Tag: rabies vaccines

Is There a Grace Period for Getting Vaccines?

You know about the standard immunization schedule.

Looking at the latest immunization schedule from the CDC and AAP, it should be clear that kids don't get 69 vaccines.
What happens if you get a vaccine a few days too early?

You may even know about the minimum ages or minimum intervals between vaccines, but what happens if your child gets a vaccine just a few days early?

Is There a Grace Period for Getting Vaccines?

Fortunately, in most cases, getting a vaccine just a little early isn’t going to mean that the vaccine dose has to be repeated.

“Doses administered too close together or at too young an age can lead to a suboptimal immune response. However, administering a dose a few days earlier than the minimum interval or age is unlikely to have a substantially negative effect on the immune response to that dose. Known as the “grace period”, vaccine doses administered ≤4 days before the minimum interval or age are considered valid; however, local or state mandates might supersede this 4-day guideline.”

General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP)

That’s because the Advisory Committee on Immunization Practices (ACIP) allows a 4-day grace period for most vaccines. So if your child got their vaccines 3 or 4 days before their 1st birthday, instead of on or after turning 12 months old, they would still count!

It is important to keep in mind that:

  • day 1 is the day before the day that marks the minimum age or minimum interval for a vaccine.
  • the grace period doesn’t apply to the rabies vaccine
  • if a vaccine is given 5 or more days too early, beyond the grace period, then the interval to the next dose starts from the day that invalid dose was given. For example, if the second dose of Hib is given two weeks after the first dose (instead of the minimum 4 weeks), then you don’t repeat this invalid dose in two weeks (four weeks from the first dose), but instead wait an additional four weeks from the invalid second dose
  • you can’t usually add the grace period to an accelerated schedule
  • live vaccines must be given at least 28 days apart if they are not given at the same time and the grace period can not be used to shorten this interval

Most importantly, in place since 2002, the grace period protects kids from having to repeat vaccines because of minor vaccine scheduling errors.

More on the Vaccine Grace Period

When Was the Last Time Someone Died from Being Bitten by a Rabid Dog in the United States?

Most people aren’t overly worried about rabies these days, at least not in the United States.

In the mid-1950s, rabies control programs began to get more and more dogs vaccinated against rabies.
In the mid-1950s, rabies control programs began to get more and more dogs vaccinated against rabies.

Is that because rabies isn’t around anymore?

Of course not. It is because a rabies vaccine has long been available both to prevent our pets from getting rabies from wild animals and to protect us if we are ever bitten by an animal that might have rabies.

Hopefully, especially after the recent rabies death of the 6-year-old in Florida, everyone understands that rabies is still around.

When Was the Last Time Someone Died from Being Bitten by a Rabid Dog in the United States?

Since 2008, at least 21 people have died of rabies in the United States, mostly after getting exposed to rabid bats.

There were more than a few exposures from dogs with rabies too. In fact, the last rabies death after a dog bite was not very long ago – it was in May 2017.

Exposure to rabid dogs typically happened while the person was out of the United States.
Exposure to rabid dogs typically happened while the person was out of the United States.

Does that mean that something isn’t working with our rabies prevention plans?

When you take a closer look at the statistics about rabies deaths after dog bites, it becomes clear where the problem is.

“In 1950, for example, 4,979 cases of rabies were reported among dogs, and 18 cases were reported among humans. Between 1980 and 1997, 95 to 247 cases were reported each year among dogs, and on average only two human cases were reported each year in which rabies was attributable to variants of the virus associated with indigenous dogs . Thus, the likelihood of human exposure to a rabid domestic animal in the United States has decreased greatly.”

Human Rabies Prevention – United States, 1999 Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Most rabies deaths in the United States from dogs occur in people who get bitten while they are traveling outside the country.

So when was the last human rabies death from a rabid domestic dog in the United States?

A 7-year-old girl died after she was bitten by a rabid dog in Texas in June 1979. Before that, in 1968, a 13-year-old boy died after getting bit by a rabid dog in Kansas.

That’s a long time ago.

Does that mean the rabies vaccine isn’t necessary anymore?

Rabies Vaccines Work

Of course not! That means the rabies vaccines works!

Two Indonesian boys proudly show off their puppy and her vaccination record.
Two Indonesian boys proudly show off their puppy and her vaccination record. Photo by the rabiesalliance.org.

There are two reasons that we don’t see human rabies deaths from dog bites in the United States anymore, unless the bites occur in another country:

  1. Most of us vaccinate our pets – fewer dogs and cats with rabies means that there are fewer chances for us to get bit and get rabies.
  2. Most folks get proper treatment if they are exposed to an animal that could possibly have rabies, whether it is an unvaccinated dog or cat, or a raccoon, skunk, fox, coyote, or bat. In fact, about 40,000 to 50,000 people in the United States get rabies post-exposure prophylaxis each year.

If you don’t believe this, just look back at what rabies was like in the pre-vaccine era, when dogs and cats would get rabies, and so would their owners. In the early 1960s and 1950s, rabies deaths from dog bites were more common, about 10 each year.

“The number of rabies-related human deaths in the United States has declined from more than 100 annually at the turn of the century to one or two per year in the 1990’s. Modern day prophylaxis has proven nearly 100% successful.”

CDC on Rabies in the U.S.

To understand just why rabies vaccines still so necessary,  you can also look at what is still happening around the world where rabies vaccines aren’t used as commonly as they are in more industrialized countries.

“Despite substantial gains in tackling this neglected disease, more than 20,000 people still die from rabies every year, mostly in Asia and Africa.”

Schneider et al on Substantial reductions in rabies, but still a lot to be done

In addition to the deaths from folks traveling outside the United States, there are many more rabies deaths in people, mostly children, who live in areas where rabies is still endemic.

Hopefully these deaths will end soon too, as experts from WHO, Food and Agriculture Organization (FAO), International Organisation for Animal Health (OIE) and the Global Alliance for Rabies Control (GARC) work together in the United Against Rabies collaboration to achieve “Zero human Rabies deaths by 2030.”

Because it has an animal reservoir, the rabies virus will likely always be around, and won’t be eradicated like smallpox, but hopefully we can one day control rabies by having fewer rabies exposures (vaccinate more of our pets) and we can eliminate dog-transmitted rabies deaths.

We won’t get there if folks continue to push myths and propaganda about rabies and the rabies vaccine.

What to Know About Controlling Rabies and Rabies Deaths

It has been a long time since someone in the United States died with rabies from a domestic dog bite, but that is simply a testament to the fact that vaccines work.

More on Controlling Rabies and Rabies Deaths

Why Did France Take the Rotavirus Vaccine off Their Schedule?

Have you heard that France took the rotavirus vaccine off their immunization schedule?

Why?

It was supposedly because two babies died of intussusception after being vaccinated.

Rotavirus Vaccines and Intussusception

Intussusception? Wasn’t that just a risk from RotaShield, the original rotavirus vaccine?

While the risk was higher with RotaShield, the current rotavirus vaccines do have a small risk of intussusception.

france-immunization-schedule
The French immunization schedule is published in the Bulletin épidémiologique hebdomadaire and has never included the rotavirus vaccine.

So did France take the rotavirus vaccine off of their schedule?

Technically, France hadn’t yet added the rotavirus vaccine to their schedule, but it had been available since 2006 and they did formally recommend infants get vaccinated beginning in November 2013.

That recommendation was suspended in April 2015, after they recorded 47 cases of intussusception over an 8 year period. This included 14 cases that required surgery and tragically, two deaths, including one child who died at home without getting any medical care. The other developed intussusception after the third dose of vaccine, which is not usually linked to any increased risk.

It is important to note that at least 80 other countries, including the United States, Finland, Germany, Norway, and the UK, haven’t stopped using the rotavirus vaccine.

Why not?

Because the risks of a natural rotavirus infection are much greater than the risk of intussusception. In other words, the benefits of the vaccine exceed its risks.

In France alone, for example, it is estimated that rotavirus vaccines could prevent 30,000 emergency room visits, 14,000 hospitalizations, and 8 to 17 deaths each year, all in children under the age of three years.

And even without the rotavirus vaccine, there are about 200 to 250 spontaneous intussusceptions each year in France. Fortunately, infants with intussusception can almost always be successfully treated, often without surgery.

Why Did France Take the Rotavirus Vaccine off Their Schedule?

It actually makes no sense that France stopped recommending that infants get vaccinated with one of the rotavirus vaccines.

The decision was widely condemned and there are calls to reassess the decision and put the rotavirus vaccine back on the schedule in France.

“After the surprising decision of the CTV-HCSP of April 2015 to suspend its own recommendation for widespread vaccination against Rotavirus (following a false and misleading pharmacovigilance report) against the international recommendations, we advise you to read the meta-analysis on efficacy (in comparative studies) and the effectiveness (field efficacy) of these vaccines.”

InfoVac Bulletin Novembre 11/2016

The benefits of the rotavirus vaccines far outweigh its risks.

“The estimated benefits of vaccination in our study greatly exceed the estimated risks and our results should contribute to provide further evidence for discussions around rotavirus vaccination in France.”

Larmrani et al A benefit–risk analysis of rotavirus vaccination, France, 2015

Why did France take the rotavirus vaccines off their schedule?

News of the Newark kids going to Paris to get Pasteur's rabies vaccine made the front page of the New York Times.
In 1885, four boys from New Jersey went all of the way to France to get Pasteur’s new rabies vaccine, which wasn’t yet available in the US.

That’s a good question.

Another good question? How many infants have died of rotavirus infections since they did? And when will they put the vaccine back on the schedule? Fortunately, the rotavirus vaccines are still available in France, they weren’t banned as some folks say.

Of course, this isn’t the first time that France impulsively suspended a vaccine.

In 1998, France suspended the routine vaccination of teens against hepatitis B because of the possible association of the vaccine with multiple sclerosis. This was done amid “pressure from anti-vaccine groups and reports in the French media have raised concerns about a link between HBV immunisation and new cases or relapses of MS and other demyelinating diseases,” even though “scientific data available do not support a causal association between HBV immunisation and central nervous system diseases, including MS.”

“In 1998, official concerns were first voiced over a possible association between hepatitis B virus (HBV) vaccination and multiple sclerosis (MS). Despite a number of studies that have demonstrated no such association, ten years on the French population’s confidence in the vaccine remains shaken and immunization rates of infants have stagnated beneath 30%. With a chronic carriage of the virus estimated at 0.68%, it seems unlikely that France will be able to control the circulation of the virus. ”

Marta Balinska on Hepatitis B vaccination and French Society ten years after the suspension of the vaccination campaign: how should we raise infant immunization coverage rates?

Do you know where all of this has left France now?

With high rates of vaccine-preventable disease (15,000 cases of measles in 2011, with 16 cases of encephalitis and 6 deaths) and a move towards vaccine mandates. As of January 2018, all infants and toddlers in France must receive DTaP, Hib, HepB, pneumococcal, MMR, and meningococcal C vaccines.

What to Know About France Taking the Rotavirus Vaccine off Their Schedule

In no longer recommending the rotavirus vaccines, officials in France actually put infants at greater risk for sickness and death.

More on France Taking the Rotavirus Vaccine off Their Schedule

 

What to Do If Your Child Is Exposed to Rabies

Do kids still get rabies?

Tragically, most folks know that they do because of the story of the unvaccinated 6-year-old boy in Florida who died after being exposed to a rapid bat earlier this year.

Getting Exposed to Rabies

Rabies is a vaccine-preventable disease.

Unlike most other vaccine-preventable diseases though, unless you are at high risk for getting rabies, you don’t typically get the rabies vaccine unless you have already been exposed to rabies.

How does one get exposed to rabies?

Now that most people get their pets vaccinated against rabies, these exposures typically come from wild animals, including:

  • raccoons
  • skunks
  • foxes
  • coyotes
  • bats

While any mammal can be susceptible to rabies, small mammals, including squirrels, rats, mice, hamsters, guinea pigs, gerbils, chipmunks, rabbits, and hares, rarely get rabies and aren’t usually thought to be a risk for humans.

Your other pets, including dogs, cats, and ferrets, are though. They should be vaccinated against rabies. As should other domestic animals, including cows, goats, sheep, and horses.

To avoid rabies, teach your kids to avoid wild animals.
To avoid rabies, teach your kids to avoid wild animals. Photo by Emilie Chen (CC BY-ND 2.0)

It is also important to teach your kids to avoid wild animals. While most kids won’t go out of their way to pet a coyote, they might try to feed a racoon or skunk, and they might pick up a bat they find on the ground.

Kids should also avoid cats and dogs that they don’t know. Your kids should not just walk up and pet unfamiliar dogs and cats.

What to Do If Your Child Is Exposed to Rabies

Unfortunately, you won’t always know if an animal has rabies, although an animal acting strangely can be a tip off that they might have rabies.

Never touch a bat that you find on the ground during the day, as it might have rabies.
Never touch a bat that you find on the ground during the day, as it might have rabies. Photo by Radu Privantu (CC BY 2.0)

That bat your kids found on the ground could definitely have rabies, especially if they found it during the day. And the bat doesn’t even have to obviously bite your child. For example, if you find a sick or dead bat in your child’s room in the morning when he wakes up, you should consider that a possible exposure to rabies.

Many other exposures happen when kids are bitten by stray cats or dogs.

What do you do?

According to the CDC, if your child is bitten by any animal or has any possible exposure to rabies, you should:

  • immediately wash the wound well with soap and water, also using a povidone-iodine solution (Betadine Antiseptic Solution) to irrigate the wound if it is available
  • see a healthcare provider
  • call your local animal control for help in capturing the animal for observation or rabies testing

Animal control can also help in verifying a pet’s rabies vaccination status if your child was bitten by a neighborhood cat or dog.

“A healthy domestic dog, cat, or ferret that bites a person should be confined and observed for 10 days. Those that remain alive and healthy 10 days after a bite would not have been shedding rabies virus in their saliva and would not have been infectious at the time of the bite.”

CDC on Human Rabies Prevention — United States, 2008

In general, unless they already appear rabid, dogs, cats, and ferrets can be quarantined and observed for 10 days to see if they develop signs of rabies before your child begins post-exposure prophylaxis.

Other animals, including skunks, raccoons, foxes, coyotes, and bats should be considered rabid, with a quick start of post-exposure prophylaxis, unless the animal can be quickly tested (brain material) for rabies. And of course, you would be more considered about rabies if the animal was acting strangely, looked sick, or if it was an unprovoked attack.

What if you can’t find or capture the animal?

Depending on the circumstances, your pediatrician, with the help of your local or state health department, can determine if your child needs rabies post-exposure prophylaxis with rabies immune globulin and a 4 dose series of the rabies vaccine over 2 weeks.

“The number of rabies-related human deaths in the United States has declined from more than 100 annually at the turn of the century to one or two per year in the 1990’s. Modern day prophylaxis has proven nearly 100% successful.”

CDC on Rabies in the U.S.

About 40,000 to 50,000 people in the United States get rabies post-exposure prophylaxis each year. That works to keep the number of rabies cases and rabies deaths in people very low.

And it is not probably not at the top of your list of things to think about at a time like this, but animal bites can also be a risk for tetanus. Make sure your child doesn’t need a tetanus shot.

What to Know About Getting Exposed to Rabies

Keep your kids safe from rabies by vaccinating your pets and teaching them to avoid wild animals, but also know what to do if your child is exposed to rabies.

More on Getting Exposed to Rabies