Saturday, November 16, 2013

Tips for Rabies and Chicken Pox Vaccine

Recently, a patient requested rabies vaccine because of a dog bite. I looked at the 'bite', it was just bruising and there was no break in the skin, thankfully.

I prescribed the patient tetanus vaccine, but the patient was adamant about getting the rabies vaccine. I was honest, I have never prescribed it before, I told the patient. I needed to check with other doctors and get back to ...the patient if it was necessary. Somehow, this did not reassure the patient but I knew I was doing the right thing.

It turns out, after discussing with some friends, that rabies vaccine is not given unless the incident happened near Thailand, because we don't have rabies in Malaysia (if anyone knows differently, please enlighten me). And if the vaccine is needed, it has to be ordered from Singapore.

Then I had another patient who presented with vesicular rash and fever due to chicken pox and the patient asked if there was a vaccine. Yes, there is but it works only 80% of the time in someone who has not been exposed to the virus.

I had chicken pox when I was fourteen and I can still remember how horrible it was. Feeling itchy everywhere all the time, in one word it was 'suffering'. One of my sisters 'brought it home' and when she was better, everyone else then started to get the rash (there were three of us, my eldest sister had left for England and so escaped the harrowing experience). The sister who was first sick was stigmatised, no one wanted to be near her, she was also at one point delirious from the high fever, that was kind of scary. My youngest sister looked at the mirror at the peak of her illness and cried because of the rash. Yup, it looked pretty horrible.

And my late dad developed shingles and an eye infection, which was bad. So all of us suffered. We spent about 2 weeks off from school and work being miserable at home.

Not too long ago, a friend of mine who was at that time a senior lecturer/colleague at a public university, kept nodding off to sleep during a meeting. This wasn't the colleagues usual behaviour (unlike me, I tend to sleep in meetings that are boring, I just cant help it). It turned out her second youngest child who was about 4 years old had chicken pox, so she was staying up all night comforting the child. Her worry was that the other children will catch it next especially the baby. Thankfully, our paediatrician friend advised to have the other children vaccinated and they didn't fall ill.

And so, I was very happy to vaccinate all three of my children against chicken pox even though the vaccine does not work 100% of the time. If I had the choice myself, I would have taken the vaccine. All three of my children were vaccinated. Unfortunately for my eldest, Zakaria (names have been changed to protect privacy), did get chicken pox when he was in standard one but it was mild and my other two children didn't get it from him, hence breaking the cycle.

Do I recommend the vaccine? Yes. Is it compulsory? No.

Just sharing.
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  • Adam Mokhtar Need to have public awareness about this. Rather than straight to vaccines, precautions are needed.
  • Zulkifli Zain dont use the same cologne Emmanuel wore :)) / sorry i cant resist it.../
  • Adam Mokhtar In Brunei, the vaccines are not freely administered as in your case. However, most people..parents..rather than sit out and listen to one doctor's advice to wait and investigate, whether the infection is viral or bacterial, they just go and get the latest, fastest way to heal. However future infections might not result in the same use of vaccine..might.
  • Othman H Siru should be reported to vet department.
  • Vasanthi Palani rabies vaccine only available in countries with outbreak...or high risk...we don't have an endemic/epidemic here...so not necessary...alwasy ask whose dog it was and if it was vaccinated,if its a house dog or stray...if its a stray ask for signs of aggresiveness,drooling etc...if they saw it...alwasy caution the patient what to watch out for in 24 hours...i read on article in JAMA how one tourist got bitten in GOA by a pup and developed coma due to rabies 5 months later...so again depends on viral load and progress...the patient died!
  • Vasanthi Palani rabies vaccine has its own side effects as well...
  • Vasanthi Palani and for chicken pox even after you vaccinate children can develop it...doesn't give 100% immunity from it...but less symptoms and suffering :o)
  • Michael Khaw Better be sure than sorry.
  • Mazlyn Mustapha Adam Mokhtar: the chicken pox vaccine is not free.
  • Mazlyn Mustapha Vasanthi: correct, I think its only 80% for the CP vaccine.
  • Adam Mokhtar Opps..only in Brunei then ;*p
  • Sathish Ch For rabies vaccination is only if you have a high suspicion or you don't have the dog symptoms will appear in the dog in about 5 days from onset of the disease but will take about 14 days to appear in humans rabies vaccination is also fraught with high side effects
  • Sathish Ch we have time period to start vaccination in case of appearance of symptoms
  • R HC Leong I don't believe that you guys do not have rabies in Malaysia! BTW, if you have high suspicion of rabies, you should also consider rabies immunoglobulin injection.
  • Regina Foo I had experience with rabies vaccine before, but not me, was my cat. My cat was a stray cat originated from Wangsa Maju area, when I moved back to Sabah, Jabatan Haiwan Sabah insisted my cat must have rabies vaccination done before it can obtained the health certificate. Futhermore, it should be quarantined for 3 months when it reached KK. The reason given by the officer at JH was...Sabah has no rabbies case, but WM has...
  • Vasanthi Palani probably sporadic cases..unreported...but alll animals require vaccine when travelling..even bats can carry rabies...including rodents and all furry critters...
  • Mazlyn Mustapha There was no break in the skin...is the patient at risk?
  • Ghazari Baharom This could also be how zombie outbreak starts.. In the movie; Its always the authority figure (doctor) brushing of the concern of the heroes... Then the outbreak happens... I joke la
  • Mazlyn Mustapha Yay! I know I'd survive a zombie apocalypse...finally, I can get my red Ferrari LOL
  • Shaktivel Palanivel Australia was rabies free until 3 months ago, a boy died from ot after a bat bite in queensland. based on that, i assume sporadic isolated cases might be lurking near the Thai border and the Kalimantan Sabah border.
  • Vasanthi Palani the case in GOA had only one tiny scrape on the skin by the pups teeth...am assuming no skin breech...so shud be safe i guess..
  • Saliza Abd Aziz I can feel you when everyone in the family gets the chicken pox... all 6 of us got it a week after another.. my youngest sis brought it back from school...he he he.. the last to get was my 20 mths baby girl at that time.. she did get the shots so she g...See More
  • Shew Yee Siang You can get rabies vaccine fr tung shin hospital or GH.
  • Shew Yee Siang I think there are sporadic cases but the last report is long time ago. That why most of overseas health authority still recommend rabies vaccination if come to Malaysia. Tung shin has it as many foreigner got or continue their vaccination there.
  • Shi Han Chicken pox vac is good so that our body can prepared for the attack. I had once during standard 6 recovered 1 week before upsr. Alhamdulillah managed to get 5As. And my schoolmate was infected during matriculation. He was quarantined for 2 weeks and I am the only one that can help him. Really funny to see your friend with black spots and spots of meds..

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