Medical care should be clear and easy, right? Person gets bitten by an animal that could potentially have rabies, follow the protocol.
Now the problem becomes – whose protocol? Centers for Disease Control? ACIP? WHO?
Getting the idea? There are difference between countries on medicines, vaccines and treatment. Most of the time, between Europe, UK, US and OZ, these differences are trivial; mostly a difference of packaging or cultural dosing. The principles are the same, the care is the same.
And then we come to Rabies prophylaxis. WHO (World Health Organization) has a five shot protocol which is based on several factors: approved and tested vaccines, rising in viral titers, and actual prevalence of rabies. The latest US protocol is a four shot series. Based on US vaccines and risks, this is more than reasonable.
Now think about Afghanistan. Some of the assumptions we make in the US are simply not true – none of the feral animals have ever been immunized. Nor have their dams. The incremental difference in anti-body titers between 4 and 5 doses is not much. In the US it is unlikely to make a difference, but what about in a location where the assumption is likely that the feral is infected. In a location where we have seen rabies in 10 week old puppies.
All militaries adhere to their national standard; the challenges come when treating someone from another country. ISAF uses the WHO standard, except, of course, where national interests over ride for own country patients.
The debate is raging fast and furious.
Meanwhile, I spent some time thinking. If I was stupid enough to get bit by a feral animal here, I would not turn down any added protection that might be offered by a more conservative protocol that offered an additional vaccine dose.