URGENT advice needed re: rabies inoculation in Russia.
July 7, 2013 3:57 AM   Subscribe

Hi there, My girlfriend was bitten by a cat earlier today in Eastern Russia. Obviously this is a rabies risk area and so she needs to get a rabies inoculation. According to her, when she went to the hospital she was told that if she has the inoculation course she will essentially be incapacitated - unable to swim, go in the sun, or even walk vigorously. Was something lost in translation or is this complete nonsense? I can't find anything online to suggest that these kind of side effects exist for any rabies shots? Please help! Thanks.
posted by FuckingAwesome to Home & Garden (17 answers total)
I'd probably contact the Embassy for your home country and touch base with them on this. They might have a good recommendation.
posted by k8t at 4:08 AM on July 7, 2013 [2 favorites]

She needs four vaccinations. See. The side effects of the vaccine aren't debilitating. Possibly, if they're giving her immunoglobulin, it might be more involved.
posted by gingerest at 4:29 AM on July 7, 2013

I have had the rabies vaccinations, although in the US, not in Eastern Russia. They were far from debilitating. I tried to rescue a cat that had been hit by a car, and of course, since it was in pain, it bit me while I was picking it up. It died on the way to the vet, and we could not get it tested in time, so it was treated as testing positive for rabies.

The first shot(s) were to the ass, the first day, the amount/number of them depended on your body weight.

Then I believe there was one three days later, in the arm. Then seven days later, then three weeks later, etc That numbering system might be slightly off, but the point is, she will need to return on time for each subsequent shot to the arm.

I was warned it might cause me to run a low grade fever, feel tired, not so hot. And it did. But that was about it -- I wasn't sick enough not to go to work, and I continued on my life as normal, just slower and more irritably for a while.

Obviously it's possible to have a more severe reaction to the vaccine, as it is to any vaccine. And, I know that once upon a time, the rabies vaccine was a much more brutal thing, and very dangerous. I am assuming they are giving the more modern version of the vaccine here.
posted by instead of three wishes at 5:31 AM on July 7, 2013

I had mine in the US, not in Russia (though also because of a cat, ha). But besides the fact that immunoglobulin shots and vaccines are inherently not fun, I was able to go about my normal life without any impediment at all. Not a single noticeable side effect.
posted by Coatlicue at 6:09 AM on July 7, 2013

She won't be incapacitated forever, but they might be using the old style of shots, which you had to take in the stomach. I can't imagine going swimming or walking around after something like that, for a few days.

The thing is, she really needs to be inoculated ASAP. Rabies is uniformly fatal. The chance of the preventative working depends in part on how quickly you get it, especially depending on where she was bitten (closer to the brain or spine is worse.) If someone told me the rabies inoculation would leave my eyeballs hanging out of my head I would say "Okay fine, let's do this." That's how urgent it is.
posted by cairdeas at 6:17 AM on July 7, 2013 [8 favorites]

(If she was bitten in the face, go get it now, even if it's the middle of the night.)
posted by cairdeas at 6:23 AM on July 7, 2013 [4 favorites]

Since it is a series of shots, if she is not going to be in the same area for the next 3-4 weeks, make sure to get the little card that lists the shots administered so she can present it at the next clinic.
posted by TWinbrook8 at 6:29 AM on July 7, 2013

I was bitten in the leg by a feral dog in Thailand several years ago and had to get the rabies immunoglobulin and the 4-shot series. The immunoglobulin is supposed to be to be injected around the bite, if possible, which wasn't fun but no big deal, and the rest of the series was 4 shots in the arm. I was still traveling at that point and except for the wasted day sitting around for the immunoglobulin to arrive from the Red Cross it didn't cause a hitch (the friend I was traveling with was a doctor and we just took the vaccine with us and gave me most of the subsequent injections. In fact my boyfriend gave me the last one when we got back--it's not difficult to do an intramuscular injection in a healthy adult).

I vote for either mistranslation or folk beliefs about the vaccine. I don't think anybody uses the old intraperitomeal injections, which were administered in that location due to some beliefs about the immune system that have now been proven false. But your girlfriend should definitely make sure she knows how it should be done in case someone tries to administer it differently.
posted by The Elusive Architeuthis at 6:45 AM on July 7, 2013

Cat bites can also cause serious infections of the non-rabies type. A course of preventive antibiotics is sometimes recommended. Some strong antibiotics can make people very sensitive to the sun. Is it possible they were going to give her an additional treatment and the side effects were from that?
posted by LobsterMitten at 7:33 AM on July 7, 2013 [2 favorites]

Pretty sure it's just mistranslation? I got mine in Hong Kong (no rabies at all here but I got nipped by a stray). In addition to the rabies series, they also gave me a tetanus booster since I forgot when was the last time I got mine.

The only side effect I had was just soreness around the injection site.
posted by astapasta24 at 8:57 AM on July 7, 2013

Regardless of whether you resolve the question of whether their advice is nonsense, it really seems that her level of activity is the least of her worries at this moment.
posted by Unified Theory at 9:03 AM on July 7, 2013 [1 favorite]

Let's examine the possible outcomes:

She does NOT get the shots. If the cat had rabies, she dies. Period. End of story. No "1% survival rate"; the survival rate is measured in "total number of humans who have survived rabies since we became a species". And you can count them on one hand. Dead. Get it?

She does get the shots. She feels bad for a few days.

It's her call. She may have several hours to make the decision. No rush.
posted by IAmBroom at 9:43 AM on July 7, 2013 [2 favorites]

I think that rabies prophylaxis protocols have changed recently in the US, so that they're not as uncomfortable as they were. However, it's possible that Eastern Russia has older-style protocols. This does need to be treated ASAP, though, and older-style protocols are much better than the alternative.
posted by amtho at 9:49 AM on July 7, 2013 [1 favorite]

This happened to a friend in provincial Russia. She got the shots, and they weren't nearly that debilitating, but she said they were more intense than getting the rabies vaccine in the US would have been. I think the longest lasting issue was that she couldn't drink any alcohol for a while because it would have made the inoculation less effective somehow.
posted by sparrow89 at 11:32 AM on July 7, 2013

I've had the post exposure shots, in the US, back in 2006. I was fine w no side effects. IMHO she should get the shots, there's no erring on the 'wait and see' side with rabies and the repercussions are unthinkable.
posted by poissonrouge at 12:51 PM on July 7, 2013 [1 favorite]

If she's anywhere near Saint Petersburg, she could try the American Medical Clinic. It may be pricey, but if nothing else, they will operate in a fashion more familiar to her (assuming she is either American or Western European) that could be helpful and will likely pursue similar treatments to the US.

She could also try to head to Finland, but there may be some issues with her visa if she does that.

(I had some wonderful medical care in Russia under Russian doctors and hospital system for a problem, but it wasn't for anything this serious. For anything really serious, I'd have gone to Finland.)
posted by zizzle at 1:59 PM on July 7, 2013

I've had rabies prophylaxis, but in the US. Yes, the current regime here is nothing like the big-needle-in-the-stomach tales of yore, and I had nothing but localized side effects (numbness around the shot location).

This is the international WHO guide to PEP shot regimes. There are differences based on type of intervention and type of material from which the vaccine was created. In any case, I would certainly defer to my doctors' advice. Rabies incidence can vary quite a bit in a country as large as Russia (or the US) and their experience with prophylaxis can also thus vary. There are also probably rural/urban divides that could factor in.

But chiefly I would simply consider that rabies vaccination is something that is done all over the world and is more a matter of getting the prophylactic dosage before the rabies virus can take hold than anything else. Given the horrible ways that rabies infection can take you before it takes you, so to speak... Just get it.

If you're not Russian nationals and you have the means, though, you may want to consider if you can start the shots in Russia and then fly someplace where you may feel more comfortable with the medical system (or the language barrier) to continue. Even restarting with the modern "lite" shot sequence might be preferable to continuing with a debilitating vintage style vaccination.
posted by dhartung at 5:16 PM on July 7, 2013

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