13/05/2018
Animal Bites:
Rabies
रैबिज
The Rabies is one of the disease known from the antiquity and one of the most feared diseases too. There is no cure of the disease and the patient dies a horrible and most painful death. Fortunately, animal bites, if managed appropriately and timely the disease is preventable to a large extent. In this regard the post-exposure treatment of animal bite cases is of prime importance.
Q: Do every animal bite is potential rabid bite and entitled to treatment???
Yes, In rabies endemic country like India, where every animal bite is potentially suspected as a rabid animal bite the treatment should be started immediately.
Type of contact, exposure and recommended post-exposure prophylaxis:
Category 1: Touching or feeding of animal and licks on intact skin'
Rx: None, but if it can be proven beyond doubts that skin was intact and animal healthy.
Category II: Nibbling of uncovered skin, Minor scratches or abrasions without Bleeding.
Rx: 1. Wound Management
2. Antirabies-vaccine
category III: Transdermal bites or scratches, licks on broken skin, contamination of mucous membranes with animal saliva
Rx:-1. Wound management
2. Rabies immuniglobulin
3. Anti-rabies vaccine.
Note: it is noteworthy that now, the WHO has also revised the categories and anybite (I stress any) is included in cat III (previously cat III included bites on hands and face)
Q: my animal is vaccinated, should i go for treatment.??
yes, even if animal is vaccinated, Rx is must because vaccination failure do occur.
Q: It was a proved bite, should i go for vaccination???
Ans: again yes. The treatment should be started immediately after the bite. The treatment may be modified if animal involved (dog or cat) remains healthy throughout the observation period of 10 days by converting post-exposure prophylaxis to pre-exposure vaccination by skipping the vaccine dose on day 14 and administering it on day 28. The observation period is valid for dogs and cats only and not for other animals.
Bite by wild animals: Bite by all wild animals should be treated as category III exposure.
Q: I am pregnant, should i go for it???
Ans: Yes, you must, Pregnancy, lactation, infancy, old age and concurrent illness are no contraindications for rabies prophylaxis. it takes preference over any other consideration being a life saving procedure. Rabies vaccine does not have any adverse effect on fetus, mother-to-be and the course of pregnancy.
Management of Animal Bite:
1. Management of wound: Clean with water, soap or detergent and clean thoroughly at least for 10 minutes under running water. thereafter any available antseptic viz betadine, soframycin, dettol etc.
Note: victim should not be deprived of the benefit of wound toilet as long as there is an unhealed wound which can be washed even if the patient reports days late.
2. Local infiltration of rabies immunoglobulin: in all bites it should be infilterated in depth and in and around the wound to inactivate locally present viruses.
it is of 2 types : 1) Horse serum derived (EQUIRAB) dose is 40units/kg, (moximun 3000units) given after sensitivity check and may cause allergic response, although these days it is very purified and there is very low chance of same but caution is warrented.
2) human derived:- very safe but very costly, dose is 20units/kg.(maximum 1500units)
it is injected in and around the wound, and remaining can be injected intramuscularly on a separate site than the vaccine.
If by chance the immunoglobulin is not available, greater emphasis on wound toileting and vaccine alone should be started, on first day two doses of vaccine are given one each on each shoulder and immunoglobulin must be injected as soon as it can be made possible (upto 7 days , after 7 days vaccination itself produce antibodies).
3. Vaccines: schedule is 0, 3, 7, 14 and 28 , another vaccine at 90 days should also be given. it must be injected on deltoid(shouders) and must not be on hips. in infants it can be injected on anterolateral aspect of thigh.
Q. What about the intradermal vaccines???
Ans: it is found that intra dermal vaccines produce quick response and amount of vaccine injected is less. but the technique is difficult and vaccine is to be injected on multiple sites. (if someone require further detail please contact).
Q: How to identify a patient with Rabies???
Ans: Rabid patient is restless, apprehensive, frightens with voice, light, sudden gust of wind (aerophobia), noise and sight of water (hydrophobia). He is thirsty but cannot drink. In late stages the neck extends and curves and patient body is tightened and in spasm.
Q: What is pre-exposure prophylaxis???
Ans: Given to high risk persons like veterinary doctors, dog and cat breeders etc. here 3doses of vaccines are given before the bite on 0, 7, 21/28 and booster when antibodies titre falls beow 0.5 units/ml. These people if bitten need only 2 doses on 0 and 3 and no anti rabies serum on immunoglobulin :)
So, Now, next time you encounter someone who has been bitten dont get confused what to do, just proceed with 1,2,3 and you are done. Please offer Immunoglobulin + vaccination to everyone however minor the wound is (virus donot need big wounds to enter), domestic or wild animal and immunised or unimmunised,,,, because rabies once occurred cannot be cured...
Stay happy, stay cool and stay Healthy......
