Can An Animal Get Rabies Vaccination When Pregnant
Exposure to rabies during pregnancy
KEY POINTS
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Bats remain the most common source of human rabies exposure in Canada.
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Postexposure prophylaxis is used in situations that involve straight contact with a bat (i.e., when there has been physical contact between human being and bat), and a bite, scratch or exposure to saliva through a mucous membrane or wound cannot be ruled out.
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Pregnancy is not a contraindication for postexposure prophylaxis.
A 44-twelvemonth-old significant woman (gravida half dozen para 3) received counselling later being bitten by a bat during her 26th week of pregnancy. The patient reported that a bat had flown downwardly and bitten her paw in broad daylight. The patient'southward partner hit the bat, which fell to the footing. The patient thoroughly washed the wound and sought immediate medical attention. The bat'southward carcass was kept for testing.
The patient was immediately started on a postexposure prophylaxis schedule, including both rabies vaccine and rabies immunoglobulin. The bat was sent to the Canadian Food Inspection Agency Center of Excellence for Rabies in Ottawa, Ontario, where a direct fluorescent antibiotic test confirmed that the bat had been rabid. The patient completed treatment — four doses of rabies vaccine and one dose of rabies immunoglobulin.
At 28 weeks' gestation, the patient presented with premature prelabour rupture of membranes. She received routine care (betamethasone for fetal lung maturation and condom erythromycin). At 30 weeks, the patient went into preterm labour and underwent cesarean delivery. She gave nascency to a salubrious boy, weighing 1474 g (50th percentile), with no further complications.
Give-and-take
Rabies is a uniformly fatal viral infection characterized by acute progressive encephalitis.one Its incubation catamenia varies from weeks to months depending on several variables, including the strain of the virus involved. Infected animals can infect others before clinical signs are present. However, only four cases of rabies in humans were reported in Canada between 1991 and 2016, owing to multidisciplinary efforts to minimize homo exposure to rabies and to prompt, effective utilize of postexposure prophylaxis.2,3
Although exposure to rabies during pregnancy is uncommon, brute bites do occur, and meaning women should receive postexposure prophylaxis. Treatment during pregnancy is the same as it is for nonpregnant women. Canadian health care providers must study all potential human exposures to rabies to local public wellness departments. Because the risk of rabies varies with different mammals and in dissimilar regions, providers are encouraged to seek public wellness guidance when rabies exposure is suspected.2
In North America, the near common source of human rabies exposure is bats.iv Of Canada's 18 species of bat, two live indoors: the niggling brown bat and the big brown bat. Most bats found in homes are big brown bats, because they are better adapted to living within year-round. Little brownish bats are nearing extinction owing to an epidemic fungal infection chosen white olfactory organ syndrome. Along with the tricoloured bat and northern myotis, they are protected under Canadian law equally endangered species because of their declining populations.5
Other animals can be infected by rabies. In Canada in 2017, of the submitted animal specimens tested, 239 gave positive results for rabies. These specimens included raccoons, skunks, bats, arctic and cherry foxes, cattle, dogs and cats.6 A substantial contributor to bats' perceived danger equally a vector of rabies is their very fine teeth: a person may not encounter or feel a bite mark and thus may not be prompted to seek treatment. A 2009 study involving 14 453 people in Quebec found that well-nigh 1 in m people feel bat exposures in bedrooms without recognized bites each year. However, researchers calculated that the incidence of man rabies resulting from such exposures is 1 per 2.seven billion human-years.seven Thus, although bat exposures in the sleeping room are common, the risk of rabies infection is remote without directly contact.
Current recommendations for bat exposure counsel "intervention for situations when there is direct contact with a bat (i.e., there has been concrete contact between human and bat) and a seize with teeth, scratch, or saliva exposure into a mucous membrane or wound cannot be ruled out."4 Examples of situations in which one might non be able to rule out direct contact include exposures in young children, older adults or people with disabilities.
If bats are establish in a home, one should contact an appropriate pest control service, which will use the "exclusion method" to stop bats from re-entry: blocking potential points of entry with one-fashion doors (letting bats leave simply not return) and sealing big structural cracks. These methods do not harm the bats, only are effective at preventing further nesting.5
Well-nigh bat species are protected in Canada and should only be captured for testing if straight contact has been confirmed.4 Attempting to capture a bat puts a person at hazard of exposure and should be left to trained wild fauna professionals.
People who call up that they may accept been bitten by, or made direct contact with, a bat or other animate being and cannot rule out a seize with teeth should immediately wash and thoroughly flush the wound with soap and water, then seek medical attending. We counselled our patient to begin a postexposure vaccination schedule. Because pregnancy is not a contraindication for postexposure prophylaxis7 and handling can exist discontinued if there is proof that the animal is not infected, there is no reason to delay using inactivated vaccine and immunoglobulin to forbid lethal infection. In this case, testing confirmed that the bat was rabid, and a full class of postexposure prophylaxis was given (Boxes 1 and 2).four
Box i: Postexposure direction to prevent rabies after a seize with teeth or contact with creature saliva4
| Source of exposure | Recommendation |
|---|---|
| Pet cat, dog or ferret, available for ascertainment for 10 days |
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| Unknown or escaped true cat, dog or ferret, or a skunk, bat, trick, coyote, raccoon or other carnivore |
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| Livestock, rodent or rabbit |
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Box 2: Postexposure prophylaxis for rabies4
| Safe agent | Dose | Schedule | Adminstration |
|---|---|---|---|
| For patients who have not previously received the vaccine | |||
| Rabies vaccine (Imovax or RabAvert) | 1.0 mL (equivalent to at least 2.5 IU of rabies antigen) | Day 0, three, 7, 14, (5th dose at day 28 for patients with immunocompromise) | Intramuscular (deltoid) |
| Rabies Immunoglobulin | 20 IU per kg body weight | 24-hour interval 0 | Intramuscular, directly into the wound and surrounding area, and a different site than the site of vaccine administration |
| For patients who have previously received the vaccine * | |||
| Rabies vaccine (Imovax or RabAvert) | 1.0 mL | Twenty-four hours 0, iii | Intramuscular (deltoid) |
Anticipation about using rabies vaccines and immunoglobulin in pregnancy is common attributable to a lack of large cohort studies categorically establishing their prophylactic. Live virus vaccines (due east.g., smallpox, varicella, measles) are contraindicated in pregnancy because of the potential risk of congenital abnormalities that tin from fetal infection. Rabies vaccines, however, are killed whole-virus vaccines and can be safely administered during pregnancy. No fetal adverse events have been reported with not-live virus vaccines. Rabies immunoglobulin is a claret product, and carries no more potential risk of viral infection than any other blood production. Immunoglobulin, when indicated, can be safely given during pregnancy.
Two cohort studies that documented the results of rabies postexposure prophylaxis during pregnancy found no negative outcomes. Sudarshan and colleagues tracked 14 cases in which postexposure prophylaxis was administered to meaning women until their children were one yr old, and establish salubrious outcomes for all exposed mothers and babies.8 Toovey and colleagues documented 251 pregnancies during which postexposure prophylaxis was given, and found no cases of built malformation or spontaneous abortion.nine In our patient's case, her pregnancy was complicated by prelabour preterm rupture of membranes and preterm birth. We practice not believe that her exposure to rabies was associated with these complications, and we were not able to identify whatever other reports of these complications later exposure to rabies or receipt of postexposure prophylaxis.
Footnotes
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Competing interests: None declared.
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This article has been peer reviewed.
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The authors have obtained patient consent.
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Contributors: All three authors (Windrim, McGeer, Irish potato) contributed to the formulation, writing and revision of this case study. Catherine Windrim initially drove this project, as a summer medical student project. Allison McGeer reviewed the manuscript and served as a content expert. All iii authors reviewed and approved the last version of this paper and agreed to act as guarantors of the results.
References
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Source: https://www.cmaj.ca/content/190/43/E1281
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