There are many misconceptions about rabies, the fatal disease caused by animal scratches and bites that kills around 3,000 people in China every year. I don’t have to worry about it now thanks to my family, who urged me to get vaccinated right after my dog gave me an innocuous scratch that I almost overlooked.
Days after I received one of the series of shots, some friends (both expat and local) were still confidently telling me I did not need them because my dog was vaccinated. I think that this one of the most fatal and common misconceptions. Vaccinated animals can still carry the rabies virus from direct and indirect contact with other animals, and being vaccinated only guarantees their safety from the disease.
Another misconception is that some people think scratching is not as bad as biting because the rabies virus is carried through saliva. In fact, any pet owner can tell you how often their dog or cat licks its front and hind paws. This was why, when my dog scratched my toe and broke the skin, we treated it as seriously as a bite. Under pressure from my family, I washed the exposed skin with water and soap and disinfected it with iodine solution, which later the doctor said was the right thing to do.
It is also natural to assume that you can get the vaccination at any hospital, but this is not true. I headed to Wangjing Hospital the next morning after I was scratched and was told to go to China-Japan Friendship Hospital.
Here (Chinese-only) is the list of local hospitals that you can get rabies vaccinations from in Beijing. Beijing United Family Hospital also offers rabies vaccinations.
Rabies is a viral disease transmitted by infected saliva from animals such as dogs, cats and bats through bites or scratches. It is fatal if no previous or immediate vaccination is given after contact.
For suspected patients who have never been vaccinated before, four to five doses the rabies shot are administered over a period of one month. The sooner the shots are received, the more effective the doses are. The first 24 hours after the bite/scratch is considered to be crucial, so it is better to know ahead of time which hospital to head to. In addition, go straight to the emergency department (instead of wandering around in the out-patient area).
For serious bites and scratches, rabies immunoglobulin will also be recommended by the doctor (I didn't need this). The vaccinations (four to five doses for post-exposure; three doses for pre-exposure) are good for six months. But if the wound is bad, see a doctor regardless as a booster may be needed in some cases.
Most importantly, teach your children how to prevent bites and scratches, especially from dogs. Here are some tips from by the American Academy of Pediatrics (via myhealthbeijing.com):
Photos: Clemence Jiang and Paul Ryding
This article originally appeared on Beijing-kids.com
One of the strange effects that rabies has on the brain, is that it can cause a fear of water, because the victim has trouble swallowing. That is why you see the foaming of the mouth of rabies victims. This extra saliva in turn causes there to be more of the virus in the mouth in the event of a bite. It also can causes fits of rage, when the brain is getting too many confused signals.
Fortunately in most countries rabies is very rare.
I listened to a long story on radiolab recently, about a girl who contracted rabies from a bat that was trapped inside a church and bit her finger when she was helping it escape.
Rabies travels into your bloodstream and attaches itself to a nerve. Once inside, it slowly inches its way up that nerve, moving very slowly (a few centimeters per day) until it eventually reaches the brain, where it begins to confuse the brain signals. Before it reaches the brain, there are no symptoms, and can be treated with vaccines. Once it reaches the brain, and starts causing any symptoms at all, such as twitches or just an unwell feeling, it is too late. Its is the single most deadly disease there is. Once any symptons appear, that person will die.
There does appear to be a very small group of people that have some antibodies to rabbies, in places like Peru where there have been are vampire bats in the population for a long time. Other than this, there is almost nothing a hospital can do, once the rabies has spread.
This is why hospitals give vaccines if there is any doubt at all that the bite could contain rabies. With the vaccines, before the symptons appear, the rabies is treated very effectively.
While I agree that it's good to err on the side of caution, my personal take on this would be to look at the context. Is the pet yours or a friend's? Does it spend a significant amount of time with unknown animals outdoors? Has it been behaving unusually?
You're correct that rabies can be carried by immunized animals, but I believe that's extremely rare. The WHO recommends that in the case of a known pet, you should begin your vaccination regimen and keep the animal quarantined for 10 days (just watch it carefully to make sure its behavior doesn't change and don't let it play with other animals). If the animal is still healthy after 10 days, you can safely discontinue your vaccinations. The reason for this 10-day quarantine is that infected dogs/cats that are symptomatic for rabies WILL die within 10 days. Even if the animal is infected, the virus is not present in its saliva during the incubation period (while it's asymptomatic). So, if the animal's still alive and acting normally, you basically have no risk of contracting the disease.
Also consider the cleanliness of the hospital you're going to, and the inherent risk in injecting something into your bloodstream.
My thoughts:
1) Wash the wound thoroughly
2) Consider the context of the bite/scratch. Is the animal yours? Was it immunized? Is it acting normal?
3) If you think it poses a risk, begin treatment
4) Quarantine the animal for 10 days. If it's still acting normal after 10 days, discontinue treatment
5) If quarantine is not feasible or if based on #2 you think you're at risk, definitely complete the treatment regimen
Source: CDC, WHO
http://www.cdc.gov/rabies/transmission/body.html
http://www.who.int/rabies/human/generalconsid/en/
Squid,
Absolutely. Backing away, running--those are clear signals that you are weak and that the dog should continue the attack. Whenever I'm out walking my own dogs and we come across an aggressive dog, I approach it with my arms wide, as if I'm herding it, giving sharp commands to my own dogs to stay back. Half the time, the threatening dog turns and heads off, after a few attempts to get around me to get to my dogs, but as long as I am strong and assertive, the dog knows that I'm not a target. The other half, they respond by backing down and wagging a lot--and then playing with my dogs as if they've been best friends forever. A lot depends on whether the dog is with its owner. I've noticed that aggressive dogs that are with their owners are usually merely reflecting the owner's insecurity about the dog. If the dog's aggressive in that situation, he's "protecting his pack"; since the owner clearly isn't in charge, the dog has taken over the role of pack leader. In that case, I usually put my dogs on their leashes, if they're not already, and make them sit quietly next to me. The quietness helps keep the aggressive dog calm; we're not approaching, so we're not a threat, and we're not running away, so we're not victims. We're just... being. The other dog can sniff and examine if he likes. Then we go on our way. As long as I stay calm, then my own dogs are calm--nothing's wrong, because I'm in charge of the situation.
Of course... if a dog's foaming at the mouth or something, that's another issue entirely. In that case, running or approaching--who knows what would work, cause the poor thing isn't thinking/responding like a normal dog. But fortunately I haven't come across any dogs with rabies yet. Rescue dogs I take to the vet immediately to get checked. Haven't found any with rabies so far, thankfully.
Doubt wisely; in strange way / To stand inquiring right is not to stray; / To sleep, or run wrong, is. (Donne, Satire III)
I am not so sure the advice about backing away from an aggressive dog, or curling up in a ball is such a good one. Unless you are a very meek or small individual, you probably are much better off making sure that dog understands YOU are the pack leader and not him. You should square up to the dog, remain calm, but assertive, perhaps even make your self as big and intimidating to the dog as possible. If there is a rock or other object nearby you can throw at him, I would do that. And lastly, if a dog is really gong to try to bite you, I don't think curling up in ball will help you. A well placed kick to the throat or groin will probably work better. You may end up with one bite on your leg, but its better than letting it get anywhere near your head.
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