If a rabid wolf bites your head and you have recently been vaccinated against rabies, will you still develop the disease?

Question

I have read that if a large rabid animal bites your head, the post-exposure treatment can be ineffective:

...a bite near the head will make the disease act too fast for the treatment to take effect... (https://en.wikipedia.org/wiki/Rabies_in_animals)

The wikipedia article cites "The Fear of Wolves: A Review of Wolf Attacks on Humans" (PDF). Norsk Institutt for Naturforskning for the claim.

My question is this: if you have recently been vaccinated and a wolf severely bites your skull, will the antibodies still do their job?

Doctors say the virus should never reach the brain.

Thanks in advance!

PS: Please delete the question, if it's too unspecific or silly. ;)

Answer 1

The CDC points out that:

From numerous studies conducted on rabid dogs, cats, and ferrets, we know that when the rabies virus is introduced into a muscle through a bite from another animal, it travels from the site of the bite to the brain by moving within nerves. The animal does not appear ill during this time.

The time between the bite and the appearance of symptoms is called the incubation period and it may last for weeks to months.

Once the disease becomes established, it is 100% fatal (King & Turner, 1993; Jackson, 2000). However, if treated immediately after exposure it is possible to prevent the development of the disease in most cases (Linnell et al. 2002).

The present treatment consists of a single injection of immunoglobulin (rabies antibodies grown in tissue culture) and multiple injections of rabies vaccine (Jackson, 2000). Survival of patients treated is high except in some cases where bites have been inflicted directly on the head and neck (Shah & Jaswal, 1976; Fangtao et al. 1988). This is because direct viral entry into the nerves without local replication results in very short incubation period, as occurs in cases with multiple bites in the head and neck region (Mahadevan et al. 2016).

References

Fangtao, L., Shubeng, C., Yinzhon, W., Chenzhe, S., Fanzhen, Z., & Guanfu, W. (1988). Use of serum and vaccine in combination for prophylaxis following exposure to rabies. Reviews of infectious diseases, 10(Supplement_4), S766-S770. https://doi.org/10.1093/clinids/10.Supplement_4.S766

Jackson, A. C. (2000). REVIEW ARTICLES-Rabies. Canadian Journal of Neurological Sciences, 27(4), 278-282. https://www.researchgate.net/profile/Alan_Jackson6/publication/12229458_Rabies/links/56f9326708ae38d710a2fa53/Rabies.pdf

King, A. A., & Turner, G. S. (1993). Rabies: a review. Journal of Comparative Pathology, 108(1), 1-39. https://doi.org/10.1016/S0021-9975(08)80224-1

Linnell, J., Andersen, R., Andersone, Z., Balciauskas, L., Blanco, J. C., Boitani, L., ... & Loe, J. (2002). The fear of wolves: A review of wolf attacks on humans. Norsk Institutt for Naturforskning https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1026&context=wolfrecovery

Mahadevan, A., Suja, M. S., Mani, R. S., & Shankar, S. K. (2016). Perspectives in diagnosis and treatment of rabies viral encephalitis: insights from pathogenesis. Neurotherapeutics, 13(3), 477-492. https://doi.org/10.1007/s13311-016-0452-4

Shah, U., & Jaswal, G. S. (1976). Victims of a rabid wolf in India: effect of severity and location of bites on development of rabies. Journal of Infectious Diseases, 134(1), 25-29. https://doi.org/10.1093/infdis/134.1.25

Answer 2

It is thought you need to have completed the series of rabies vaccination for at least 7 days to be protected. If that is not the case, then you'll need rabies immunoglobulin as well.

Pre-exposure rabies vaccination consists of three full intramuscular (i.m.) doses of cell-culture- or embryonated-egg-based vaccine given on days 0, 7 and 21 or 28 (a few days’ variation in the timing is not important). For adults, the vaccine should always be administered in the deltoid area of the arm; for young children (under 1 year of age), the anterolateral area of the thigh is recommended. Rabies vaccine should never be administered in the gluteal area: administration in this manner will result in lower neutralizing antibody titres.

..

What is the difference between rabies vaccine and HRIG?

A course of rabies vaccines (given into the shoulder muscle) works to develop long term immunity, but this may take seven days to begin providing protection. For this reason, HRIG is usually given into the wound or site of injury to provide immediate short term protection while the rabies vaccines start to work. Long term protection is essential as rabies infection can take a long time to develop. Not everyone potentially exposed to rabies or ABLV will be advised to have HRIG. For example, HRIG is generally not required for people who have been previously vaccinated against rabies. When recommended, it is important to have the HRIG as well as the vaccine to ensure complete protection against rabies or ABLV.

http://conditions.health.qld.gov.au/HealthCondition/condition/14/119/117/Rabies-vaccine-human-rabies-immunoglobulin

https://www.who.int/ith/vaccines/rabies/en/