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by Dr. Viraj Peramuna

Suppose, you are going to your next-door house, to have a chat about current political events. Unfortunately, all of sudden the dog comes and bites you! Oh! it is a deep bite!!

What you have to do?

First of all, ask the owners to isolate dog for observation for 14 days. Then wash the wound thoroughly with soap and plenty of water. Preferably by a tap for about 5 mins. Then clean it with an Iodine solution. Then seek your Doctor's advice.

What will the Doctor do?

The doctor will admit you to the hospital (for a short period). He will do the following:

* Injection of Anti Rabies Serum (ARS) He will observe you for about 12 hrs for possible reactions.

* Injection of Tetanus vaccine.

* Injection of Anti Rabies Vaccine (ARV).

Two injections will be given (one for each arm).

Next 2 doses will be given on the 7th day and 21st day respectively. Then you will be discharged from the hospital with anti-biotics. Now what you have to do?

You observe the dog for 14 days. If it is healthy even after 14 days, the dog doesn't have the virus, and you may happy!

What are you going to tell to the owner of the dog?

* Tell him to give the rabies vaccine to the dog.

1st dose at the age of 3 months.

2nd dose - 6 months after the 1st dose.

Then annually.

* Ask him to get the dog registered.

* Ask him not to allow the dog to be bitten by other dogs & wild animals.

What are the features of a mad dog (Rabid dog)?

* Change in behaviour (aggressive/irritable)

* Bites without provocation.

* Bite of unusual objects like straws, sticks, mud etc.

* Changed voice of barking.

* Drooling of saliva/froth from mouth.

* Run-away from home & wanders aimlessly biting people/animals.

* Finally the dog dies in about 3 days.

* Remember that, the dog may show no any symptoms - except the sleepiness!

If you suspect the dog is having rabies, then what to do?

You kill the dog. Send the head in an ice-container to the MRI (Medical Research Institute) - Colombo. If the dog is having rabies, its brain cells contain "negri bodies".

If it is confirmed that the dog is having rabies, what to do?

Don't worry! It doesn't mean that you are going to get rabies definitely. You seek your doctor's advice and get completed your course of vaccines. Remember that, the incubation period varies from 4 days to several years (usually 1-2 months). This means that you may get rabies even after couple of years! Also remember that, there is no cure!!

It is almost always fatal!!?

What does the Rabies virus do?

The virus multiply in the wound, travel along the nerves to the brain and spinal cord, and multiply again. Then come down along the nerves to the salivary glands. (virus doesn't come into the blood stream). The virus damages the brain, spinal cord and nerves.

What are the more dangerous factors?

* Facial bite is more dangerous than the leg (close to brain).

* It is more dangerous in children than adults.

* Deep bites are more dangerous than superficial bites.

If you developed Rabies, what are the features?

* It begins with headache, vomiting, fever, sore throat and loss of apitite. The specific symptom is the tingling sensation around the wound. These symptoms may last for 2-4 days.

* Nervousness/Apprehension.

* Intolerance to noise, bright light & cold air. These may initiate violent sporms of the throat muscles.

* Swallowing of water/even saliva precipitates violent muscle sporms in the throat.

Therefore fear to drink water - Hydrophobia.

* Drooling of saliva, lacrimation and excessive sweating.

* Fear of death, irritability & anger.

* Finally, death in 3-5 days.

Then what should the family members do?

Family members who had close contact with the Rabies patient should take ARV. But remember that, Human to human transmission is very very rare! The possible ways of the infection are - saliva, air borne droplets and bite or lick by the patient. Therefore special care should be taken by the nursing staff and the bystanders.

What to do in case of a stray dog bite?

The dog should be killed at once and the head should be sent to the MRI. The victim should take the course of ARV.

What are the modes of infection?

* Bites

* Licks - contamination of saliva on abraded skin.

What are the other sources of Rabies?

Cats, bats and other wild animals.

Who are the high risk people?

Lab workers, veterinary staff, wildlife officers. They should take ARV regularly.

(Primary prevention)

What should the Government do?

* Regular vaccination of dogs

* Registration of all the domestic dogs.

* Elimination of stray dogs.

* Quarantine of imported dogs for 6 months.

* Health education of the public.

We wish, never to find a Rabies patient in Sri Lanka!

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