Rabies

The incidence of Rabies in our country is 0.1 per 100,000 population. Annually, 59,000 mortalities are reported from dog- mediated rabies worldwide and the majority of deaths are in Asia. 

Rabies has 100% case fatality rate in 2023 in the Philippines as reported. As of January 2023, there have been 30 rabies survivors. Some have complete recovery, others have mild sequelae like mild dysarthria, ataxia and focal dystonia; those with moderate sequelae showed distal paraparesis ; and those with severe sequelae became mute and had flaccid quadriplegia.

The causative agent is the Rabies virus and transmission is through saliva of a rabid dog or cat after a direct bite or contamination of mucosa or skin lesions. 

Other animals with possible rabies are monkeys and bats.

We have available rabies vaccines and they can be given to an individual :
1. Pre-exposure
2. Post- exposure

The pre- exposure rabies vaccinations are recommended for children 2-10 years old, especially from areas with high incidence of rabies, due to increased risk and severity of animal bites in this age group. 

It is also recommended for high-risk individuals such as veterinarians, staff in a rabies laboratory, animal handlers, healthcare workers directly handling patients with rabies and travelers to areas with high incidence of rabies.

The post-exposure vaccinations are recommended to the following:
– children bitten by rabid dogs, cats, monkeys, bats and rabid humans
– when saliva, cerebrospinal fluid or central nervous system tissue of animals contaminate an open wound or mucous membrane
– there is no minimum age to receive the rabies vaccine

Experts categorize the affected individuals and manage according to what category they belong. The following are the categories:
A. Category I
– touching or feeding an animal
– licking of intact skin
– exposure to patient with signs and symptoms of rabies by sharing of eating or drinking utensils
– casual contact and routine delivery of health care to patients with signs and symptoms of rabies

B. Category II
 – nibbling of uncovered skin with or without bruising / hematoma
– minor/ superficial scratches/ abrasions without bleeding, including those induced to bleed

C. Category III
– transdermal bites or scratches/ abrasions with spontaneous bleeding
– licks on broken skin or mucous membranes
– exposure to a rabies patient through bites, contamination of mucous membranes or open skin lesions with body fluids through splattering or mouth- to – mouth resuscitation
– unprotected handling of infected carcass
– ingestion of raw infected meat
– exposure to bats
– all category II exposures located in the head, face and neck

So, what is the effective first aid measure for dog bites? As in all animal bites, one should wash the bite wound immediately with running clean water for 15 minutes and soap. This is to remove dirt, debris, saliva and as much virus present. 

Only antiseptic solution may be applied on the wound and if there is an active bleeding, direct compression using a clean cloth may be applied. The application of torniquet is discourage as it may compromise the affected limb. Then, the patient should see a physician for antibiotic prescription and for tetanus and rabies vaccination.