Rabies alert! What to do incase of a dog bite

Many people travel and may at one point interact with dogs whose vaccination status is unknown. If such a dog bites someone, there is a risk of contracting rabies. It is therefore prudent to know what to do to avoid the risk of getting this fatal disease.

What is Rabies?

Rabies is a vaccine-preventable, zoonotic, viral disease. Once clinical symptoms appear, rabies is virtually 100 per cent fatal. In up to 99 per cent of cases, domestic dogs are responsible for rabies virus transmission to humans. Rabies can also affect domestic and wild animals. It is spread to people and animals through bites or scratches, usually via saliva.

Simon Karanja, a clinical nurse working at Aga Khan University Hospital, Nakuru East says rabies is one of the Neglected Tropical Diseases (NTD) that predominantly affects poor and vulnerable populations who live in remote rural locations.

Alarmingly, for the last five years, human rabies cases have tremendously increased in Kenya, transmitted through the bites of rabid domestic and wild canines. Recorded human deaths in the last five years is over sixty (60). Post exposure immunisation has been encouraged as well as first aid management.

How is rabies transmitted?

Karanja says: “People are usually infected following a deep bite or scratch from an animal with rabies.”

Transmission can also occur if saliva of infected animals comes into direct contact with human mucosa or fresh skin wounds.

What are the signs and symptoms?

“The incubation period for rabies is typically two to three months but may vary from one week to a year, dependent upon factors such as the location of virus entry and viral load. Initial symptoms of rabies 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 develops,” says Karanja.

There are two forms of the disease:

1.     Furious rabies results in signs of hyperactivity, excitable behaviour, hydrophobia (fear of water) and sometimes aerophobia (fear of drafts or of fresh air). Death occurs after a few days due to cardio-respiratory arrest.

2.     Paralytic rabies accounts for about 20 per cent of the total number of human cases. This form of rabies runs a less dramatic and usually longer course than the furious form. Muscles gradually become paralysed, starting at the site of the bite or scratch. A coma slowly develops, and eventually death occurs.

What to do incase of a dog bite

Karanja defines post-exposure prophylaxis (PEP) as the immediate treatment of a bite victim after rabies exposure that prevents virus entry into the central nervous system.

What treatment entails:

Extensive washing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; a course of potent and effective rabies vaccine that meets World Health Organisation standards; and the administration of rabies immunoglobulin (RIG), is key.

“This first-aid measure includes immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that remove and kill the rabies virus,” says Karanja.

 Rabies vaccine

Vaccination must be performed under medical supervision in a specialised rabies treatment centre. Post exposure treatment includes local, non-specific treatment of injury, passive immunisation with rabies immunoglobulins (RIGs) and vaccination depending on the type of injury and the status of the animal.

Pre-exposure vaccination should also be considered for subjects at frequent risk of exposure to the rabies virus, such as veterinarians and their assistants, animal handlers.

[The writer is Resident Vet at FarmKenya Initiative, PKangethe@standardmedia.co.ke]