Dog Bite - Rabies

[JimmyTheMook]

Is rabies still prevelant in Thailand ?

I was bitten by a very skanky street dog on my leg and the wound drew blood , was in the emergency room an hour later getting the first of the series of Rabies shots.

Should I be worried ?

[phaethon]

Not unduly, if you're having the shots make sure you complete the series.

Any chance the dog can be identified and caught for observation/testing? (without further risk to you or others)

There is a 10 day lag between the animal's saliva becoming infectious and the appearance of signs of rabies. If the animal is alive and healthy 10 days after the incident then it probably was not shedding virus in its saliva and further shots are unnecessary. If signs do become apparent the animal will be killed and tested, if positive you can complete your shots.

[hanno]

Personally, I would always assume any animal in SE Asia that bit me to be rabid. Whilst Thailand has had a lot of success in dealing with rabies, it is still prevalent. As phaethon said; It would be easier if you have access to the animal.

[JimmyTheMook]

The dog did not appear rabid with a foaming mouth or strange behavior , not sure how I'd go about killing it test out the saliva.

[IMA_FARANG]

The dog did not appear rabid with a foaming mouth or strange behavior , not sure how I'd go about killing it test out the saliva.

Ouch!

Many years ago (too long I care to mention) a classmate was bit by a bat that she and the school biology teacher were getting ready to show to students. The animal control people took the bat and killed it, then tested it. It took 3 or 4 days to run the tests (they had to grow a culture and examine it for Rabies virus at that time). It turned out to be negative so they stopped the series after the 5th shot. Otherwise they would have needed all 14 shots, one per day. I hope the technology has improved since then.

Don't mess with Rabies. If the symptoms show the chance of survival is low. With the shots that condition is unlikely. So take the shots, even if they are painful. Even if you turn out not to need them, it is much better than any of the alternatives.

[patklang]

Apparently,you are allowed to kill any dog if you get bitten.the method is by cutting its head off.if i was realy angry then i could do it especially if i didnt like the dog.supposed to test the brain for signs of rabies.wish next doors dogs would bite me as that would be the only way to stop the shit and noise.

[Rimmer]

In Thailand, between 200-300 human rabies deaths are reported annually with 95% due to dog bites. A survey of 1,882 foreign travelers in Thailand determined that 1.2% had a history of dog bites

One of my cats bit me one day early this year and, as with dog bites cat bites are full of bacteria so I went to the little hospital down the road where they insisted on giving me rabies shots as well. Cost me about 200 baht a shot for maybe six or seven injections which I knew I did not need but at that price I could not refuse. They last for ten years anyway with the booster shots.

[hanno]

The dog did not appear rabid with a foaming mouth or strange behavior

An animal may already carry the virus prior to displaying any symptoms.

the method is by cutting its head off

Where did you read that? Doesn't matter how you kill the animal for an autopsy.

[JimmyTheMook]

In Thailand, between 200-300 human rabies deaths are reported annually with 95% due to dog bites. A survey of 1,882 foreign travelers in Thailand determined that 1.2% had a history of dog bites

One of my cats bit me one day early this year and, as with dog bites cat bites are full of bacteria so I went to the little hospital down the road where they insisted on giving me rabies shots as well. Cost me about 200 baht a shot for maybe six or seven injections which I knew I did not need but at that price I could not refuse. They last for ten years anyway with the booster shots.

Looked at some horrible videos on YouTube of humans infected with rabies and it sure looks like a horrible way to go.

The shots are really painful but I'll continue the series and figure out a way to kill the dog.

[Sheryl]

The reason for the cutting ioff the head opart is that it is the head that needs to be exmined. Can kill the dog in any manner but once dead, the head is what needs to go (on ice) to the appropriate place which is somehere at the Thai Red Cross.

Take care not to get bitten again in the process.

BTW the reason the shots are a long and painful course is because they are post-exposure. There is a preventive vaccine you can get (series of I think 3 shots, and normal jabs like any othetr vaccine, not liek what you are getting now) which will provide lifetime protection to rabies.

Everyone should have it and most especially everyone in or coming to Thailand. I have.

Once this ordeal is behind you, look into it. After all, plenty more dogs (not to mention rapid cats and bats!) out there.

[Rimmer]

The reason for the cutting ioff the head opart is that it is the head that needs to be exmined. Can kill the dog in any manner but once dead, the head is what needs to go (on ice) to the appropriate place which is somehere at the Thai Red Cross.

Take care not to get bitten again in the process.

BTW the reason the shots are a long and painful course is because they are post-exposure. There is a preventive vaccine you can get (series of I think 3 shots, and normal jabs like any othetr vaccine, not liek what you are getting now) which will provide lifetime protection to rabies.

Everyone should have it and most especially everyone in or coming to Thailand. I have.

Once this ordeal is behind you, look into it. After all, plenty more dogs (not to mention rapid cats and bats!) out there.

I must have had the post exposure shots but they are not painful, just a shot in the muscle of my left arm, hardly noticed them at all, during the shot or after effects.

I just looked on my hospital card and have had eight shots to date.

[phaethon]

Firstly you don't kill the dog yourself get a professional to catch it and take it to a vet for observation, only if it develops symptoms will it be put down and the brain examined for rabies.

Don't let out-of-date statistics scare you - you got the right treatment and there have been huge drops in mortality in recent decades, mainly due to a huge campaign of vaccination of the nation's dogs. The figure quoted (without citation) is probably from the 1980s (MITMOONPITAK et al. cite 390 deaths in Thailand in 1980 in "Rabies in Thailand", Epidemiology and Infection (1998), 120 : 165-169)

From Kasempimolporn et al. (2008)

Table 2. Human deaths from rabies, 1997-2006(6)

Year Bangkok*/Thailand

1997 7/58

1998 4/57

1999 7/68

2000 6/50

2001 8/37

2002 0/30

2003 3/21

2004 0/19

2005 3/20

2006 2/26

* Bitten by dogs located in Bangkok

These deaths would have been people who could not afford/did not seek post-exposure prophylaxis (PEP).

Rabies is a very efficient killer once symptoms develop - only one person ever has been documented as recovering from rabies (in Wisconsin in 2004 IIRC) They were bitten by a bat and it is speculated that bat-born rabies is less neuro-active than the dog variety.

In the old days shots were given into the abdomen, modern shots are first given in the vicinity of the bite and further ones in the arm - not so painful. Rabies vaccination (pre-exposure) is only recommended if you are at real risk from being exposed. Serious reaction to vaccine are rare and if bitten by a suspect animal you still have to get two shots (one immediate + one 3 days later) just in case. Personally I won't bother unless exposed or likely to be travelling out of reach of PEP.

Some interesting points from Kasempimolporn et al. (2008):

50,000 deaths from rabies worldwide (WHO figure -can vary from about 30,000 - 100,000 - K.

"Dog bite-related rabies cases account for 70% to 95% of the reported human rabies deaths. The other vectors included cats, non-human primates and rodents. The majority of victims were children. Cases of rabies in domestic animals other than dogs have been traceable or believed to have been at the origin of exposure to rabid dogs."

20%of Bangkok households report owning dogs with an average of 2.1 dogs/household.

"The cost of a postbite treatment in humans is about twenty to one hundred times more costly than the vaccination of a dog." (Presume the higher figure is for farangs - K.)

"The prevalence of rabies virus infection among 3,314 stray dogs [in BKK] investigated in 2004 was 0.03%"

Oh, and quit scaring yourself with youtube!

[bina]

sheryl, actually all the vets i've worked with have had them and there is a varying time frame for how long they last; in the states i believe they do a titre to see before diciding to give u boosters; here, they just give them... i actually tried to get them and in the end gave up.. public health decisions here are nuts... (wasnt a vet, just a helper therefore dont qualify)...

its just three jabs, and one vet i spoke to says that the more u have an adverse reaction (he had hives, and other stuff), the longer the titre stays high, others that got the vaccine w/o any reaction had to redo more often...

not sure what brand used either...

other note: rabid dogs do not neccessarily foam at the mouth; some just stand or wander in circles, some are carrying but not yet really sick, although any animal that looks like it has neurological symptoms (shaking convulsing, spasming) could be : if a dog either distemper or rabies , in other mammals, other disorders, but if bitten, treat like rabies bite:

wash for 15 minutes vigourously soap and warm water, the idea is that blood should come out, as opposed to a dry puncture wound which in any case is problematic

washing with mild solution of povodine

usually tetanus and antibiotics are needed for bite wounds

dead animal REFRIGERATED NOT FROZEN!!!!!!!! to the lab...

or, if dog or other animal is known (pet /local) 10 quarantine if animal acts sick, worst case scenario is prescribed. there is a time lag to be vaccinated doesnt have to be within the hour unless it was on your face or neck

but no time lag for antibiotics since puncture wounds from carnivores infect rapidly and aggressively

(same goes for dog to dog bite wounds btw)... just cause it looks small on the outside doesnt mean it is small on the inside. puncture wounds from dog canine teeth are deep and small and close over (scab) leaving anaerobic bacteria and swollen tissue inside.

for a dog, the course is usually cipro or cehpalexin by body weight, at least 7 days (usual antibiotics for animals can be from 3-7 days with 10 days for extreme), including first dose by injection. for people the antbiotic treatment is similar (we get cipr or cephalaxin) etc also....

keep a close eye on bite sites for extreme redness, swelling, fever, if they appear, get medical attention immediately dont put it off... bite wounds that are serious take a long time to heal and often get complications...

i was bitten about 15 yrs oago by an angry rock hyrax female, trust me, no fun whatsoever and its a rodent not a carnivore.

bina

[Hairy]

Rabies is a very efficient killer once symptoms develop - only one person ever has been documented as recovering from rabies (in Wisconsin in 2004 IIRC) They were bitten by a bat and it is speculated that bat-born rabies is less neuro-active than the dog variety.

Only slightly out of date. There've been three now, with one reported just last week (another "bat bites boy" story).

Boy makes rare recovery from rabies

By Raymond Colitt Raymond Colitt

Fri Nov 14, 2:13 pm ET

BRASILIA (Reuters) – A 15-year-old boy in Brazil recovered from a normally deadly rabies infection, becoming one of a handful of survivors of the virus worldwide and the first in the country, the health ministry said on Friday.

The teenager, who was bitten by a blood-sucking bat in the northeastern state of Pernambuco, was found to be clear of the virus after more than a month of hospital treatment using a combination of drugs.

The case is one of only three known in which a person survived a confirmed rabies infection, the ministry said in a statement. There are five other cases of people surviving suspected rabies infections, a ministry spokesman said.

The virus -- transmitted by infected animals such as dogs, cats or bats through their saliva when they bite, scratch or lick humans -- causes inflammation of the brain and usually leads to death if left untreated.

The ministry said it was investigating why the teenager was not given a rabies vaccine immediately after he was bitten.

He was treated with a combination of antiviral drugs, sedatives and injectable anesthetics, a procedure called the Milwaukee protocol after the U.S. city where it was first successfully applied in 2004.

Doctors at the Oswaldo Cruz University Hospital in the state capital Recife plan to publish details of the Brazilian case in an international medical journal. They did not rule out some lasting damage to the boy's motor functions.

Brazil hopes to eradicate rabies transmitted to humans by domesticated animals such as cats and dogs by 2010 through a vaccination campaign for pets.

The number of recorded human rabies cases in Latin America's largest country has fallen from 44 in 2005 to nine in 2006 and just one last year.

(Editing by Stuart Grudgings and John O'Callaghan)