Why should you worry about dogbites?
Rabies cases have been on the high of late and has been a major cause for concern among the public and healthcare workers alike.In India,the wide majority of cases are caused by dogbites.The magnitude of this infectious disease is evident in the fact that while being a vaccine-preventable disease,it is 100% fatal if you contract it.India is endemic for rabies accounting for 36% of the world’s deaths.About 30-60% of reported rabies cases and deaths in India occur in children under the age of 15 years as bites that occur in children often go unrecognized and unreported.
How can one get Rabies ?
Dogs are the primary source of rabies virus transmission through bites or scratches,via saliva. Initial symptoms include a fever with pain and unusual or unexplained tingling, pricking, or burning sensation at the wound site. As the virus spreads to the central nervous system, progressive and fatal inflammation of the brain and spinal cord can develop.
Children between the ages 5 and 15 are most vulnerable to dogbites due to a multitude of causes.They often play with dogs playfully without being aware of the diseases and consequences.Many of them often conceal their wounds from their parents and often the history would be ignored until the symptoms develop.
Human-to-human transmission through bites or saliva is theoretically possible but has never been confirmed. The same applies for transmission to humans via consumption of raw meat or milk of infected animals.
Which animal bites warrant rabies consideration?
Though dogbites are of supreme importance,bites by cats and all wild animals including monkeys must be considered as serious enough.Bats are also considered as potential sources.Exposure to domestic rodents, squirrel, hare and rabbits do not ordinarily require Post Exposure Prophylaxis.
Are all dogbites the same?
No.
There are different categories based on the nature of dogbite and the exposure level also varies accordingly. The three categories of bites are as given below:
All Category II and III wounds require Post-exposure prophylaxis.The risk for contraction of rabies increases if:
the dog looks sick or displays abnormal behaviour.
the exposure has occured in a geographical area where rabies is prevelant
direct contact with saliva on open cuts or mucous membrane like mouth,
unprovoked bite.
unvaccinated or unknown animal.
What must I do if I get bitten by a dog?
The steps you must adhere to,following a bite is collectively called Post-Exposure Prophylaxis(PEP).The aim of PEP is to halt the progression of the virus into the nervous system.
Components of PEP
Extensive and thorough washing of the area of contact under running water with soap
Rabies vaccination as per schedule.
Administration of Immunoglobulin in selected cases.
Always visit a hospital as soon as possible.
What should I NOT do?
Do not touch the wound with your bare hands.
Do not apply any irritant substances like turmeric,herbal preparations,betel leaves,soil etc.
Treatment
Category I wounds
Washing properly with soap and water is the only treatment needed.This must be done diligently for a period of 10-15 minutes.There is no need for vaccine administartion or immunoglobulins ideally but the former may be given in doubtful cases.
Category II
Wound washing and immediate vaccination schedule starting from the day of first treatment is needed.The vaccines can be intradermal(over the skin which is relatively painless also) or Intramuscular(comparatively painful).
Category III
Here in addition to wound washing and vaccination,Immunoglobulin administration-as a means of passive immunization-is also recommended.Generally,the calculated dose of immunoglobulin must be infiltrated around the wound and the rest to be given intramuscularly though WHO says the latter may not be strictly followed.The wounds are usually not stitched as there is possibility of virus spread through pricks but if very large and unsightly loose suturing can be done.
Source: WHO
Should the dog be kept under observation?
If possible,the biting animal has to be identified and if alive,must be quarantined for observation while if dead,must be submitted for examination.The PEP should be continued during this period.
Treatment may be discontinued if no signs of rabies is found after this period.This is based on the fact that animals can transmit the virus only after it has reached its brain and consequently,if it was infectious atthe time of bite,it won’t survive more than 10 days.Along with this,it is to be noted that the closer a wound is to brain,the more rapid the progression would be.
Remember: The vaccination status of the animal should not be a deciding factor to start PEP.
WHO also recommends prophylactic rabies vaccination to high-risk population such as those living in endemic areas or those having increased susceptibility to contract the virus as part of their livelihood.
28th September every year,is observed as ‘World Rabies Day’ to increase the awareness about this disease.This year’s World Rabies Day theme is: “All for 1, One Health for all”.
Take-Home messages
Ensure that your pet dogs have been vaccinated correctly.
Do not provoke an animal by any means-teach children also to strictly adhere to this.
Adequately wash the wounds with soap and water after exposure.
Always visit a health care facility even if you think it is a simple Category I wound.
Always complete your prescribed vaccination schedule.
So dogs are cute and funny alright,but a bite can be perilous hence be alert!
Do let me know if you have any doubts!