To share with you a case of rabies, which is used to make rabies a science to make them clearer.
This is a female patient, young, 32 years old, working in a wholesaler.
One month ago, the patient was under stress for work reasons.
The response of the family, the patient ‘ s general ability to calculate, often miscalculated, resulted in the miscalculation of the consignment and the abuse of the boss.
Gradually, patients are suffering from the symptoms of poor sleep and are unable to sleep.
I’m upset, I’m afraid of noise, sometimes my fingers are numb.
Three days ago, things got weirder.
That day, she suddenly appeared with her chest suffocated, her breathing and her nervousness, as if someone were after herself.
It’s never happened before. The patient doesn’t know what he’s got.
Fortunately, this discomfort lasted only a few minutes and gradually eased.
The patient herself has become more agitated, unable to sleep at night, and a slight noise would upset her and tighten her throat.
It’s really hard.
She thought it was an accident and thought that she was under a lot of stress during that time, possibly due to stress.
I thought two more days would be fine.
But then she became aware of the seriousness of the problem.
Patients have schizophrenia, and doctors say that mental illness is hereditary, and if there are relatives in the family who are mentally ill, family members are more likely to be ill than ordinary people.
She gets more nervous when she thinks about it.
I’m not too close to my blood. I’m in trouble.
What makes her all the more surprising is that this situation has been repeated several times.
The next few days, when she was thirsty and wanted to drink, she had difficulty breathing and breathing, as if she had seen the devil.
In the winter, when the air cooled down, the patient was even more anxious when he stood on the window and was blown by the wind.
The family reacted that she saw the wind as if she had seen a ghost, as if the wind was going to kill her, and the windows in the house were sealed up in the last few days.
Not in the wind.
But she still has panic attacks.
The family took her to the local central hospital, where she was subjected to numerous examinations, including chests, electrocardiograms, cardiac colours, etc., which were not unusual.
In the end, the doctor recommended to the psychiatric clinic, and the doctor was particularly concerned about whether the patient had hallucinations, such as vision or hearing, or whether he had seen some demons.
Patients shake their heads, which means they don’t, but it’s easy to get nervous.
If there is no illusion, it is unlikely to be schizophrenia.
After a comprehensive medical assessment, the patient was diagnosed as “anxiety disorder”.
According to the doctor, anxiety disorder is a mental disorder, characterized by anxiety experience.
When asked about the history of the disease, consideration was given to the fact that the patient had suffered from poor working conditions, unsatisfactory performance, multiple errors and abuse by the boss.
Anxieties are also acute and chronic, and acute anxiety attacks are called panic attacks.
As soon as the family heard the panic attack, the patient was in the same state at home.
A little bit of anomalous noise scares her, and the whole person looks like he’s seen something dirty, and the family almost asked the big one to come and do it.
Doctors continue to explain that panic attacks (acute anxiety attacks) are easy to understand and that patients are nervous and worried about what they are not.
Families cry, and patients are not only restless, they are like needles.
And sometimes patients have a sense of near-death and experience certain environments, such as closed spaces or something they don’t want to face, when they suddenly have a sense of extreme fear and feel that the whole person is about to go.
The doctor explained that this was the case with the panic attacks.
It was then said that, in addition to the above-mentioned manifestations, there were also signs of neurological disorders in plants, such as heart palpitation, hand shaking, numbness of hands and feet, easy sweat and frequent toilet visits.
Almost all.
There were doctors who had previously suspected that it was a cardiologist ‘ s disease, but the cardiologist had read it over and over again, and all aspects were normal.
There are also doctors who question whether epilepsy, acupuncture, etc.
It does not seem to be a physical disease, but a mental disease.
The family finally got it.
Lastly, the doctor recommended hospitalization, which was not appropriate for the time being to continue working in order to avoid further complications. In future, if the condition stabilizes, it is recommended to replace the job and find a relatively easy job.
Without the doctor, the family knew that the job was not going to work.
The admission process was soon completed.
The latter performed a thorough medical examination of the patient, and a more obvious finding was that the patient’s emotions remained tight and his hands were covered with his chest and his breath was sometimes too high.
However, the patient’s own consciousness is clear and the answer is clear.
And the patient himself told the doctor that he was not well.
In the course of questioning the history of the disease, the patient again suffered from sudden respiratory difficulties, extreme pain in his face and, from time to time, beat his chest with his hand, feeling as if he had died in pain, as if he were helpless, helpless and sad.
This process lasted for a few seconds before it gradually subsided.
He was young, had never seen such a terrible shock, and at first he almost got scared.
Because the patient looks too serious, it feels like he’s about to be rescued.
When the patient is relieved, everything is back to normal.
The bedkeepers are also very concerned about whether patients are hallucinating, delusional, etc., and whether there is an incoherence of mind, which are common symptoms in the psychiatry, especially for schizophrenia.
On several occasions, however, the patients did not have hallucinations, delusions, normal narratives, and did not say that the sight of ghosts, etc., was an inexplicable shock.
The professor then came to check the room.
The professor, as soon as he entered the door, asked how the door was closed in broad daylight.
The windows were also locked and the curtains were drawn, and the professor immediately indicated that he could not do it without ventilation, that there were all the patients in the hospital and that there could be bacterial viruses everywhere.
This sentence scares the patient and corrodes.
The family explained that it was because the patient was afraid of the light.
The professor heard about a panic attack, so he came here to see it.
The professor told the doctor below that you’d be able to see it. The patient is particularly strange, and most likely the disease is a terrible disease.
The professor asked the patient if you’d thought about it carefully. In a couple of weeks?
The patient was in a better state, and then thought back a few months ago, he was bitten on his finger by a puppy near the factory.
The professor’s heart is already half cold.
Other doctors were shocked to hear that.
It’s only then that we understand what the professor’s word is about a disease that’s timid.
The professor paused and continued to ask, “Did you get rabies? I’m sorry.
“No, no. He washed himself with water and left him bleeding. I’m sorry.
The professor listened to the closed eyes and lamented.
Other doctors also took a breath of cool air.
If the professor hadn’t come to the room, the patient would have been dead without knowing what the disease was.
This is not anxiety!
Ugh!
The professor called his family outside, saying that the patient was not a panic attack, not a psychiatric disease, but a rabies disease, a classic rabies disease.
“I wonder if it’s not easy to hear the patient is so nervous when he drinks, the door is locked, the window is closed, the wind is cold, and the dog bit him a few months ago. I’m sorry.
The professor said that to the bedkeeper and blames the young doctor for not having a clear history of illness, but for not having an expanded mind.
“We have a lot of psychosis that needs to be completely eliminated before we can diagnose it. I’m sorry.
“Like this rabies, a patient dies of rabies in a few days. What do the families think of us if they don’t diagnose rabies in time. How? “The patient died in mysterious circumstances?”
The family’s legs are soft.
The professor noded, and in case of an illness, 100% died.
There’s one example of survival abroad, but our own data still think rabies mortality is 100%, and none of it is.
It would also be inappropriate for the professor to say that, under great pressure, but not to give a false expectation to his family.
The family is paralysed, pale and helpless.
Then wept.
So, how did the patient get infected?
The professor explained:
“It is very likely that the dog that bit the patient had rabies in his saliva, which spread through the bite, and of course the saliva with the viral dog, which invades the body through various wounds and scratches, the mucous membranes and the skin that licked it. I’m sorry.
“Well, not all people get sick from canine bites, and this is about 20 percent, but if there’s a disease, the mortality rate is 100 percent, so we place great emphasis on timely vaccination. I’m sorry.
“The city has been free of rabies for years. This is the first case I’ve heard or seen in almost five years. I’m sorry.
Dr. Piper was scolded by the professor, very guilty.
He asked, “Why do rabies fear water? They do panic once they’re ready to drink water. They thought it was a normal shock, not a rabies disease. I’m sorry.
The professor explains:
“When rabies enter the human body, they climb all the way to the brain through the outer nervous system, causing damage to the ecstasy, the larvae and the neurological nuclei under the tongue, both of which control the oscillation of muscles and respiratory muscles, which, if damaged, can lead to swallowing and respiratory convulsions, as long as the patient drinks water, or even lifts it (or hears the sound of water), they can induce the suffocation of the throat muscles and the respiratory muscles, so that the water is terrified. I’m sorry.
The professor told the doctor before he left.
“Go to the hospital, to the infectious disease hospital. Don’t stay here with us anymore. Once the rabies go on, most of the whole thing dies in five days, and she’s already gone on for days, and she’s probably gonna die soon. I’m sorry.
The bedkeeper contacted the Infectious Diseases Hospital to communicate with his family and to reflect the situation with the patient.
On the afternoon of that day, he was transferred to the Municipal Communicable Diseases Hospital.
A follow-up call was made the following day.
The epidemiological clinic doctor stated that the patient had diagnosed rabies and had died last night.
The doc is missing.
In the next science class, we’ll share the concerns of several people.
Cope Class: What do you need to be vaccinated about being bitten by a dog?
How long was rabies in?
What’s the lurking period? Simply put, it’s a period when animals (dogs, cats, etc.) are bitten to the point where they have no symptoms before they develop.
The 9th edition (2018) entitled ” Epidemiology of Infectious Diseases ” describes that the duration of the incubation varies, mostly within three months, and can last for more than 10 years. The duration of the incubation period is related to age, the extent of the wound, the depth of the wound, the number of invasive viruses and the virulent force.
The Technical Guide to rabies Prevention and Control, published by the CDC of China in 2016, states that, in general, between 1 and 3 months, very few within 2 weeks (with severe head bites, the onset of the disease is relatively short because of faster brain intrusion) or longer than 1 year (less than 1 per cent of the total for such long incubation).
The two above-mentioned documents should be the most authoritative statement in the country.
2020 WHO official network description of rabies’ insulation period: usually 2-3 months, less than 1 week, longer than 1 year.
The maximum possible rabies in the current international mainstream scientific community is six years. This is a case reported by American scholars in 1991 and published in the New England Journal of Medicine (1991; 324:205-211), but the chain of evidence for this case is incomplete and it is difficult to establish that the patient must have been infected by a dog six years ago instead of having been exposed to the virus in midway, so many scholars are not convinced of the case (not believing that the period of submersion exceeded six years), even when the author himself made it clear that he was not.
And very few cases do not necessarily have universal significance, and many people think that cases with an incubation period of more than one year are extremely rare and that if a dog or cat bites more than one year, it is usually not necessary to supplement rabies (this is the WHO view) because the possibility of re-emergence is negligible.
New professors of rabies in the country, who do a lot of work and are the best in science, also say that they have been searching the country for cases with an incubation period of more than one year, but no firm evidence has been found for 30 years.
We’re dealing with a very serious problem, so the conclusion should have been scientifically proven, not hearsay that a man in the village next door had been bitten by a dog for 10 years. There are plenty of dogs and cats in rural areas, and the probability of secondary exposure is not low. In order to be reliable, the results of the assessment will have to have the participation of professionals to be included in the case report and as research material.
The statement in the textbooks that the insulation period can last for more than 10 years is still controversial, because it is an incomplete chain of evidence for cases that makes it difficult to ensure that there is no second infection in the course of 10 years, and that cases are too rare to have universal meaning, and that “over 10 years of insulation” can cause psychological fear. But as a textbook, it’s probably based on a “better to kill” attitude, which we understand.
In conclusion, cases with a potential incubation period of more than one year are extremely rare, ranging from WHO to WHO, which considers that the incubation period is longer than one year (the subtext is not more than one year), to some scholars, who believe that after more than one year they will not need to be vaccinated, as there will be no disease.
Many people were bitten by dogs a few years or even a decade ago, and then heard about the horror of rabies, and went to replant a vaccine, which is not really necessary, because, according to the prevailing view (no more than a year’s sleep), they were bitten for more than a year without a disease, suggesting that it was not rabies, that there was no further disease, and that vaccinations were simply wasteful and self-embracing. If we are not reassured that we will not be able to escape the psychological shadows, go for vaccination and ensure that all rabies risks of the past are eliminated.
How’s rabies coming along? How many days will he die?
The article’s case is not intended to scare readers, but rather to make them more aware of the details of rabies. First, it should be made clear that only dogs or cats with rabies virus in saliva can be infected or licked, and that a common dog cannot cause a disease.
Once rabies occur, most of them have typical three-stage clinical performance.
First, there is a frontal period, where low heat, powerlessness, headaches, nausea, whole body discomfort, and then anxiety, insomnia and sensitivity to sound, wind, light, etc. This phase lasts 2-4 days.
It then enters a period of high excitement, fear, fear of water, fear of wind, high fever, which may not be available to every patient. The patient’s spirit is clear, and a few are hallucinating, and this period lasts for one to three days.
Finally into paralysis, muscle convulsions stopped, completely paralysed, unconscious, and eventually respiratory cyclic failure ended in death, a period that was generally 6-18 hours, not exceeding 1 day.
The above shall normally not exceed six days.
Our national medical schoolbook Epidemiology (8th edition) makes it clear that rabies are the most dangerous viral disease of all infectious diseases, with a 100 per cent death rate if they occur.
rabies are terrible when they happen. So many people are very afraid of rabies, and in fact the vast majority fear that their rabies will eventually prove not to be rabies, which are already more serious than rabies themselves.
The purpose of Cope is to give a clearer picture of rabies, the horrors of rabies and the importance of vaccines, but there can be no unjustified fear of rabies, otherwise the end will be reversed.
You got bit by a dog. Under what circumstances?
This is one of the most important concerns and one of the most critical. This involves a professional concept: exposure. The exposure to rabies is defined as the bite, scratch, licking of a mucous membrane or defaced skin by rabies, suspected rabies, or failure to determine whether a resident active person suffering from rabies has a rabies disease, or the direct contact with an open wound, a mucous membrane with saliva or tissue that may contain rabies.
It’s called rabies. Not all of them are exposed to rabies, suspected rabies, or the fact that they are not rabies. If a dog bites his own, the dog is always home, never outside, never touching another dog, it can’t have rabies, it bites at this time, most of them bites, no rabies, which does not require rabies vaccination, provided you make sure your dog is innocent.
Exposure to rabies is classified into three levels according to the nature and severity of exposure:
For those exposed at I and III levels, the vaccination procedure is generally 5 needles, i.e. 0 (on that day), 3, 7, 14 and 28 days of one shot, for a total of 5.
How long is rabies vaccine protection?
The so-called rabies vaccine protection period is that if we are vaccinated and if re-exposure takes place at a certain interval, it will also be safe if there is no need for re-inoculation (or if there is no need for another full-scale vaccination), which is the period of vaccine protection.
WHO states that for those at continuing high risk, immunization needs to be increased only when the moderate and antibody drip drops below 0.5 IU/ml, while if the antibody drops above 0.5, the higher the antibody drops, the greater the impact on the virus, the longer the protection period may be.
Let us start with rabies vaccination, pre-exposure, post-exposure prophylaxis.
9th edition of Epidemiology, rabies: Pre-exposure prophylaxis are three doses of 1 ml each, carried out on 0, 7 and 28 days, and one more injection in 1-3 years. Pre-exposure prevention is used mainly for high-risk groups such as veterinary doctors, cave explorers, rabies researchers, animal managers, etc.
Post-exposure prophylaxis: 5 vaccinations, each 2 ml, completed in 0, 3, 7, 14 and 28 days.
The introduction to rabies in the textbooks is as above, without any mention of the so-called protection period, or whether it would be enhanced if the vaccine had been injected previously, or if it had been bitten again (exposed again). It was because textbooks did not introduce them that professionals were prone to confusion and the general public was more afraid of the end.
Let’s look again at what China’s CDC published in 2016, the Technical Guide to rabies Prevention and Control, says: If for pre-exposure prevention purposes, the people who have received the whole basic immunisation (3 needles) do not need regular immunization enhancements. Regular immunization enhancements are only recommended for persons at constant, frequent or higher risk of exposure for occupational reasons (e.g. laboratory staff and veterinary doctors exposed to the virus).
The first exposure (the first bite), the wound must be cleaned and then the whole course of vaccination (5 needles, completed in 0, 3, 7, 14 and 28 days), during which the 14th and 28th days of vaccine can be avoided if the bite is observed and the dog is not dead 10 days later. If you can’t observe animals, finish the five.
If a person who has received a full course of vaccinations is re-exposed within three months, if the animal is healthy and immune and can be observed for 10 days, this can delay the immunization (suspension). In the case of re-exposures of more than three months, 1 dose (up to 2 per day with enhanced coverage instead of the whole course) is required for days 0 and 3 respectively.
This is the introduction of the 2016 Guide to China, which in fact does not explicitly refer to the concept of a protection period, but which is much more detailed than the 2018 textbooks, and also takes into account some of the WHO recommendations.
However, the WHO updated document, rabies vaccine: WHO position paper, published in 2018, makes it clear that if re-exposure occurs within three months of the previous exposure and the exposed person has undergone complete post-exposure prophylaxis after the previous exposure (e.g., a full five-shot) then re-exposure requires only post-exposure treatment of the wound and no vaccination against rabies and immunoglobin.
In other words, as long as the re-exposure takes place within three months of the completion of the full course of vaccination after the previous exposure, there is no unconditional need for further vaccination, i.e. the absolute protection period for rabies is three months.
Previously, the WHO view was also ambiguous, and it was often stipulated that, as long as it was re-exposed, no time interval was taken into account, a two-inoculation injection was given. But the WHO document of 2018 was finally updated and clearly introduced the concept of an absolute protection period of three months.
The WHO view is that, regardless of whether the animal is immune or not, and whether or not 10 days can be observed, it can be discontinued as long as the exposure occurs within three months of the full course of vaccination. However, given that rabies cause death, it is preferable to be conservative, and if they are exposed in a particularly serious way, they can be reinforced by two needles even within three months, but this particular severity is clearly defined as a very severe head bite, rather than a slight graft, so do not misuse the vaccine.
In the case of previous full-scale inoculations and subsequent exposure to an enhanced one-to-two needle, the enhanced needle has a three-year effective protection period during which no further booster injections are required except for particularly severe bites. Minor exposure (bite without bleeding or scratches) is protected throughout life.
A lot of people say. What’s a 10-day observation? What’s appropriate?
I’m sure a lot of people have heard about the 10-day observation law. After being bitten by a cat or dog, you can have a vaccine while you watch (not watching for 10 days to decide whether or not to deal with it), and if you don’t die 10 days later, it doesn’t have a virus, and the biter naturally doesn’t have rabies, then you can stop fighting and don’t fear.
Why 10 days of observation? Because the virus first invades the brain and then enters the saliva, and if the saliva has a virus, it means that the brain has been infected, and if the brain is infected, it basically dies within five days, not more than ten days at the latest, so 10 days, if it’s not dead, means that its brain is not infected, that it is less likely to have a virus, and that the biter will not have an illness. This is a scientific fact that has been tested over and over again.
WHO introduced the concept of a 10-day observation law in 2005 in the first report of the expert consultation on rabies. For the next decade or two, the scientific validity of the 10-day observation method has been very strong.
At the domestic level, however, 10 days of observation was delayed in the publication of authoritative educational materials. In fact, a long time ago, most of the academic community agreed with the 10-day observation method, but since most Chinese dogs were not vaccinated and many bite dogs were not domestic dogs, it was thought that 10 days would be difficult to observe it, who would catch the dog? Who’s watching? If it’s past ten days, who’s in charge? There were many problems, so while the theory was correct, it had not been implemented.
The latest version of Epidemiology in 2018, on rabies, did not mention the 10-day observation method, nor, of course, in earlier textbooks.
I can find the first document to show the 10-day observation method, the Technical Guide to rabies Prevention and Control published in 2016, which says: WHO and the United States CDC recommend the 10-day observation method, but also specify that ” The day observation method is limited to domestic dogs, cats and ferrets, and injured animals need to have a clear record of effective rabies vaccinations two times.
In any case, the first time that the Chinese guide has written in the 10-day observation is a great advance.
In conclusion, if you’ve never been vaccinated against rabies before, this time by a dog or cat, you’ll have to clean up the wounds first and then you’ll be vaccinated according to the vaccination process (if you can be sure that your dog is healthy, you can’t be vaccinated), and you’ll watch the bite dog (if it’s a domestic dog, you can be observed for 10 days) and if the dog is still alive after 10 days, he’s healthy, then the next two needles will stop. That’s what we call a dog-watching as a vaccine.
But if you were vaccinated shortly before being bitten by a dog or a cat and were in a protective phase, then there was no need for another vaccination, as we mentioned later.
Are you going to inoculate a dog or something?
All dogs should be vaccinated against rabies. Ninety-nine percent of rabies in the world are from dogs, 95 percent from dogs in China, and about two percent from cats.
The second report of the WHO expert consultation on rabies makes it clear that all dogs, regardless of age, weight or state of health, should be vaccinated during major vaccination campaigns.
On February 25, 2019, the National Commission for Human Rights and Human Rights issued a press conference in which the then member of the National Political Consultative Council, a member of the Chinese Academy of Sciences and Director of the Chinese Center for Disease Control stated that there was a proposal this year: How can we eradicate rabies?
Director Gao said, “Why is there no appeal to call a dog for a vaccine?” That makes sense: what do the world’s advanced nations need to eliminate rabies? It’s to fight vaccines to dogs. Regulating canine management is the key to preventing rabies from being eradicated, and if rabies are not controlled, rabies will occur. WHO proposed the goal of eliminating rabies by 2030, and it’s our bottom line. The responsibility of grass-roots communities and whether their dogs were all vaccinated should be the focus of the work.
Data for 2011: China received 15 million rabies per year, or about 80 per cent of the global total. And every year around 2000 people are killed by rabies, second only to 20,000 deaths per year in India.
In recent years, our data has improved, falling to about 300 deaths per year in recent years, a great achievement. (Data from China CDC documents).
The expert who called for the vaccine to be delivered to the dog was not only one person, but also one of the new professors. Internationally, more than 20 years ago, it was made clear that China had made a mistake in its direction and course in this regard (the new professor).
Sustained and effective immunization of 70 per cent of dogs in a given area can cut off the spread of rabies and achieve their elimination. The problem of rabies is addressed mainly by animal rather than human vaccines, but by the Ministry of Agriculture rather than the Ministry of Health. China has always been the opposite, treating the symptoms and not the root causes.
For a variety of reasons, however, we have not been able to achieve this fully. However, the situation has also improved, at least now that there are almost no rabies in urban areas (although the number of rabies is very high), almost all new cases of rabies occur annually in rural areas, where it is difficult to manage dogs, but it is possible to do so if you are willing to do so. Case number: YX111 RgXKyD
I don’t know.
Keep your eyes on the road.
