Rabid about rabies
Of the many infectious diseases that we get a lot of queries about, it would be the risk of getting rabies from animal bites, particularly from dogs and cats. Unfortunately, the number of human rabies cases through the years has steadily been increasing, based on the latest data from the Department of Health, which greatly tips the scales toward the impossibility of reaching the goal of having zero deaths from human rabies by 2030. Perusing travel advisories, the Philippines remains at high risk.
Digging deeper, a prospective study by Sato et al. from October 2019 to September 2022, conducted in the largest referral rabies center in the country, sought to document the reasons behind nonreceipt of post-exposure prophylaxis and identify the animal responsible for human rabies cases to fill the gap from the lack of studies, which were mostly retrospective in nature.
The findings were that dogs were the primary biting animals followed by cats owned either by the patient’s household or a neighbor. From the number of cases wherein they were able to obtain data on the dog’s age, puppies were the ones mostly involved. Most exposures were from transdermal bites, with a few from scratches or licks of an open wound. Among the bites frequently involved were the hands, followed by the lower limbs, the face and neck, and the upper limbs.
Of the reasons behind the nonreceipt of post-exposure prophylaxis, the most common was the misconception that medical consultation was unnecessary as bites were minor in nature and not severe enough to cause rabies. Others cited were: traditional beliefs, financial constraints, lack of awareness of the need for medical treatment, preference for self-medication, failure to get to facilities because of the pandemic and the lockdown, distance from facilities, and sadly, the failure of some children to let their parents or guardians know that they were bitten.
With regard to the patient’s knowledge and practices after animal bite exposure, while there was significant knowledge about rabies, including how it is transmitted and the facilities to go to, quite a number did not seek treatment for reasons as stated above. While patients knew that they had to wash the wound, most did not adhere to what was recommended.
Knowing all this, what is paramount is to stress the importance of prevention as rabies is uniformly fatal. By now, you must have read about real stories of loss and regret. While the 2030 target to eliminate human deaths from dog-mediated rabies may seem impossible, we can always work toward it.
How? In 99 percent of cases, according to the World Health Organization’s website, dogs have been identified as the source of human rabies cases. For starters, make sure your pets are vaccinated. This is part of your responsibility as a pet owner. Aside from providing a home where they are adequately cared for and keeping them parasite-free, their vaccinations need to be initiated and given regularly. While I enjoy seeing a lot of fur babies accompanying their parents to various places, I wonder how many are up to date. You must have heard of free immunization services being given by local government units. If your puppy is ineligible at that particular moment because of age, please invest and make sure that they are seen and attended to by your friendly veterinarian. When outside the home, keep a tight watch as some pets may not be used to being in busy and noisy environments and may react to being touched by people unfamiliar to them.
If you have pets at home, it would also be prudent to have family members receive pre-exposure prophylaxis, especially the children. Existing literature shows that they are at an increased risk for animal bite exposure because of their being small in size and their tendency to engage in provocative behavior, which may send the wrong signal to their pets and may incite acts of aggression.
In the unfortunate incident of a bite or scratch, wash the wound thoroughly with soap and water for 15 minutes and seek immediate consult with a nearby facility for assessment. Subsequent treatment and management are based on how exposures are classified and involve a detailed regimen.
While I may have mentioned the importance of vaccination, may I just clearly state that even if you or your pet has received adequate immunization, this is not reason enough to be complacent. Make that necessary trip to the nearest facility. You still need to be seen for proper assessment.
Rabies is a vaccine-preventable disease and should never be a reason for the loss of precious human lives. Scratching this off our list can be fatal.
Let us all help take serious control of this public health concern.
