Do I need a rabies vaccine if my child is scratched by a cat?

There are a lot of common misconceptions surrounding rabies. Rabies is not a contagious virus that can be transmitted from person to person, but spreads through the saliva of a wild animal that is infected by rabies. If a cat scratches your child, there are many different factors to consider before deciding how to go about the situation. A few questions to think about are: Is it an open wound? Was your child scratched by a domestic pet or wild cat? Has your child been vaccinated for rabies before?

Because there is no treatment or cure to rabies, it might be beneficial for your child to take the vaccination as a precaution which will provide antibodies and immunity against the virus. However, if kept untreated, it can be fatal. It will not be necessary for you as the parent to get the vaccination because you have not had direct contact with an infected animal. Below is an in-depth guide to rabies, as well as information about signs, symptoms and treatment which will assist in the management of your child’s wound.

What is rabies?

As described by the Centers for Disease Control and Prevention, rabies is a viral infection which is found in many warm-blooded animals. In the United States, common transmitters of the disease are wild animals such as skunk, fox, bats, coyotes and racoons. Stray dogs and cats may be carriers of rabies because they come in contact with many wild animals. In some parts of the U.S. cats are more likely than dogs to be rabid. The Centers for Disease Control and Prevention suggests in 2018, 241 rabid cats were caught and tested positive for rabies compared to 63 rabid dogs found from different states in the same year.

Most of these wild animals have sharp teeth and claws, which will pierce the cat’s skin and transmit the disease. The disease is then transmitted to humans if rabies fluid from the animal’s saliva comes in contact with an open wound. The saliva of the infected animal is what is contagious. In terms of your child’s scratch, it is unlikely to contain rabies particles; the only possibility is if the cat had just recently licked its paws and then attacked your child. If the infection reaches the brain, then the virus travels down the nervous system and multiplies into different organs. Rabies actually does not survive long outside the mammal’s body. Usually, UV rays from the sun can kill the virus.

 

 

Signs and Symptoms:

It is highly recommended to take precautions for rabies, even before symptoms start showing. The Clinical Infectious Diseases describes the incubation period as generally between 20-60 days. However, in some cases, it can be over 6 months to a year. A child may be at increased risk of infection if they live in an area where rabies is more prevalent in wild animals.

Stanford Children’s Health provides a list of some general symptoms that may occur in the initial stage. This includes, but is not limited to fever, vomiting, fatigue and headaches. If rabies is left untreated, it will get gradually worse. The second stage could involve symptoms such as disorientation, confusion, unusual behaviour followed by paralysis and coma. Unfortunately, in more severe cases, rabies also leads to death. The three stages of rabies in cats are categorized as prodromal stage, furious rabies stage and paralytical stage.

The speed at which the signs and symptoms appear can vary depending on a few factors such as:

• Where the scratch/ infection occurred (if it is closer to the brain then the virus will spread to nervous system and tissues faster)
• How severe the scratch is?
• The amount of rabies infection that was exposed to the child. At the time of the scratch (Rabies might not have been present in the cat’s paws whist the scratch occurred).

 

Diagnosis and Treatment of Rabies:

There is no way to be sure if your child has contracted rabies after the scratch, so it is essential to act quickly. Under the John Hopkins Medicine guidelines, for smaller wounds, wash it with lukewarm water and gentle soap.

 If a big scratch has occurred, that is bleeding:

– Apply pressure with a clean bandage to stop the bleeding.

– Try not to touch the wound and apply some antiseptic cream with a cotton pad if possible. — Dry and cover the wound with a sterile dressing.

– Do not scrub or clean the wound too vigorously as this could cause further complications. — Seek help from a doctor or medical professional immediately.

Also, the Encyclopedia of Children’s Health reminds parents  to reassure children during this time. It might be quite overwhelming for them so try not to panic. Bringing the child’s comfort toy to the doctor and hugging and praising them will help them in remaining calm.

Knowing whether or not an animal has rabies can help you decide whether your child needs to be treated with a vaccine. The test outcomes are available within a few hours. In many cases, the animal may run away, but a DFA test (direct fluorescent antibody test) is used to detect rabies in animals if the animal can be caught. Think about the general environment of the cat before you make any assumptions. If the cat is domesticated and only lives indoors, there are zero chances of them coming in to contact with wild animals that may have rabies. There is also no single test which can determine whether your child has contracted rabies. Samples may need to be taken through your child’s blood, saliva, skin biopsy and spinal fluid.  

In order for a more accurate and thorough diagnosis of the infection, there are a few questions your health-care provider /doctor will ask you, to understand more about how the incident occurred. Be prepared to answer some of the following questions:

– Where did the incident occur?

– Type of Animal

– If the pet/animal has been vaccinated for rabies (if you know)

– Type of wound (cut/scratch/bite)

 

Vaccinations

Sadly, there is still no cure for rabies, but vaccines can provide immunity against the disease. Usually, vaccines are given as a preventative before exposure to a particular virus or disease. Rabies vaccination is different from others because it is given after believed contact with an animal with rabies.

According to The Children’s Hospital Of Philadelphia, if you believe your child is exposed to rabies, the vaccine’s quantity and dose will depend on previous vaccination history.

1) For children who have been exposed to rabies for the first time, the vaccine is given in 4 doses to the shoulder muscle. The first shot is given immediately after the animal’s scratch has occurred to prevent rabies from spreading progressively. The next three days later, seven days later and 14 days later. This may vary depending on the doctor.

2) The doctor may advise a Rabies Immune Globulin (RIG) for the child immediately after exposure to help protect your child straight away. This immunization is made from human serum that contains a significant number of antibodies that will protect the child against rabies.

3) If your child has already been vaccinated but has been re-exposed to rabies, the child won’t be required to take RIG. 2 vaccines will be administered for further prevention; one immediately and one three days later.

4) If the cat that scratched your child is a domesticated cat that already has been vaccinated, it is unlikely to transmit rabies to your child. The doctor will advise further steps, but vaccination will probably not be necessary in this case.

Your child may feel some side effects of the vaccine such as sore arm, headache or vomiting, but these symptoms are generally mild. If you have any further concerns, you can consult your doctor.

 

What is the 10-day observation method?

The 10-day observation method means that after being bitten or scratched by a suspected rabid animal (dogs, cats, ferrets only), the animal is tied and observed for 10 days (in rabies-endemic areas, timely vaccination is required before observation), and if the animal remains healthy during the 10-day observation period, or if it is confirmed by reliable laboratory diagnostic techniques that the animal does not carry the rabies virus, the remaining vaccination can be stopped.

The 10-day observation method is based on a 100% reliable scientific principle: rabies virus is a neurophilic virus, and in dogs and cats in the incubation period, the virus is only in the peripheral nervous system and is not contagious at this time. Only after the virus enters the central nervous system in large numbers and enters the salivary glands via the brain, at which point it becomes contagious. Dogs and cats with such an encephalomyelitis attack are bound to show very obvious abnormalities within 1 week from the time they become contagious, and are bound to die or be near death within 10 days.

In response to the WHO’s recommended rabies prevention and treatment method “10-day observation method” circulating on the Internet in 2016, people often misinterpret it as doing nothing after being bitten, only the dog or cat that bit the person is locked up and observed for ten days, the animal is fine and the person is fine.

In fact, rabies prophylaxis should begin immediately after exposure. Especially in high-risk countries or regions for rabies, where the rate of vaccination against cats and dogs is generally low, the injured person should also receive rabies vaccination immediately after ensuring that he or she is given proper wound treatment. Once bitten or scratched by a cat or dog, do not take any chances and go to the hospital for disposal at the first opportunity.

In addition, the Second Report of the WHO Expert Consultation on Rabies also states that factors that should be considered in deciding whether to administer post-exposure prophylaxis include the epidemiological likelihood of rabies in the animal involved, the severity of the exposure, the clinical characteristics of the animal and its immunization status (especially in dogs and cats), and the feasibility of observation and laboratory testing for it. All exposures determined to be at risk for rabies require post-exposure prophylaxis.

 

Conclusion

One thing is for certain, that the parent of a child that has been scratched by a cat will not be required to take a vaccination because contact with a person that is exposed to rabies is not associated with the risk of infection. Be mindful, rabies can be a fatal illness if is left untreated by someone who has been exposed to a rabid animal. Although chances of the spread of rabies from a cat scratch are quite low, it is important to act quickly; wash the scratch, try to rub some antiseptic ointment and visit a health care professional as soon as possible. As stated above, there is no cure for rabies, but a vaccination can be provided to the child as a precaution to give them immunity against rabies. There are many different factors to consider before the vaccine is given to children, but it does provide children with antibodies. In addition the 10-day observation method is also a proven method, but ensure that it is applied properly.