A BITE that Could be Fatal

Rabies continues to be a major health issue in Bangladesh killing an estimated 2000 people annually. This is a fatal disease but totally preventable by proper vaccination or post-exposure management. Facts states that approximately 1 lakh people receive treatment yearly in the country.
The disease is transmitted from animal to animal or from animal to human. Human infection by rabies virus usually occurs as a result of transdermal bite or scratch from an infected animal. Transmission is also possible when infectious material such as saliva from a rabid animal comes into contact with a victim's mucus membranes (mouth, nose, eyes) or fresh skin lesions.

Animals transmitting Rabies
Domestic: Dogs and cats
Peridomestic (if bitten by a rabid animal): Cows, buffaloes, sheep, goats, and  horses
Wild: Foxes, monkeys, bears
Special situations: Bats, rodents, birds, squirrels
Rabies is a deadly disease that affects the nervous system causing swelling of brain and ultimately death. The incubation period of Rabies virus, ranges from weeks to months, hence you won't, see the symptoms right away, and it may take days for things to show up.

Symptoms includes
Fever, Headache, Nausea, vomiting
Agitation, anxiety, hyperactivity
Hallucination, confusion, insomnia
Hydrophobia (fear of water, as difficulty in swallowing)
Difficulty in swallowing, excessive salivation

What needs to be done?
It is advised to seek immediate medical care if you're bitten or scratched by any animal. Based on your injuries and the situation in which the bite occurred, you and your doctor can decide which category you fall in, and what actions are to be taken. Usually the following protocol is followed-

Where can the drugs be found?
At present, IDA (infectious disease hospital) at mohakhali, provides Anti-Rabies vaccine, but they are NTV (nerve tissue vaccine) which though are cheap but are somewhat reactogenic and are soon to be discarded. It is better to opt for CCV (cell culture vaccine), which is more effective with minimal side effects. These new line of vaccines are available in renowned drug stores and are practiced by physicians.

Is it safe?
Luckily, the new line of anti-rabies vaccines can be administered through both ID (intra-dermal) and IM (intra-muscular) routes, and are usually limited to 4 doses. So, one doesn't need to worry about getting 14 injections around the belly (a myth, commonly believed). The side effects are minimal compared to the previous ones. Plus, it is safe in pregnant and lactating mothers.

When to take the shots?
Post-exposure treatment is 100% effective; hence it is unnecessary to have anti-rabies shots taken before any sort of exposure. Prophylactic regime is recommended for vets, travelers or hikers or any other professional dealing with a lot of animals. General mass can just relax, and wait for the shots, only after getting bitten.

Things to remember-
Keep safe distance from dogs whose mouths are frothing, they are rabid.
Safe distance should be maintained from unknown pets and stray dog.
Get vaccinated for Tetanus
Get your pet vaccinated from Rabies
 

The writer is a project researcher physician of the ICDDR,B