A boy died of rabies despite being vaccinated. Is the “vaccine ineffectiveness theory” coming again?

Recently, a boy in Nanyang, Henan Province was bitten by a roadside dog and died 18 days later. I believe everyone has noticed from the official media reports in the past few days that the boy had received rabies vaccine and anti-rabies immunoglobulin in time after being bitten by the dog (the boy had not received the fifth rabies vaccine when he died). As a result, the "rabies vaccine is useless" theory began to spread on the Internet, and various rumors and conspiracy theories also became rampant.

It is important to emphasize that vaccines are one of our most important weapons when facing the extremely dangerous rabies . Let’s talk about this in detail.

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1. About rabies

Rabies is a zoonotic infectious disease caused by rabies virus infection . It is mainly transmitted through bites from infected animals (such as dogs, cats, badgers, red foxes, etc.), and can also be transmitted through broken skin or mucous membranes contaminated with the saliva of infected animals. In China, the main source of rabies is dogs, especially stray dogs.

Due to the lack of specific treatment for rabies, once the disease occurs, the mortality rate is almost 100%.

When an infected animal bites a person, the virus enters the body and spreads rapidly through the nervous system. The rabies virus first enters the wound and then spreads along the peripheral nerves toward the central nervous system (such as the brain). Once the virus reaches the central nervous system, the condition worsens and eventually leads to the severe symptoms of rabies.

2. Why do people still get sick after being vaccinated? Is it because the vaccine is ineffective?

The vaccine protects the body from infection by activating the human immune system to produce antibodies to fight the rabies virus. After being bitten, timely vaccination against rabies can effectively reduce the risk of infection, especially during the incubation period of the virus.

Many people therefore think that once bitten by an animal, all will be well after getting a rabies vaccine. In fact, vaccination does not mean absolute immunity . After the rabies virus invades the human body, it takes a certain amount of time for the vaccine to produce enough antibodies, so there is still a risk of infection during this period. In addition, there are several other reasons:

1. Vaccine injection dosage . After rabies vaccination, the patient did not follow the vaccination procedure and did not complete the dosage injection according to the doctor's instructions. This resulted in the body being unable to produce sufficient immunity and poor immune effect.

2. Bites or scratches on the head, face, neck and external genitalia . Since these areas are rich in nerves, the virus can quickly invade the nerves, causing the disease to occur before immunization measures take effect.

3. Delayed medical treatment or improper wound treatment . If the wound is not treated in time after being bitten, or the wound is too deep and the treatment is not thorough; or before the vaccine is injected, the rabies virus has begun to spread along the nerves, eventually causing damage to the central nervous system, etc., which may cause the virus to invade the blood and increase the risk of infection.

4. Vaccine failure . If the patient does not replace the rabies vaccine with a new one in time when injected, the vaccine may become ineffective, affecting the production of antibodies in the body, and thus failing to prevent rabies.

5. Individual differences . Because different individuals have significant differences in immune system responses and susceptibility to immune diseases, some people have relatively weak immune responses after vaccination, which allows the virus to still have a chance to attack the body.

Therefore, it cannot be concluded that the vaccine is ineffective.

3. Prevention is the key, prevention is better than cure

Rabies vaccine is one of the key measures to prevent rabies. On September 16, 2023, the National Center for Disease Control and Prevention issued the "Rabies Exposure Prevention and Treatment Work Specifications (2023 Edition)".

The standard divides rabies exposure into three levels according to the mode of contact and degree of exposure:

Contact or feeding of animals, or licking of intact skin is considered a Category I exposure.

A light bite on exposed skin or minor scratches or abrasions without obvious bleeding is considered a Level II exposure.

Single or multiple penetrating skin bites or scratches, or licking of broken skin, or open wounds or mucous membranes contaminated by saliva or tissue, or direct contact with bats are Level III exposures.

At the same time, it is clearly stipulated that: " Level II and III exposure persons should receive rabies vaccine once each on the 0th, 3rd, 7th, 14th and 28th days after being bitten, for a total of 5 doses, and try to use the same brand of vaccine for vaccination ."

If you are scratched or bitten, you should receive standardized treatment as soon as possible. This is the most important way to protect yourself from getting sick. Usually, the complete process includes: wound treatment (wound flushing → debridement → disinfection) → immunoglobulin injection (if necessary) → wound suture (if necessary) → vaccination .

Of course, for rabies, prevention is better than cure. In my country, although the incidence of rabies has decreased, there are still certain risks and challenges. Therefore, the following points are recommended for everyone to keep in mind:

1. Keep a certain distance from wild animals and avoid contact between domestic pets and them. Do not approach, touch or disturb stray animals at will. When caring for stray animals, always pay attention to the risks and do not keep stray animals as pets.

2. Families with pets should take their pets for rabies vaccination regularly to ensure the health of their pets and reduce the risk of rabies. When walking your cat or dog outside, remember to tie the leash to prevent the animal from hurting people.

Image source: Xinhua News Agency

3. High-risk groups such as veterinarians, zoo staff and other institutional staff should be vaccinated against rabies.

4. Strengthening public education, promoting relevant knowledge, and raising people's awareness and prevention of rabies are important links in preventing the spread of the epidemic.

Know the truth, don't be afraid of rabies. It is very important to popularize correct knowledge on rabies prevention, which requires all of us to jointly improve our scientific and rational cognition.

Author: Li Nannan, Director of Hunan Science Writers Association, Expert on Science Popularization in China

Reviewer: Tang Qin, Deputy Secretary-General and Senior Researcher of the Expert Committee of the Chinese Medical Association

Produced by: Science Popularization China

Produced by: China Science and Technology Press Co., Ltd., China Science and Technology Publishing House (Beijing) Digital Media Co., Ltd.