Dog Bite

RABIES !! isn’t it a scary word ? To me its the worst disease one can get in this whole world . So far , I have seen 8 patients who were infected with rabies dying infront of my eyes , NO ONE COULD NOR CAN SAVE THEM !! Once infected , 100 % death for sure , and believe me its the worst way to die !!

RABIES on the other hand is a 100 % preventable disease by vaccination ( before or after the bite too )

According to World health organisation , around 55,000 people die because of rabies around the globe , out of which 31,000 are from Asia .

In India most common way of getting rabies is through unvaccinated stray dogs ,

but there are other animals that can spread too . they are ,

1) Racoon

2 ) FOX

3 ) BAT

4 ) CAT

5) SKUNKS

6)Ground hogs

How do you get RABIES ?

People and animal get rabies if they are scratched or bite by an animal that already has rabies .

Rabies is carried by the saliva of an animal with rabies !!

How does Rabies make you sick ?

Once inside the body , the virus travels along the nerves to the spinal cord to the brain which leads to death ultimately .

MICROSCOPIC PICTURE OF RABIES VIRUS :

SYMPTOMS :

The incubation period of rabies can vary from person to person ( this is the time between exposure and actually getting the symptoms ) . It may take several weeks to months after an exposure , before people become sick with rabies .

The symptoms start with a
1) headache , fever and sore throat ,

2) leading to nervousness , confusion ,

3) pain or tingling at the site of the bite

4)Hallucinations :
- seeing things that are not really there

5)Hydrophobia
-” fear of water ” due to spasms in the throat

6) Aerophobia
- fear of wind or when air is blown

7)Paralysis
-Unable to move parts of body

8) Coma

9) Death

What do we do as a FIRST AID ?

1) Wash the wound with plenty of water and soap .

Soap reduces infectivity by breaking up the out coating of the virus and thereby decreasing the viruses effect . So washing with plenty of soap and water is very much advised .

There are two types of vaccination ,

1)Purified tissue culture vaccine ( preferred among the others like nerve tissue vaccine , etc )
2)Anti-rabies Immunoglobulin
Not all the bites would require the above vaccine , depending on the WHO’s classification the injections are given .

WHO ( world health organisation ) classifies dog bites as following

• 
  Category I: touching or feeding suspect animals, but skin is intact


• 
  Category II: minor scratches without bleeding from contact, or licks on broken skin


• 
  Category III: one or more bites, scratches, licks on broken skin, or other contact that breaks the skin; or exposure to bats

For Category 1 :- No injections are given
For Category 2 :- Administer Vaccine ( purified tissue culture vaccine ) immediately . Stop treatment if animal remains healthy for 10 days after contact
For Category 3 :- Administer anti-rabies immunoglobulin and vaccine immediately . Stop treatment if animal remains healthy for 10 days after contact .

Dose and schedule :

Vaccine :
Post-exposure (after the bite) :-
one injection on days 0 , 3 , 7 , 14 , 30( 0 is considered as the day of first injection given and not the day of bite)
Pre-exposure ( before the bite , anybody can take this ) :-
One injection on day 0 , 7 , 28 , followed by 1 year later and 3 years later .

Important Information :

The vaccine should be given on the arm only , should never be given in the buttock , except for small children where it can be given on the thighs .

Anti-Rabies Immunoglobulin are of 2 types :
1) Anti-rabies serum , dose is 40 IU/kg ( cost-effective , risk of allergy present because it is extracted from horse blood )
2) Human Immunoglobulin , dose is 20 IU /kg ( Highly costly , risk of allergy is very less because it is produced by biotechnology)

Half of Anti-rabies immunoglobulin must be given around the bite wound and half on the arm .

NOTE :

Suturing of the dog bite should be avoided as much as possible , if at all it needs suturing then lot of gaps should be left while suturing , because there is a possibility of spreading the rabies virus faster if sutured fully

THANK YOU FOR YOUR PATIENT READING !