Reality bites
I was on my first year of fellowship training and was the second person on call. The patient was a 5-year-old boy who was brought in because of ascending paralysis. He was in tears and whether it was due to pain, fear from being unable to move his legs, or from being in the emergency room, or a combination of all three, who could blame him?
Our initial working impression was of Guillain-Barré syndrome. This is an autoimmune condition that attacks a person’s peripheral nerves, causing weakness of the muscles or, in extreme cases, paralysis. It may be rapidly progressive, usually occurs weeks after a respiratory or gastrointestinal infection which could be viral or bacterial in nature, is noncontagious, and though more common in adults than children, may affect any age group.
On further history, we were able to gather that he was bitten by a neighbor’s dog a month prior to his admission. Though I have written a previous article on this topic, a repeat performance is warranted. It is both a duty and advocacy.
March is Rabies Awareness month.
At the end of 2022, the epidemiology bureau of the Department of Health reported 370 cases, as compared to the previous year’s 284. Case fatality rate was at 100 percent. This means that amongst the number who were diagnosed, no one survived. This is tragic because rabies is vaccine-preventable. Once symptoms have set in, there is no treatment. Subsequent immunization with the vaccine and administration of immunoglobulin cannot halt the progression of the disease. Knowing that the country is endemic for rabies, one can only wonder just how much is reported or go unrecognized, most especially if manifestations are not typical, or a history of exposure is not elicited or pursued.
As a quick review, how does one contract rabies? The most common mode of transmission is through the bite of an infected animal. Other routes of entry would be from scratches, licking of broken skin, or mucosal exposure such as through the eyes, nose, and mouth with infected saliva or inhalation of the aerosolized virus in enclosed spaces such as bat caves or diagnostic laboratories. In the Philippines, dogs followed by cats are the most commonly implicated sources. Rabies, contrary to common notion, cannot be acquired through bites from rodents such as rats, mice, rabbits, guinea pigs, or hamsters, from birds, reptiles such as snakes, or fish. Bites from horses, pigs, cows, goats, or wild animals like bats and monkeys, on the other hand, require post-exposure rabies prophylaxis.
The time to symptom manifestation or the incubation period on average may be from one to three months but could be shorter or longer and depends on how much of the virus was inoculated into the wound, the severity of exposure (single vs. multiple bites), and location of the bite (shorter if closer to the central nervous system, such as the neck or face). It is noteworthy that inadequate prophylaxis may also be a factor.
What to do? In any case of a bite or scratch, wash thoroughly with soap and water for 10 minutes and apply a disinfectant thereafter. Do not apply any cream or ointment or choose to seek the help of traditional healers. Bring the patient immediately to the nearest health facility or animal bite center for a thorough assessment and further management. There is no contraindication to vaccination. Compliance with the vaccination schedule is key.
For the biting animal, it should be confined to a cage, given appropriate care, and observed for 14 days. If the animal gets sick or dies, inform and consult the municipal or city health veterinarian for the next steps.
Rabies is fatal but preventable. If we are to seek a rabies-free Philippines by 2030, we need to push for stronger political support and implementation of the national prevention and control program. Of the identified strategies, one is to vaccinate at least 70 percent of the total dog population. This is where we can all contribute. In an individual capacity, let us be more proactive. Have your pet vaccinated yearly and practice responsible pet ownership. After all, they are family.
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