PAKISTAN ranks fifth among the countries in the world most affected by rabies, with between 2,000 and 5,000 deaths reported every year. Various hospitals in the country have reported 25-30 cases of dog bites per day. Rabies is a viral infection, caused by a virus secreted in the canine saliva. It affects a dog’s nervous system, including the spinal cord and brain, and is fatal once symptoms present themselves.

The first symptoms of rabies may be similar to flu, including weakness or discomfort, fever and headache. There also may be discomfort, prickling, or an itching sensation at the site of the bite. These symptoms may last for several days. Symptoms then progress to cerebral dysfunction, anxiety, confusion and agitation. The first symptoms of rabies can appear from a few days to more than a year after the bite happens.

Because of the risk of infection, one should see a healthcare provider within 24 hours of any bite that breaks the skin. If you are caring for someone who was bitten, be calm and reassure the person. Wash the bite area with soap and water. If the bite is bleeding, put pressure on it using sterile gauze or a clean cloth. If the bleeding has stopped, put antibiotic ointment on the area. Cover the area with a bandage or sterile gauze.

If one is bitten by a cat, or dog, that appeared healthy at the time one was bitten, it can be confined by its owner for 10 days and observed. No anti-rabies prophylaxis is needed. It is always suggested, however, that a visit to some healthcare provider is essential.

The standard schedule for vaccination is five doses on days 0, 3, 7, 14 and 30, with day 0 being the day of the commencement of vaccination. A regimen of five 1ml doses of rabies vaccine should be administered to previously unvaccinated persons intramuscularly at upper arm since the buttocks have lots of fat which may interfere with the absorption of vaccine. Adult victims should receive a tetanus vaccine, called the tetanus toxoid vaccine, if the most recent tetanus vaccine was more than five years previously.

Most government hospitals do not have proper facilities to handle dog bite cases like a dedicated washing space, trained doctors and the vaccines to take care of such patients. Even private hospitals or clinics are not equipped to handle such an emergency. Unfortunately, parents also do not realise the importance of dog bite, and the municipality does not immunise dogs. The dice, thus, is loaded among the masses.

Dr Asghar Naqvi
Karachi

Published in Dawn, May 14th, 2023