The Biting Truth About Rabies

Years ago, my son was bitten by a neighbor’s cute little poodle. I washed the two red dots on his buttocks with soap and water. We were assured that the little imp of a dog named “Sugar” is free from rabies because it has regular anti-rabies vaccines.

We took our son to the doctor and he was given a toxoid booster shot, and we were told to observe the dog for 14 days. It was scary when the doctor said, “At the slightest change in the dog like loss of energy, loss of appetite, or anything at all, rush your kid back here.” We were relieved when Sugar lived over the 14 days but it left me with a fear of dogs, especially stray dogs.

Recently, my niece was bitten by their own dog. I told my sister that all her daughter needed was a toxoid booster while the dog would be put under observation, but it seemed that everything has changed now. My sister was shocked when she was given an estimate of Php20,000.00 for what’s called the post-exposure prophylaxis. Another hospital she took my niece to for a second opinion, promptly confirmed the amount. The dose would depend on the patient’s body weight, so my sister would have to shell out Php22,000 for a tiny tooth mark on my niece’s leg. The amount does not even include the scheduled rabies vaccine shots. The whole package would cost Php30,000.

What is Rabies?

Rabies is a deadly viral disease of dogs and other animals which can be transferred to humans through their saliva. This viral disease is spread when one rabid animal bites another animal or bites a human.

Rabies is an acute but completely preventable viral infection that affects the central nervous system, including the brain and the spinal cord. During the incubation period (time of exposure to the virus to the appearance of the symptoms), the virus travels along nerves to the brain. This process takes at least 10 days to 30 or 50 days. The viral infection causes inflammation of the brain and spinal cord which can lead to encephalopathy and later, to death. Encephalopathy is a type of disease that changes the brain's structure or function.

What causes Rabies?

The most common cause of rabies is the bite of a rabid animal. The virus is in the saliva of the infected animal and can enter the body through the bite wound. Rabies may also be acquired from a non-bite exposure, such as a rabid animal licking a person’s broken skin, mouth, nose, or eyes.

The high-risk animals are non-domesticated dogs or stray dogs but rabies can also infect, cats, rats, bats, and other warm-blooded animals, whether domestic or wild.

Domestic animals can be infected if bitten by rabid animals, so it is important to get pet dogs and cats vaccinated against rabies.

What are the symptoms and complications of Rabies?

Once the rabies virus enters the body, it goes to the brain along the nerves. Human dog-bite victim may first show signs of rabies infection in 10 to 50 days from the time the virus has entered the body, such as:

  • Fever
  • Headache
  • Depression
  • Loss of appetite
  • Muscle stiffness
  • Nausea and vomiting
  • General feeling of illness
  • Numbness or a tingling sensation at the bitten area
  • Sensitivity to light, sound, and changes in temperature

When the virus starts to multiply in the brain or spinal cord, the neurological symptoms appear, such as:

  • Anxiety
  • Insomnia
  • Confusion
  • Restlessness
  • Difficulty in breathing
  • Paralysis and seizures
  • Excessive production of saliva
  • Hyperactivity, hallucinations, delirium
  • Thirsty but experiences hydrophobia or fear of water
  • Problems with swallowing due to painful throat and voice box spasms
  • Episodes of uncontrollable excitement recurring with periods of calmness

After the appearance of the symptoms, death usually follows within a week, often due to cardiac or respiratory failure.

When a Dog Bites

1. Clean the wound. When bitten or scratched by an animal, immediately wash the wound with soap and running water for at least 10 to 15 minutes. Local antiseptic such as iodine may be applied on the wound.

2. Get medical help. Take the victim to a doctor or to the nearest Animal Bite Treatment Center for post-exposure prophylaxis treatment even if the injury is only some minor scratches without bleeding.

Post exposure prophylaxis (PEP) consists of a single dose of Human Rabies Immunoglobulin (HRIG) followed by a strict schedule of injections of the rabies vaccine. The immunoglobulin immediately provides protection against rabies until the vaccine starts working. The vaccine helps the person's immune system produce antibodies against the potentially deadly virus.

HRIG and the first vaccination are given on Day 0 (day of first vaccination), then three additional vaccinations are given on Day 3, Day 7, and Day 14.

If the victim does not have immunization against tetanus and the wounds are deep, then tetanus serum and toxoid injections must be given. A course of antibiotics may also be needed for deep wounds to prevent secondary bacterial infections.

3. Observe the dog. The dog must be observed for 14 days which starts from the day the person is bitten. A rabid dog usually dies within 14 days but if it stays healthy within the observation period, the immunization can be stopped. But if there is a change in the dog’s behavior or if the dog dies, the animal is considered rabid and the full course of vaccination has to be completed. There will be more injections after Day 14.

If there are multiple severe bites, if the dog responsible is rabid, or if the bite-wound is on the face, neck, back or anywhere near the spinal column, immediate medical intervention is urgent.

Philippines Anti-Rabies Act

At present, the Philippines ranks high worldwide in incidence of rabies infection. Many Filipinos die from rabies every year. The government wants the public to have greater awareness of the rabies virus by creating programs of rabies prevention and control. This program is supported by Republic Act No. 9482, or the Anti-Rabies Act.

RA 9482 states the responsibilities of the local government units and the pet owners. It lays out the responsibilities of the owner of the dog that has bitten a person. It emphasizes that pet owners whose pet has bitten a person or another dog must shoulder the cost of treatment for the injured party.

RA 9482 has tasked the Department of Health to ensure that DOH pre-qualified human anti-rabies vaccines are available and adequate in Animal Bite Treatment Centers at all times.

Under this act, pet owners are mandated to:

  • Have their dogs vaccinated against rabies regularly; maintain a registration card containing all vaccinations given to their dog, for recording purposes.
  • Submit their dogs for mandatory registration.
  • Be sure not to allow their dogs to roam the streets or any public place without a leash.
  • Provide their dogs with proper grooming, adequate food, and clean shelter.
  • Within 24 hours, report any dog biting incident to the concerned officials for investigation, or for appropriate action, and to place the dog under observation by a government or private veterinarian.
  • Assist the dog bite victim immediately, and must pay for the medical treatment and other incidental expenses associated with the victim’s injuries.

What is Human Rabies Immunoglobulin (HRIG) and Equine Rabies Immunoglobulin (ERIG)?

When a person is bitten by a dog, the bite wound must be cleaned with soap and water. Then he needs to be injected with anti-rabies, anti-tetanus, and the Human Rabies Immunoglobulin (HRIG).

Human rabies immunoglobulin (HRIG) is a shot given immediately to dog-bite victims after a likely exposure to rabies. It contains rabies antibodies that quickly inactivate and control the rabies virus until the vaccine starts to work.

At private hospitals, HRIG vaccine costs so much. The entire package including the anti-tetanus and the anti-rabies injections costs several thousands.

This is probably the reason why hundreds die from rabies in the Philippines because most people who cannot afford such expensive vaccines seek other alternative medicines, such as the “Tandok” which accordingly absorbs the rabies virus by placing a deer horn over the wound.

But there is an alternative to the costly HRIG – the ERIG or the Equine Rabies Immunoglobulin Vaccine. This is a much cheaper vaccine which is prepared from horse serum, and most of the currently available preparations are highly purified and quite safe.

A patient has to undergo a necessary skin test before being injected with ERIG. Only when the skin test yields no negative reaction after 30 minutes, can the shot be administered.

Those who have the ERIG vaccine shots may be advised not the eat some types of food which might trigger an allergic reaction, such as seafood, chicken, fish, canned goods, instant noodles, and processed food. When an allergic reaction occurs, an antihistamine may be taken to relieve the allergies, but also upon the orders of the doctor.

A dog-bite victim in the Philippines can run to the Animal Bite Treatment Centers put up by the government all over the country. The patient is not going to be charged several thousands of pesos but there are many cases when the centers run out of anti-rabies vaccines and the victims have to buy their own vaccines, then go back to the center for the staff to administer the doses. It may cost a few thousands but it is still way, way cheaper than going to private hospitals. But when in luck and the center has the stocks, the victim might be able to get the shots for only a few hundred pesos.

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