How to treat dog bites ( rabies )
Rabies can be proven only by brain biopsy which is not obtainable easily. So, consider the abnormal behaviour of all animals, especially dogs , to be due to rabies until proven otherwise. When in doubt consider immunoprophylaxis.
Point of importance :
Has the animal demonstrated rabid behaviour?
Has it been exposed to other stray or known rabid animal ?
Was it provoked bite ? What were the circumstances leading to the bite ?
Is the animal effectively immunized ? Dogs under 3 months and cats under 6 months are not effectively immunized .
Can the animal be observed for 10 days?
Has the victim received previous antirabies vaccination and if so when, type of vaccine and dosage ?
Rat and monkey bites do not requires rabies prophylaxis, unless the monkey has demonstrated violence or has bitten several people .
Cat and dog scratches are also rabies prone as they may have saliva on their pawns.
Licks on the face of the men who shave on scratches and on mucous membranes need the same treatment as bites.
How to manage the condition ?
First aids - wash the wound thoroughly with soap since it reduces infectivity by breaking up the lipid capsule of the virus
- Administer tetanus toxoid.
- The preferred medication for post exposure prophylaxis is a purified tissue culture rabies vaccine.
- Anti rabies immunoglobulin is advised in class 3 exposure if animal is suspected to be rabies
- If financial constraints exists, give Anti rabies Serum.
Dose and schedule of vaccine
One vial per dose irrespective of age and weight.
Administer as deep intramuscular injection at deltoid region for adults and anterior aspects of the thigh in children.
One injection on days 0,3,7,14 and 30 each (day 0 indicates the day of vaccination commencement and not the day of the bite.)
Day 90 is optional . Recommended in those who are immunocompromized , in extreme age or on corticosteroid therapy.
Pre exposure - prophylaxis ( WHO recommendation)
On day, 0 , 7, 28 follwed by a booster at 1 year and then every 5 years.
Post exposure prophylaxis ( WHO recommendeation)
Refer to anti rabies immunization table.
Immunity lasts for 3 years after full course of post exposure vaccination .
If exposed to rabies again, no immunoglobulin or anti rabies serum is required but 2 booster doses 3 days apart may be given if risk is moderate to severe.
Brain tissue vaccine should never be given repeatedly due to risk of neuroparalytic reaction.
Anti rabies immunisation information.
Class 1 - nature of exposure - contact with no lesions, lick on intact skin,touching or feeding the animal.
Treatment recommendation - None, if reliable case history is available.
Class 2 - nature of exposure - nibbling of uncovered skin, minor scratches or abrasions without bleeding,licks on broken skin.
Treatment recommendation - Administer vaccine immediately. Stop treatment if animal remains healthy for 10 days of contact.
Class 3 - nature of contact - single or multiple transdermal bites or scratches.Contamination of mucous membrane with saliva.
Treatment recommendation - Administer rabies immunoglobulin and vaccine immediately.Stop treatment if animal remains healthy for 10 days after contact.
The decision to give heterologous (equine) anti rabies immunoglobulin 40 IU/kg, max 3000 IU or human anti rabies immunoglobulin (20IU/kg) should be weighted against cost and risk of prophylaxis. Encourage the patient to make this decision.
Administer intradermal skin sensitivity test prior to giving heterologoous immunglobulin.
Inject as much volume of the immunoglobulin as possible around the wounds.The remaining quantity is to be administered by intramuscular injection in the contralateral deltoid region.
Optimum time to administer the immunoglobulin is within the 7 days post exposure. After this, effectiveness is questionable. However , in case of a rabid dog bite on extremities, a course of tissue culture vaccine may be justifiable even after 2 months.
If animal dies within 10 days of observation, full immunoprophylaxis is required.
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