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Biting business
Rabies can be fatal. However, with a few important and quick steps it can prevented, even after bitten by the animal. Dr Naseem Salahuddin tells how
IT is sunrise. Shafiq steps out of the gate for his morning constitution, swinging his wooden cane. As he walks past the house at the end of the street, a gate opens and a handsome black German Shepherd growls and takes a lunge. The colonel strikes with his baton but the angry creature snips his trousers and draws blood from the ankle.
The household wakes up to the commotion; they cannot produce a certificate of the dog’s vaccination. The fuming colonel delivers threats, terminates his stroll and goes home to call his doctor.
A family of 10 lives in a remote village. They have always kept a shaggy, unkempt dog to guard their home from thieves. They do not fear dogs even though almost every member has at some time had an encounter or two. They simply instill the wounds with surma or naswar, and remain complacent about the consequences. Only one child among them had died of rabies. But then that was the will of God, they sigh.
Any of the above persons is at risk for rabies. How many will actually get the disease is similar to playing Russian roulette. It all depends upon whether there is rabies virus in the saliva or not.
Without accurate lab tests one can never be certain. In the absence of lab testing in Pakistan one has to assume that the biting dog had rabies. Other questions that comes to mind are if the wound is deep or not; and if the dog is vaccinated against rabies. Also, if the wound was thoroughly washed with soap and water; and finally, whether proper post exposure prophylaxis was done as per WHO standard recommendations. Failure to address any of these issues can cost someone his/her life.
In Pakistan there are an estimated 1.5 million dog bites per year and 2000 - 5000 deaths from rabies. If the virus were to be present in the dog’s saliva, then within two weeks to a few months the person is likely to get fever, headache, confusion and in the next few days will have difficulty swallowing food or water (hydrophobia).
It is an acknowleged fact that rabies is fatal. However, the disease can be prevented if the wound is managed urgently and correctly. Decision on using immune globulin and vaccine is a complex issue and should be left to the discretion of a physician trained and experienced in rabies prevention. Unfortunately, Pakistan still follows the old method of giving injections into the abdominal muscle, a practice which has been discarded all over world due to lack of efficacy and serious side effects.
The obvious answer to prevent rabies in humans is to eliminate the disease in dogs. Killing dogs has never been the answer any where in the world. The proven scientific method that has worked in other countries is to capture the animal, vaccinate, neuter and release into the community. This will not only reduce the dog population over months and years but also eliminate rabies in animals. Of course this requires proper organisation through a well developed chain of veterinary services. Owned dogs should be vaccinated with modern vaccines and kept on a leash.
The Alliance for Rabies Control (ARC) has taken the initiative to secure international support to declare a World Rabies Day celebrated by various events throughout the world, including a Race for Rabies (R4R). This will be an annual advocacy event, designed to reach out and engage the general public in discussion and debate on the issue of rabies prevention. The event is in close collaboration with the Centers for Disease Prevention and Control (CDC), the World Organisation for Animal Health (OIE) and co-sponsored by WHO.
Fifteen different organisations have pledged support for a campaign to raise awareness through radio, television and print media.
In Pakistan, medical and vetinary professionals are taking various steps to awre the masses about Rabies, which include a walk in Karachi.
There is a lot of confusion and alarm regarding Rabies in this country. Following are a few important reminders, that if kept in mind, can save a lot people from this disease. Just remember:
• Once symptoms of rabies have emerged, it is 100 per cent fatal
• Rabies is equally preventable, provided proper wound care, correct use of vaccines and Rabies immuneglobulin (RIG) is undertaken.
• Dogs are mainly responsible for rabies. Cats, bats, cattle, monkeys, wolves and bears are known to occasionally cause rabies.
• Rats, mice, squirrels or birds do not transmit rabies and their bite does not require rabies prophylaxis with vaccine.
• Bites, scratches with licks from a rabid animal over broken skin can be dangerous Alos, Rabies in an animal should be suspected if:
• There is any change in its normal behavior suggesting aggression or depression
• It is running aimlessly and attacking without provocation
• It is drowsy and withdrawn
• It has excessive salivation
• It refuses to eat
• It is chewing unusual objects like wood, stone, metal.
• It dies due to undiagnosed illness
The biting animal should be captured and observed for 10 days if possible. The animal incubating rabies generally becomes ill in 3-4 days and dies in another 3-5 days. If in doubt, it is best to consult a vet.
Wound care and treatment
• Wash all wounds under running water for at least 10 minutes. This will remove or at least dilute the saliva
• Clean the wound thoroughly with soap and rinse with water
• Do not use iodine, or household applicants like salt, spices or other powders. These cause local irritation and push the virus deeper into the wound
• Cover loosely with a bandage
• Ask for WHO approved tissue culture vaccine. Do not accept Nerve tissue vaccine (Semple vaccine)
• Consult a knowledgeable doctor about need for Rabies immuneglobulin (RIG) and vaccine Patients, especially children should be comforted and reassured as animal bite in itself is painful and fearsome.
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