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Posted

My 2 year old daughter was bitten by a puppy belonging to a neighbor and the next day the puppy and my daughter were very sick with a very high fever. My wife took my daughter to the Bangkok Hospital in Phuket and the doctor gave my daughter a rabies vaccine and is asking her to come back 5 times over the next several weeks to get several more vaccinations. I was shocked to find out that this vaccine was given right away without checking with the owner of the puppies and find out what was wrong with the puppies. I read on line that Phuket was free of rabies so I don't understand why the doctor at Phuket Hospital gave the rabies vaccine to my 2 year old daughter without any investigation. My wife has since found out that the puppies were all vaccinated against rabies. I feel that that the Bangkok Hospital has been severely negligent for giving this vaccine without any test or waiting the 10 recommended by the Thai public health department to see if the animal was rabid before giving the vaccine. If anyone out there has any advice of how to deal with Bangkok Hospital Phuket about this. They want my daughter back in the hospital for the second injection on Wednesday, June 14th. I am in the states now on my job and will not return to Thailand before November and I want to advise my wife what to do about this terrible mal practice!

Posted

Rabies is prevalent in all of Thailand.

The vaccine needs to be given within 24h after exposure to be effective, there is no time to wait for further investigations.

The series of injections may be stopped later if there is sufficient proof that the dog was not rabid.

In my opinion, the hospital followed proper protocol according to international standards. Rabies is 100% fatal and to err on the side of caution, especially given the severe time restrictions there is with the start of the vaccination, is appropriate.

Posted
Rabies is prevalent in all of Thailand.

The vaccine needs to be given within 24h after exposure to be effective, there is no time to wait for further investigations.

The series of injections may be stopped later if there is sufficient proof that the dog was not rabid.

In my opinion, the hospital followed proper protocol according to international standards. Rabies is 100% fatal and to err on the side of caution, especially given the severe time restrictions there is with the start of the vaccination, is appropriate.

The puppy that scratched my 2 year old daughter infected the other puppy at that house and the other puppy died yesterday. The owner buried the puppy in his garden. The puppy that died had been vaccinated for rabies. I would like to have the dead puppy dug up and checked for rabies but I am in Florida now and my wife is back in the hospital with 2 year old now admitted until the cause of the high fever is determined. They have taken blood I suppose to check for swine flu. It seems that Phuket has been under reporting the swine flu cases. My wife called the two phone numbers to get someone from the Phuket health department to check about the animal deaths but they don't appear to interested. We have had many cats die and now dogs in our neighborhood in the last two weeks and now my daughter has a high fever. I just wish I could get someone to dig up that dead puppy just to eliminate rabies so that my daughter will not have to continue these vaccination and maybe they will find the cause of all these mysterious animal deaths. They all seem to come with high fever and lung problems followed by death.

Posted

The animal deaths are very concerning and perhaps someone with any vet experience will post here as well; usually, the rabies test on fresh or nearly fresh brain tissue and, if an animal had been buried, the brain tissue degenerates very fast beyond the point where a reliable diagnosis can be made.

The fact that the puppies had been vaccinated is not necessarily a 100% guarantee that they are immune.

The vaccinations are quite an ordeal for such a young child but, given the grave consequences of a possible exposure holds, I would not advise to stop.

All the best!

Posted
The animal deaths are very concerning and perhaps someone with any vet experience will post here as well; usually, the rabies test on fresh or nearly fresh brain tissue and, if an animal had been buried, the brain tissue degenerates very fast beyond the point where a reliable diagnosis can be made.

The fact that the puppies had been vaccinated is not necessarily a 100% guarantee that they are immune.

The vaccinations are quite an ordeal for such a young child but, given the grave consequences of a possible exposure holds, I would not advise to stop.

All the best!

The puppy that bit my daughter is still alive but barely. I will tell the dog owner that he has no reason to dig up the dead puppy from your advice which has been confirmed by the vet hospital in Florida. I did find out the procedure though for the state of Florida. There is a lab in the state and when the vet has a an animal that is freshly dead that she suspects of having died from rabies, she removes the head of the dog and refrigerates the head and drops the head off in a government office near Miami. The head will then be transported by the state to a lab in central Florida where the brain tissue will be examined. The vet will then get a report back from the lab in a few days and rabies can be eliminated in this case and the painful injections can be stopped for my daughter.

I just want to know if such a lab exists in Thailand maybe in Bangkok and if so how to to get the head of this sick puppy to the lab to do this test for rabies. That is if this puppy dies which is very likely. It is very hard for me to get information about this from Thailand when I am in Florida. My daughter is still in the hospital in Phuket and is now being tested for H1N1 and may get quarantined if the doctor feels that she may have that virus. If you know of any sources to get more information about rabies testing, please let me know right away. The man who is helping me in Phuket is going to pick up the dead puppy if it is too late to stop this and the live one to take them to a vet in Phuket in a few hours from now.

Posted

Take the live one to the vet in Phuket.

There are labs in Thailand that can do the brain analysis and the local vet should have all the detail.

Apologies for the late reply but I am in a different time zone from Thailand since yesterday.

Posted

Why bother to wait for the live one to die? Offer the neighbor 500 baht for the sick puppy. They'll probably take the money gladly and it can be destroyed by the vet and the brain sent for testing immediately.

Posted

My sister in law is a (very good/ high quality) nurse at a hospital in Phuket (speaks pretty good english); I will find out tonight if it's the same hospital..if it is I will get my wife to tell her about this..she is friends with the head nurse there as well.. I have been in that hospital several times and if it is the same one.. it is a good one..so please try not to worry too much..God bless your family,Dean

Posted
Rabies is prevalent in all of Thailand.

The vaccine needs to be given within 24h after exposure to be effective, there is no time to wait for further investigations.

The series of injections may be stopped later if there is sufficient proof that the dog was not rabid.

In my opinion, the hospital followed proper protocol according to international standards. Rabies is 100% fatal and to err on the side of caution, especially given the severe time restrictions there is with the start of the vaccination, is appropriate.

You do not know what your talking about.rabies take at least 10 to incubate and the vaccine is effective up intill the time symptoms apears,then it's to late :) and the girl should not have been treated, the dog had it's shots.

Posted
Rabies is prevalent in all of Thailand.

The vaccine needs to be given within 24h after exposure to be effective, there is no time to wait for further investigations.

The series of injections may be stopped later if there is sufficient proof that the dog was not rabid.

In my opinion, the hospital followed proper protocol according to international standards. Rabies is 100% fatal and to err on the side of caution, especially given the severe time restrictions there is with the start of the vaccination, is appropriate.

The puppy that scratched my 2 year old daughter infected the other puppy at that house and the other puppy died yesterday. The owner buried the puppy in his garden. The puppy that died had been vaccinated for rabies. I would like to have the dead puppy dug up and checked for rabies but I am in Florida now and my wife is back in the hospital with 2 year old now admitted until the cause of the high fever is determined. They have taken blood I suppose to check for swine flu. It seems that Phuket has been under reporting the swine flu cases. My wife called the two phone numbers to get someone from the Phuket health department to check about the animal deaths but they don't appear to interested. We have had many cats die and now dogs in our neighborhood in the last two weeks and now my daughter has a high fever. I just wish I could get someone to dig up that dead puppy just to eliminate rabies so that my daughter will not have to continue these vaccination and maybe they will find the cause of all these mysterious animal deaths. They all seem to come with high fever and lung problems followed by death.

probably leptospyrosis :)

Posted

Actually a vaccination is not %100 percent effective. So, if it were you had been bit and you wished to take the chance that the puppies vaccinations were effective, then hey go for it. But to advise someone else to do the same based on flawed information?

Posted
My sister in law is a (very good/ high quality) nurse at a hospital in Phuket (speaks pretty good english); I will find out tonight if it's the same hospital..if it is I will get my wife to tell her about this..she is friends with the head nurse there as well.. I have been in that hospital several times and if it is the same one.. it is a good one..so please try not to worry too much..God bless your family,Dean

I really appreciate your concern. My wife is now home with the baby who still has a high fever. I tried to explain to her how important it is to get this puppy to the vet to have it checked. But she is so upset about the baby that she can't leave the house to deal with the neighbor. The neighbor is German and he dug up the dead puppy on Monday but since I am in Florida and my wife was in the hospital no one came to pick up the dead puppy. I tried to stop this by sending him an SMS during the night once I found out that once the puppy was buried for that long, it was too late to test for Rabies. Now I can't reach that German guy on the phone and I can't reach my wife either. I did reach her earlier this morning Thai time but she just didn't understand the importance to getting that puppy to the vet right away. The second vaccine is due on Wednesday and unless I can get that puppy to the vet somehow, I don't see how we can stop these rabies vaccines. I tried to call the Phuket public health but the lady that answered the phone spoke only Thai and I cannot speak Thai.

If you know someone in Phuket who can help, please let me know who it is and how to contact her.

Posted
Why bother to wait for the live one to die? Offer the neighbor 500 baht for the sick puppy. They'll probably take the money gladly and it can be destroyed by the vet and the brain sent for testing immediately.

I thought of that. I offered to pay all the vet bills to check this puppy. The owner is German and one of his puppies died already. He dug up the dead puppy already for me. I can't seem to get through to him by phone for some reason from the states. So I don't know what is going on. I would gladly pay what ever he wanted for this puppy to make sure that it was not rabies and my daughter could stop the vaccines. From what I heard it was kennel cough or pneumonia that killed his other puppy. But it needs to be verified by the vet before I can stop the vaccines.

Posted
Take the live one to the vet in Phuket.

There are labs in Thailand that can do the brain analysis and the local vet should have all the detail.

Apologies for the late reply but I am in a different time zone from Thailand since yesterday.

We found out that the puppy that is still alive did not get vaccinated because it was too young. It seems that the puppies both had kennel cough and the one that dies is suspected to have died of pneumonia, perhaps from the kennel cough. I can' t seem to reach the German guy who owns this puppy and I am trying to get my wife to go to the guys house and ask him to take the sick puppy to the vet and find out what is wrong. But my Thai wife doesn't want problems with the German neighbor who already dug up the dead puppy for me and no one came to pick it up. For some reason I cannot get through to the German neighbor by phone from Florida and I can't reach my wife either who is now home from the hospital. I am getting very worried. The 2nd vaccine is scheduled for tomorrow and my daughter is only 2 years old and has a high fever. So I don't really know what to do.

Posted

thaisail,

The rabies vaccine can sometimes cause a slight fever but it is more likely that there is another condition underlying or developing. The best I can suggest is to have a good pediatrician examine her and treat accordingly.

The worst of the rabies post-exposure protocol is the immune globuline that is given with the first dose. The second and subsequent injections are just the vaccine and much less traumatic than the first episode.

Just hang in there...

Posted
Rabies is prevalent in all of Thailand.

There were only 3 deaths in Thailand last year, not really prevalent.

The Queen Saovabha Memorial Institute, Thai Red Cross and WHO Collaborating Centre for Research in Rabies, Bangkok.

The prevalence of canine and human rabies in Thailand has decreased significantly during the last decade. This has been associated with an increasing number of human post-exposure treatments. Educational efforts, mass vaccination of dogs and cats and the use of safe and effective vaccines have all made an impact. The proportion of fluorescent antibody positive dogs, among those examined for rabies averaged 54% indicating that rabies is still a major public health threat. Canine rabies vaccination is not usually performed in animals < 3 months old. However, this study revealed that 14% of rabid dogs were < 3 months old and 42% were < or = 6 months old. This is the age group most likely to interact with humans and other dogs. Our study also supports the World Health Organization's recommendation that observing suspected rabid dogs for 10 days is an adequate and safe practice.

Posted
thaisail,

The rabies vaccine can sometimes cause a slight fever but it is more likely that there is another condition underlying or developing. The best I can suggest is to have a good pediatrician examine her and treat accordingly.

The worst of the rabies post-exposure protocol is the immune globuline that is given with the first dose. The second and subsequent injections are just the vaccine and much less traumatic than the first episode.

Just hang in there...

40 degrees is not a slight fever. That comment someone made about only 3 deaths in Thailand on this thread is incredible! That is 3 HUMAN death he is talking about. The real question here is how many dogs gets rabies each year?

Posted

40 degrees is not a slight fever. That comment someone made about only 3 deaths in Thailand on this thread is incredible! That is 3 HUMAN death he is talking about. The real question here is how many dogs gets rabies each year?

Indeed; far higher than expected with vaccination but with a 2 yo a 40 deg temp happens quickly. Especially if she is a bit dehydrated.

Any underlying or developing illness must be diagnosed and managed if possible.

As my quote above indicates (refer to the highlighted section) 54% of dogs tested had a positive Rabies saliva test, in other words could transmit the disease. In previous series, and in some northern areas figures are as high as 74%.

These studies are all done by the Thai Red Cross and WHO resources.

There has been very extensive rabies control measures and awareness campaigns run in Thailand and animal vaccination rates have gone way up which accounts for the lower rate in later studies.

In your case, the puppy need not be killed but a saliva test and a blood PCR can be done while the animal is still alive. Under the Thai regulatory approach, the sick animal would be kept for 10 days as well as indicated in the last sentence of my quote.

The above info is definitely not intended to be alarmist and surely not intended to cause you more distress but posts like the one you have referred to needs to be addressed.

It is stressful but so far, the proper protocols have been followed and you have done all you possibly could. It will all be better soon, I am sure!!

Posted
40 degrees is not a slight fever. That comment someone made about only 3 deaths in Thailand on this thread is incredible! That is 3 HUMAN death he is talking about. The real question here is how many dogs gets rabies each year?

I found out that a saliva sample has been taken from the puppy and sent to Bangkok. This information just arrived by SMS from a friend in Phuket who must have called my wife. It conflicts with this email that just arrived at the same time. Must be a problem with translation.

Paywan went to the pet doctor with the puppy.

The doctor will require a test. It will take 5 days before it arrives

here. The test itself only takes five minutes.

If it should happen that the dog dies duringtheese five days, it's

still possible to take the test from the dead dog.

Anyway the doctor recognized no signs of rabies.

All the same Paywan ordered the test since you had asked for it. When

it comes, Jasmine already has got the next two vaccinations if you

continue the vaccination program though.

That means she has almost ended the program before you have got the

answer from the test.

But in order not to take any risk, it seams to be the only way.

Posted

It is most probably the saliva and/or blood test but it seems that it can only be done in BKK, hence the time delay.

Good that the vet did not think that it clinically is rabies but that alone is not sufficient evidence to stop the vaccinations, unfortunately..

Posted
It is most probably the saliva and/or blood test but it seems that it can only be done in BKK, hence the time delay.

Good that the vet did not think that it clinically is rabies but that alone is not sufficient evidence to stop the vaccinations, unfortunately..

More confusion now. It seems that the Vet in Phuket has ordered a test kit that will be sent from Thailand in order that the rabies test can be done in Phuket. I can't get the real story because I can't seem to get a good phone connection from the US to Thailand right now so all is being sent through the internet and the phone cable at my home is broken right now so I am only able to get information through friends and neighbors that are on line. For some reason they can call my wife's cell phone but I cannot from the US direct.

Posted

The rabies test on the animal is at this point in time of less importance. We have past the point of no return with the vaccination schedule. It would be good to have the test result of the animal for future reference but irrespective of wether the test is sent to BKK or the test kit sent to Phuket, there will be the same time delay.

Most important now is to get a proper diagnosis on the fever and focus on getting that sorted. The vaccination will have to continue as, after just one or two vaccinations, she will not develop protective levels of antibodies.

The HRIG (Human Rabies Immune Globuline) that was given with the first dose, is just passive antibodies (this is not a vaccine) to neutralise any virus that entered the wound. The vaccination will stimulate her own antibodies and that will require further doses as the HRIG will also depress any formation of antibodies while still active. HRIG will last a few days to a week or so and then the vaccine will stimulate her immune system to develop its own.

Posted
The rabies test on the animal is at this point in time of less importance. We have past the point of no return with the vaccination schedule. It would be good to have the test result of the animal for future reference but irrespective of wether the test is sent to BKK or the test kit sent to Phuket, there will be the same time delay.

Most important now is to get a proper diagnosis on the fever and focus on getting that sorted. The vaccination will have to continue as, after just one or two vaccinations, she will not develop protective levels of antibodies.

The HRIG (Human Rabies Immune Globuline) that was given with the first dose, is just passive antibodies (this is not a vaccine) to neutralise any virus that entered the wound. The vaccination will stimulate her own antibodies and that will require further doses as the HRIG will also depress any formation of antibodies while still active. HRIG will last a few days to a week or so and then the vaccine will stimulate her immune system to develop its own.

I am in contact with our union doctor who is advising me to stop the vaccine based on his extensive experience in Colombia. He feels that that there is no risk that this puppy has rabies at this time based on the Vet's diagnosis and his experience in the field. The pediatrician at Bangkok Hospital is agreeing that now that this animal has been examined by a qualified vet that he also sees no need to continue with this vaccination program. The test kit has been ordered from Bangkok which will take 5 days to arrive in Phuket and then we will have a definitive result. The doctor at our union has asked about the immunological test that can be done in less than 24 hours. He doesn't understand why this test is not available in Phuket. Also this test is 24 hours anywhere in the US. Why 5 days in Thailand that has such a large problem with rabies? I have sent the link to this thread to our union doctor to see if he would like to add his opinion to this thread.

Posted
The rabies test on the animal is at this point in time of less importance. We have past the point of no return with the vaccination schedule. It would be good to have the test result of the animal for future reference but irrespective of wether the test is sent to BKK or the test kit sent to Phuket, there will be the same time delay.

Most important now is to get a proper diagnosis on the fever and focus on getting that sorted. The vaccination will have to continue as, after just one or two vaccinations, she will not develop protective levels of antibodies.

The HRIG (Human Rabies Immune Globuline) that was given with the first dose, is just passive antibodies (this is not a vaccine) to neutralise any virus that entered the wound. The vaccination will stimulate her own antibodies and that will require further doses as the HRIG will also depress any formation of antibodies while still active. HRIG will last a few days to a week or so and then the vaccine will stimulate her immune system to develop its own.

The baby is on her way to the hospital for the 2nd vaccination now. The doctor will call me from Bangkok Hospital Phuket and ask me my decision. Our union doctor says to stop the injection but then again the union is paying for the vaccines which are not cheap at Bangkok Hospital. My wife finally contacted the Phuket health department who told her that 48 hours later, they would give the rabies result if she brought them the head of the puppy but no one has the heart to kill this puppy so I guess we will wait for the test kit to arrive from Bangkok to get the result is. In the mean time the vaccine will continue. Thanks for all the help and information that you have sent my way. I just hope that this vaccine is from a good batch. It is too bad the dogs owner didn't bring the dead puppy to the health department when it died which would have saved us so much grief. The dog's owner feels real bad and has agreed to pay the 5000 baht for the test kit for his dog.

Posted

Thanks for the update.

Please keep us updated with the progress.

The most value in these forums is from experiences of people like you that have gone through an ordeal such as this.

Best!

Posted
Rabies is prevalent in all of Thailand.

There were only 3 deaths in Thailand last year, not really prevalent.

Only 3 deaths does not mean its not here, if bitten most doctors give you the shots... Rabies has almost a 100% death rate if you don't get the shots.... You can't tell me with all the stray dogs running around its not prevalent... Just most people get shots when bitten, they are free for the poor.

So far their has only been one case of a person getting rabies with out having the shot and living... one case, in the US and they stopped her from dying by putting her in a chemical comma for around a week, effectivly shutting down the brain while her anti-bodies built up and faught off the rabies, after words she had to learn to walk, talk, and everything again like a baby... Now she talks funny and walks funny... I would gladdly take the shots...

Posted
thaisail,

The rabies vaccine can sometimes cause a slight fever but it is more likely that there is another condition underlying or developing. The best I can suggest is to have a good pediatrician examine her and treat accordingly.

The worst of the rabies post-exposure protocol is the immune globuline that is given with the first dose. The second and subsequent injections are just the vaccine and much less traumatic than the first episode.

Just hang in there...

"Just hang in there" is actually good advice in this situation. I'm not clear what is the problem with having the rabies vaccine. It is no longer injected into the abdomen, as it was in the past, so it's just a shot and will protect against rabies in the future. I will probably opt to have the vaccine in the future since I love wandering around small villages and love to visit caves. When I suggested having the vaccine series at Bumrungrad, however, my doctor said he has never been personally aware of a case of rabies in his entire career, although he admits there are rare cases in Thailand.

Posted

Actually, a little girl died on Koh Phangan a few years ago from rabies, she was bit by a rabid dog, in the face, and did not get treatment in time for it.

Posted
thaisail,

The rabies vaccine can sometimes cause a slight fever but it is more likely that there is another condition underlying or developing. The best I can suggest is to have a good pediatrician examine her and treat accordingly.

The worst of the rabies post-exposure protocol is the immune globuline that is given with the first dose. The second and subsequent injections are just the vaccine and much less traumatic than the first episode.

Just hang in there...

40 degrees is not a slight fever. That comment someone made about only 3 deaths in Thailand on this thread is incredible! That is 3 HUMAN death he is talking about. The real question here is how many dogs gets rabies each year?

buddy take a pill and relax........do you have any idea how many people are killed on the road here???? :)

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