Online Reporter
Dr Tendai Zuze
Health Matters
RABIES is one of those diseases that sounds like something from another era, yet it remains very much with us here in Zimbabwe and across Africa.
The good news is that rabies is preventable. The important part is knowing what to do after an exposure and acting quickly.
Dogs are responsible for the vast majority of human rabies cases worldwide, and children are particularly vulnerable. They are more likely to approach, play with or be bitten by dogs, sometimes without appreciating the danger. Bites involving the face, head and neck can be particularly concerning because of the shorter distance to the brain.
One of the biggest misconceptions about rabies is that only a visibly mad dog can transmit it. Unfortunately, it is not that simple. An infected dog may not initially look obviously sick. Changes in behaviour, unexplained aggression, excessive salivation, difficulty swallowing, unusual restlessness or paralysis can occur, but you cannot reliably determine the rabies risk simply by looking at the animal.
Another common misconception is that a bite from a dog you know is automatically safe. Knowing the dog is useful information, especially if its vaccination history is known and the animal can be appropriately observed, but it does not mean the bite should simply be ignored.
The circumstances of the bite, the dog’s vaccination status and health, and the nature of the wound all need to be considered.
The size of the wound does not tell the whole story either. A tiny puncture or scratch can still be significant if saliva from an infected animal has entered broken skin. A bite does not have to be deep or bleeding heavily before it deserves proper attention.
The first thing to do after a bite is actually very simple; wash the wound immediately and thoroughly. Use soap and plenty of running water and flush the area for at least 15 minutes.
Do not wait until you get home and do not simply wipe the wound with a cloth. Good wound washing is one of the most important first steps after a possible rabies exposure.
It is also important to resist some of the traditional remedies that people may recommend after an animal bite. Chilli, soil, herbs, acids, chemicals or other substances should not be put into the wound. They do not prevent rabies and may cause further damage to already injured tissue.
After washing the wound, seek medical attention as soon as possible. The health professional will assess the exposure, clean and manage the wound, check whether tetanus protection is required and consider whether antibiotics are appropriate. Most importantly, the rabies risk will be assessed and, where indicated, post-exposure treatment will be started.
Rabies post exposure prophylaxis can include rabies vaccine and, for certain higher risk exposures, rabies immunoglobulin. These treatments are highly effective when given appropriately and promptly. In Zimbabwe, post exposure vaccination involves four injections given over three weeks.
There is sometimes a temptation to wait and see what happens to the dog before seeking treatment. This is not advisable. If the dog is available, veterinary or public health authorities may be able to arrange appropriate observation of the animal. However, the person who has been bitten should not delay medical assessment while waiting to see whether the dog becomes sick.
It is also worth remembering that antibiotics and rabies treatment are two different things. Antibiotics may be necessary because dog bites can introduce bacteria into the wound, but antibiotics do not prevent rabies.
Prevention starts before the bite happens. Children should be taught not to approach unfamiliar or stray dogs and should be supervised when playing with animals. Dogs should not be disturbed while eating, sleeping or caring for puppies. Even a familiar and friendly dog should be treated with some respect, because animals can behave unpredictably when frightened, injured or threatened.
For us in Zimbabwe, responsible dog ownership is an important part of rabies prevention. Vaccinating dogs against rabies protects not only the individual animal but the whole community. Keeping dogs properly vaccinated and reporting stray or suspicious animals to the appropriate authorities can make a real difference.
Perhaps the most important message is that a dog bite does not mean that someone has rabies, so there is no need to panic. At the same time, it is not something to simply brush off. Wash the wound. Don’t put harmful substances into it. Seek medical attention promptly.
Rabies is almost always fatal once clinical symptoms develop, but deaths can be prevented when appropriate post-exposure treatment is given before symptoms appear.
For more on rabies, contact [email protected]
