and all kinds of bizarre theories are quite common among "experts" and the public, causing some people who have contact with dogs and cats (or even those who have no contact at all) to suffer from long-term Being in fear can even develop into obsessive-compulsive disorder or "hysteria". Some people have been vaccinated multiple times, but still travel thousands of miles to Wuhan every month for antibody testing, fearing that "once the antibodies are reduced, rabies will break out." Some people believe that the virus has sneaked into their brains and that they are destined to die. They lose their jobs, search for information online all day long, and are at a loss among all kinds of conflicting information. Some people suspect that the vaccine is fake, that there is live virus in the vaccine, that the rabies virus can be transmitted through the air, that the nurse, the expert... they struggle with endless troubles all day long.

When talking about rabies, we should first clarify one of the most basic facts: the risk of rabies is not comparable to that of AIDS (the latter has no effective vaccine, and the relevant basic immune mechanism is still unclear). The prevention and treatment of rabies is a problem that has been basically solved medically. Rabies has been effectively controlled in all developed countries and some developing countries around the world. The annual number of rabies deaths has remained at 0 or close to 0 for many years. Rabies is 100% preventable: No matter how severe the exposure is, as long as the treatment is carried out according to the protocols recognized by the World Health Organization (WHO), the disease can be 100% avoided.

In this article, the author will list some representative situations and explain how to avoid the abuse of rabies vaccine. The author will provide several simple and practical judgment criteria to help patients with psychophobia 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? China wants to create another Guinness record? In some professional magazines and even textbooks in China, it is often stated that the incubation period of rabies can last for decades.

Are these "cases" in China really rabies? Since there is no basis for laboratory diagnosis, or it is impossible to prove that no new infection has occurred recently (such as infection through some special or rare routes), these "cases" have not been recognized by the international academic community, and have even been uploaded as jokes internationally. , as an example of the low level of relevant science in China.

Domestic and foreign data show that the incubation period of rabies is usually 1-3 months. The incubation period of a few serious bites on the head and face may be as short as 7 days. In very few cases (less than 1% of the total) The incubation period may also be greater than one year.

The longest incubation period of rabies currently recognized by the international mainstream scientific community is 6 years. American scholars reported this case in a professional magazine in 1991. The deceased was a Filipino immigrant and had never left the United States after immigrating to the United States. Since the chance of contracting rabies in the United States is extremely rare, and the results of partial genetic sequence analysis prove that the rabies virus isolated from the brain of the deceased is the same as the strain circulating in the country where the deceased came from, the report provides the most convincing evidence to date. It has been demonstrated that the incubation period for rabies may be as long as 6 years.

Because the number of similar cases is too small and the relevant evidence chain is not very complete, there are still objections to the case report in the relevant academic circles. For example, many French scholars believe that cases with an incubation period of more than one year, if any, are extremely rare and the possibility of recurrence after one year is negligible. They laughed off talk of a longer incubation period.

There are too many people in China who have been bitten by dogs in the past few decades. If the incubation period of rabies is really that long and so many people should be vaccinated, then the number of rabies cases in China every year Vaccinations will also increase by a considerable amount. Many rabies patients are frightened by the legend of the long incubation period of rabies.

Promote the "Ten-Day Observation Method"

We should firmly believe that healthy dogs do not spread rabies! A related paper jointly written by experts from China and the United States based on the results of field investigations in China has been published in the 3rd issue of 2008 in the American Journal of Vector-Sourced Human and Animal Disease. However, appearance of health does not mean true health. Experimental testing or "ten-day observation method" must be used for identification. After a person is bitten by a dog, if the dog can be killed immediately and the brain tissue is taken for testing, the test results (the presence or absence of the virus) can be used to determine whether the bitten person needs to be vaccinated. If the animals are unconditionally killed on the spot for testing, the "ten-day observation method" recognized by the WHO can be applied: "If the dog (or cat) remains healthy during the 10-day observation period... then treatment can be terminated."

In the past ten years or so, our laboratory has not found any evidence at home or abroad that is sufficient to negate the "Ten-Day Observation Method." This method is a simple and practical method to determine whether a dog (or cat) is contagious, and it is also applicable to China.

It should be noted that in rabies-endemic areas, those who have not been vaccinated before should start post-exposure prophylaxis immediately when starting the "ten-day observation method", and then determine whether it is possible based on the observation results Save the 2 or 3 shots of vaccine for later.

The vast majority of dogs or cats raised in cities now are pets and usually have little contact with the outside world, making it easier to implement the "ten-day observation method." If the "Ten-Day Observation Method" is promoted in China, not only the dosage of the vaccine can be greatly reduced (perhaps by half of the total dosage), but also the vast majority of patients with psychophobia can achieve mental liberation more quickly.

What to do if bitten by rats or rabbits

WHO’s relevant report pointed out: “Examination of thousands of wild and residential rodents in rabies endemic areas in North America and Europe showed that rabies infection in rodents is rare, indicating that these animals are not reservoirs of the disease. "Exposure to rodents such as rabbits and hares rarely requires specialized anti-rabies post-exposure prophylaxis."

< p> There are occasional statistical reports of rat-to-human rabies cases in our country's literature reports, but the confirmation of the injured animals relies on the oral recollections of the patients or their family members, which has limited scientific value and the total number is very small.

According to the author’s years of data collection and research, I believe that the above views of the WHO are basically applicable to China. Especially if someone is bitten by a rat or rabbit in a non-key epidemic area, the possibility of contracting rabies is extremely small, and rabies vaccination is usually not required.

There are many chances for people to be bitten by rats - accounting for 3%-10% of all animal injuries. If vaccination is not administered under such circumstances, annual vaccine consumption may be saved by up to 1/10.

As for the treatment of rats biting humans, the Ministry of Health of my country has not yet issued relevant work regulations. Regarding the cases of rats actively injuring people in key epidemic areas in the south, it is recommended to objectively publicize that the probability of rabies caused by rat bites is extremely small, and at the same time, let the patients weigh whether they need to be vaccinated against rabies.

In addition, birds (such as chickens, ducks, and geese), reptiles (such as lizards, turtles, and snakes), fish, and insects never get rabies and therefore cannot transmit rabies.

Treat "indirect transmission" correctly

The source and transmission route of rabies are relatively single, mainly through scratches or bites from dogs or cats. WHO clearly stipulates that post-exposure prophylaxis is managed in three levels. For Level I exposure, that is, contact with or feeding an animal, or an animal licking intact skin, no precautions are required. The other so-called "indirect transmission" methods that many phobia patients worry about are very unlikely to actually occur and can usually be ignored. If some people have a particularly heavy psychological burden due to this, which seriously affects their daily work and study, they can also receive 3 preventive vaccinations.

After vaccination, you can basically rest easy - neutralizing antibodies may last for years or even decades, during which time there is sufficient resistance to so-called "indirect transmission".

The important role of wound cleaning should be fully understood. Proper wound irrigation can reduce morbidity by more than 50%. For many plausible "indirect transmissions," or minor exposures in non-endemic areas, wound cleaning is actually enough to completely remove the very slight possibility of infection without insisting on vaccination.

There is a most typical example of the important role of wound treatment: the earliest recorded rabies in Europe occurred in Lyon, France in 900 AD: a bear went crazy, bit 20 people at once, and then escaped to The other side of a small river. Among the people who were bitten, 14 swam across the river to chase the bear. Perhaps because the river water naturally washed away the virus in the wounds, none of these 14 people were infected with rabies virus; while 6 of the people who did not chase the bear (and therefore did not clean their wounds) Everyone later died of rabies (it seems that those who acted bravely were rewarded).

Viruses in the central nervous system

Many patients with "maniaphobia" like to raise this question: after the rabies virus enters the nerve cells, will the antibodies triggered by the vaccine no longer work? ? Can antibodies clear viruses in the central nervous system (CNS)?

A large amount of original and newly discovered evidence shows that rabies virus antibodies can not only neutralize the virus in peripheral nerve cells, but may also completely clear the virus in the CNS under certain conditions; rabies virus After entering the CNS, it will either be cleared or become ill within 3-5 days. Under no circumstances is rabies virus likely to remain dormant in the CNS (including the brain and spinal cord) for long periods of time.

Once a person's rabies attacks, they will die within ten days. Therefore, if any symptom is suspected to be related to rabies, the patient will definitely die of rabies after ten days (at least he will be admitted to the intensive care unit for rescue). If this is not the case, the symptoms are certainly not related to rabies (and should be referred to another specialist as soon as possible). Some patients with rabies are convinced that they have rabies and claim that typical symptoms of rabies have lasted for several months or even longer. I hope no one will make fun of themselves like this again.

There are numerous examples demonstrating that treatment may be effective days or even months after exposure, suggesting that antibodies may also clear rabies virus from the CNS.

Some patients who were actively rescued by modern life support systems and maintained their lives for a long time found that the rabies virus was completely eliminated from the whole body (including the CNS) during post-mortem autopsy, which can be indirectly proved. Antibodies can enter the CNS and clear the virus in the CNS.

In fact, most vaccination failures occur within 20 days after the first injection, mainly in patients with severe bites on the head and face. If the disease does not occur after this time, the possibility of developing it again in the future is almost non-existent.

The rabies virus does not cause changes in the morphology of brain cells. The whereabouts of the rabies virus in the human body cannot be detected before the onset of the disease. Whether the brain function is damaged can only be judged based on the symptoms. The detection of sufficiently high antibodies before the "onset" proves that his brain function has not been damaged, at least not severely, and he will not get sick again in the future.

In short, as long as the vaccine is fully vaccinated before the onset of illness and antibodies are produced, there will be no more rabies virus "lurking" in the body (including the CNS), and the illness will not occur again. After searching relevant literature at home and abroad, basically no cases were found that violated this standard. This is another simple and practical criterion that can help liberate rabies patients from their blind fear of rabies.

What to do after re-exposure

Some recently published clinical trials have shown that people who have received 3 to 5 doses of the initial series of rabies vaccinations have a certain degree of immune protection that can last for decades. Year. Regardless of whether the person has detectable antibodies, two doses after reexposure are enough to elicit a good immune recall response (and immune globulin is not necessary under any circumstances after reexposure).

There was a related survival case in Germany a few years ago. Before an organ provider was diagnosed with rabies, her liver, pancreas and two kidneys were transplanted to four people. Among these four people, only one who received a liver transplant survived, and the other three died of rabies within weeks of the transplant. Further investigation revealed that the surviving liver transplant recipient had been vaccinated against rabies as a child.

This case may demonstrate the durability of rabies vaccine efficacy.

The latest regulations from WHO are: No matter how long ago you were vaccinated, you only need 2 shots after being exposed again.

The domestic Ministry of Health’s 2009 regulations on treatment after re-exposure are: 3 injections within 1-3 years, and a full course of vaccination (5 injections) required after 3 years.

Compared with WHO regulations, it can be seen that booster vaccination with more than 2 shots falls into the category of abuse. Therefore, the regulations of the Ministry of Health should be revised.

Currently, domestic rabies vaccines are packaged in a box of 5 shots and cannot be sold in pieces. There are quite a few rabies clinics, and all those who come for vaccination, including those after re-exposure, are given 5 shots indiscriminately. As a result, it is not uncommon for a person to receive 10 or 20 injections in a year. There are even extreme cases where a professional dog owner needs more than 50 injections in more than a year due to frequent dog bites. This is the most obvious form of vaccine abuse.

Maniaphobia is a phenomenon unique to China. There is no other country in the world that takes rabies as seriously as China. China is currently the world's largest producer and user of rabies vaccines. If the relevant management departments and all sectors of society can work together, make full use of the knowledge and experience of rabies prevention and control in various countries around the world, and resolutely put an end to the abuse of rabies vaccines, then comprehensive calculations show that the annual use of rabies vaccines in China is likely to be reduced by half from the current level. The above will not increase the number of rabies deaths.