Rabies: More than Just a Dog Bite

By Maricris Q. Aquino, RPh

Rabies, a disease caused by animals widely distributed throughout the world, has been classified by the World Health Organization in 2008 as Neglected Tropical Communicable Diseases. The Philippines, ranking 6^th with highest incidence among countries, apparently belongs to the High Risk Category of the WHO with reported 200 to 300 deaths annually and increasing number of incidences of animal bites every year.

What people do not usually know is that this infection is caused by a virus, which is spread by the infected saliva of an animal that enters through a bite or a broken skin. According to WHO, this virus will then travel from the site of wound to the brain where it will cause inflammation and eventually, and if left untreated, it may become fatal.

On Recognizing the Symptoms: In Dogs and In Humans

The PPD Better Pharmacy has indicated the symptoms, which may vary according to the manifestations of the behavior of the infected animal, predominantly in dogs here in the Philippines. The dog may either appear to be furious: exhibiting marked shift from being tame to wild, unusually restless, evident foaming of the mouth and thick saliva, difficulty in eating and drinking, or on the other hand, may seem to be dumb: being inactive or showing signs of depression, often hiding in dark places, resists eating and posing a “far away look”, jaw dropping, frail, and even sudden death without any sign.

In humans, symptoms may not appear after one has been bitten by an infected reservoir, that is the so-called “incubation period” of the virus for 10-14 days, and may even also last up to 30 days. During this time, prompt treatment is necessary to prevent further progression of the infection. The manifestation of symptoms have two phases: prodromal period, where the patient is experiencing excessive salivation, sensitivity to light, sound and change in temperature, muscle stiffness, loss of appetite, depression, nausea and vomiting and fever; and the neuroleptic phase, where the patient is already showing signs of hallucinations, hyperactivity, seizures and paralysis, difficulty in breathing and feeling of pain when swallowing, and hydrophobia (fear of water).

On Prevention and Treatment

The only thing one should be reminded of is to avoid being bitten by wild and stray animals. People who are at risk of exposure (that is if you are a pet-owner or surrounded by stray animals, or you handle animals, or  even those who explore bat caves) should be given (before exposure) rabies vaccine  for immunization. And to some degree, this vaccine may even protect people for the rest of their life provided the booster shots are administered every 2 years.

What to do when a person is bitten by a rabid animal? One must bear in mind that cases of rabies could be fatal, thus, appropriate measures should be done without delay. The wound should be treated immediately, cleaned with soap and water. People without immunization shots may be given an injection of rabies immunoglobulin (different from the vaccine as this provides immediate protection). This has antibodies against the virus, depending on the state of the animal. The WHO guidelines state that the shot is given initially (day 0), followed by shots of vaccine on days 3, 7, 14, and 28, as it stimulates the body to protect itself from the virus with much longer time.

According to the Merck Manual of Medical Information, if an immunized person has been bitten by a rabid animal, the risk of developing the rabies is reduced. However, it is still advised that the patient should be given immediate wound care and rabies immunoglobulin.

Once the symptoms develop in the victim, neither the vaccine nor the immunoglobulin is effective against the virus. Treatment is only limited, in this case, to relieving the pain and other symptoms making the person comfortable as possible; in most cases, death results due to cardiac or respiratory failure.

Prevention is always the key. Never approach animals or pets you don’t know of. Responsible pet ownership should be promoted as this can reduce the incidence of animal bites in our country. The goal is to make the Philippines a Rabies-Free nation. The world celebrates Rabies Day every 28^th of September.

Image References:

[Rabies: The Facts] n.d. [image online] Available at: http://www.seasidevet.com/rabies-the-facts [Accessed 27 February 2013].

[World Rabies Day: Working Together to Make Rabies History!] n.d. [image online] Available at: http://www.who.int/rabies/worldrabiesday/en/ [Accessed 27 February 2013].

Text References:

Medicomm Pacific, Inc., 2011-2012. PPD Better Pharmacy. 11^th ed. PasigCity: Medicomm Pacific, Inc.

World Health Organization, 2013. Animal Rabies. [online] Available at: http://www.who.int/rabies/animal/en/ [Accessed 27 February 2013].

Corpuz, Niña, 2012. Rabies deaths in PH down, but dog bites up. ABS-CBN News, [online] 28 September. Available at: http://www.abs-cbnnews.com/nation/metro-manila/09/28/12/rabies-deaths-ph-down-dog-bites [Accessed 27 February 2013].

A.D.A.M., Inc., 2012. Rabies. [online] PubMed Health. Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002310/ [Accessed 27 February 2013].

Merck Sharp & Dohme Corp., 2011. The Merck Manual of Medical Information. 2^nd Home ed. USA: Merck Sharp & Dohme Corp.

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Police Dog Bites Are More Serious Than Bites by Pet Dogs and More Often Result in Hospitalization and Surgery

Do bites by police dogs differ from bites by pet dogs? Without having thought at all about it, I probably would have assumed that the difference would come from the fact a police dog is often trying to subdue someone who is running away, while a house pet might be inclined to bite someone playing too rough or too long, or doing something else the dog doesn’t like. There are other differences, according to a trauma physician who looked at records of bite victims of the Los Angeles Police Department K9 Unit form 1988 to 1990. Dr. Meade also looked at bite victims at the King-Drew Medical Center, an LA inner city public hospital.

Police dog bite victims were bitten multiple times 73% of the time and hospitalized 42% of the time, while domestic dog bites were multiple only 16% of the time and resulted in hospitalization 6.9% of the time. Police dog bite victims were male 98% of the time and female only 2% of the time, while with domestic bites the victims were male 69% of the time and female 32% of the time. Children under 13 were bitten by police dogs almost never (0.2% of the time), while 74.8% of police dog bites were of individuals from 13 to 29 years old. Domestic dog bites were of children 29% of the time and were spread more evenly across age ranges. Police dog bites involved angiograms 8.9% of the time and operations 4% of the time, while angiograms were rare (0.1%) in domestic dog bites, and operations resulted 2.3% of the time.

Police dogs in the study were generally of larger breeds, such as Malinois and Dobermans, weighing from 70 pounds up. The dogs were taught to bite down hard, using their full mouths, including incisors in the front and molars at the back in order to strengthen their hold on a suspect. They were trained to “bite and hold,” i.e., not to let go until commanded to do so. Officers generally allowed dogs to continue to bite suspects as long as they struggled and fought to free themselves. This is called “bite until passive.” There were other differences. Police dogs bite the torso or limbs close to the torso, while domestic dogs more often catch a hand. The figure above shows the percentage of bites by body area, with police dog bites on the left and domestic dog bites on the right.

There were racial patterns. Caucasians made up 41% of LA County under the 1990 census but received only 7% of police dog bites. Hispanics made up 37% of the county population and were 32% of police dog bites. African-Americans made up 10% of the county population, yet were 60% of police dog bites. The article did not look at deployment patterns of police dogs and contained no discussion as to the disparity in the ethnicity of police dog bite victims. Judges have sometimes questioned whether racial factors might be present in the use of police dogs. See the dissent of Judge Logan of the Tenth Circuit in U.S. v. Moore, 22 F.3d 241 (10th Cir. 1994), questioning whether sniff searches at the Albuquerque train station might have indicated racial profiling. See also Chavez v. Illinois State Police, 27 F.Supp.2d 1053 (N.D. Ill. 1998), where the basis of a civil rights action concerned possible targeting of African-American and Hispanic motorists for drug sniffs.

Peter C. Meade, Police and Domestic Dog Bite Injuries: What Are the Differences? What Are the Implications about Police Dog Use? Injury Extra 37(11), 395-401 (2006). DNA testing has begun to be used to determine if a specific dog was involved in an attack. This could be useful in eliminating the need for rabies vaccinations in some cases. Brauner, P., Reshef, A., and Gorski, A., DNA Profiling of Trace Evidence–Mitigating Evidence in a Dog Biting Case. Journal of Forensic Sciences 46(5), 1232-1234 (2001). Matching a dog’s mouth to bites is complicated as density of tissue and other factors can affect the bite pattern. See Bush, M.A., Thorsrud, K., Miller, R.G., Dorion, R.B.J., and Bush, P.J. (2010). The Response of Skin to Applied Stress: Investigation of Bitemark Distortion in a Cadaver Model. Journal of Forensic Sciences, 55(1), 71-76.