Q: I am asking this question on behalf of my sister. I am residing abroad. Is consuming milk (unboiled) from a rabies infected cow dangerous? There is a 3 days delay in knowing that the cow has been killed due to infection (the owner did not disclose this information). However, we have decided to take an injection for the whole family including the kids. My sister's mother is having high blood pressure and diabetes and is under treatment. Will this course of injection create any complications?

A:It is recommended that people avoid consuming tissues and milk from rabid animals as transmission of rabies virus in non-pasteurised milk is theoretically possible. Regardless of the amount of viable rabies virus that may be shed in cows milk, the theoretical risk for transmission of rabies from this route can be eliminated if all dairy products are pasteurised before consumption. As temperatures below those used for cooking and pasteurisation inactivate rabies virus, eating cooked meat or drinking pasteurised milk from a rabid animal is not an indication for post-exposure prophylaxis (PEP). PEP comprises administration of human rabies immune globulin (HRIG) and the human rabies vaccine. Generally, there is a very low incidence of serious adverse reactions to the rabies PEP regimen. Local pain and low-grade fever may follow administration of HRIG. Pain, erythema (redness), swelling, itching, and other mild local reactions are reported among 30% to 74% of people receiving the vaccine. Headache, nausea, abdominal pain, muscle aches, dizziness, or other systemic reactions are reported among 5% to 40% of those vaccinated. Rabies PEP should not be interrupted or discontinued because of local or mild systemic adverse reactions to rabies vaccine. Non-steroidal anti-inflammatory drugs and antipyretic agents may be used to control mild adverse reactions. An immune-complex-like reaction (generalized urticaria, sometimes accompanied by arthralgia, arthritis, angioedema, nausea, vomiting, fever, and malaise) occurs in approximately 6% of pre-exposure-vaccinated individuals receiving a booster dose. This reaction can rarely occur in persons receiving their primary vaccination; however it has not been reported to be life threatening in either case. When a person with a history of serious hypersensitivity to rabies vaccine must be revaccinated, antihistamines may be administered concomitantly with the vaccine.