Everyone I talked to said I should go see a doctor. I was bitten by a soi dog at 6 pm the day before and woke up the next morning and decided to go visit Dr. Donna, my doctor of choice in Bangkok. It appears those who convinced me to go were wise indeed. Some stats:
The highest incidence of rabies continues to be in Africa and Asia, particularly India. Most deaths from rabies occur in India and Southeast Asia, Africa and Latin America. Thailand has an estimated 10 million stray dogs, with 1 in 10 dogs in Bangkok estimated to be infected with rabies.
What follows is the best article I found on the net.
What should I do if I am bitten by a dog?
https://www.thaitravelclinic.com/blog/travel-medicine-issue/what-should-i-do-if-i-am-bitten-by-a-dog.html
Bitten or scratched by a dog, cat or monkey is a common problem seen in our travel clinic. Most important concern in this scenario is a rabies risk. Since it is a serious and untreatable disease. Once someone develop symptoms of rabies, it will always fatal. So we have to do everything we can to prevent rabies virus when they have been bitten/scratched by a mammal. Here are some useful information and advice
1. Once you exposure to any mammal (dog, cat, monkey, etc), the first step is to clean your wound immediately with antiseptic or just soap and water. This is an important step that could minimize the risk of getting rabies. Do not forget to do this.
2. You can get rabies only when you ‘expose’ to an infected mammal. The keyword ‘expose’ is important and should not be confused. The World Health Organization (WHO) has classified the possible rabies exposure in three categories as followed;
3. You’ll see, in most cases, if you’re bitten you are likely to have a category III exposure which require rabies vaccine and immunoglobulin. Rabies immunoglobulin, in simple word, is just a rabies antibody that could neutralize the virus at the wound. So the concept is, if someone has trans dermal bite (bite that break to the deep layer of the skin); it is possible that rabies virus could find its way to the nervous system. So we immediately need something to neutralize it. We cannot just give a rabies vaccine and wait for the protection since it could take more than a week before a series of vaccine will become effective. And unfortunately, the incubation period of rabies could be as short as 7 days. No one would take that risk.
4. If you has been scratched by an animal, the wound is not deep and there is no bleeding. We could categorize as category II exposure. In this case, you just need a series of rabies vaccine i.e. 5 shots on Day 0,3,7,14,28.
5. However it is not always easy to categorize the exposure in the real life. Someone might get bit; the wound is small but there is some minimal bleeding or bruise. Should we categorize into category II or III. Sometimes it is difficult to say. However, giving that rabies is 100% fatal, so in the grey zone case, most doctors prefer to give ‘over’ treatment to ‘under’ treatment. We also agree, we prefer to err on the side of caution.
6. There is a common scenario that traveler has category III exposure, but rabies immunoglobulin is not available on the first visit. On that case, you still need to get the vaccine and should find the place where you can get the immunoglobulin without delay.
7. If you have already completed rabies pre-exposure series i.e. 3 shots, it is not necessary to receive immunoglobulin. You just need two shots of rabies vaccine on day 0 and day 3 once you exposure to animal.
8. If you’re not sure, whether you should go to see a doctor or not; or whether the scratch is severe or not. DO NOT try to consider it by yourself. You need a qualified medical doctor to assess for you. Visiting a doctor is an urgent issue after possible exposure to rabies virus.
9. In the standard recommendation, we do not use the ‘behavior’ or the ‘looking’ of the dog/cat to consider the necessary of the rabies post-exposure treatment. Since even healthy-looking dog/cat could transmits rabies. So we will consider all exposure to animal is a rabies risk. We could be sure that there is no rabies risk when that dog/cat survive more than 10 days after exposure. However, the rabies post-exposure treatment must begin immediately on the day of exposure.
10. Once you get bitten/scratched, you should seek for medical care as soon as possible. No one knows the safe time-frame that you can delay, i.e. we have always been asked whether it is ok to delay the treatment for 12 hours/24 hours/48 hours, etc. Unfortunately, no one know the answer. Generally speaking you should do it as soon as possible.
After a quick visit with Dr. Donna she suggested her Thai medical partner would best be able to server me as he had lots of experience in dog bites in Thailand.
The Thai doctor asked me quite a few questions which boiled down to the fact the bite was unprovoked and I did not have access to the dog or the dogs owner (if any) to discuss whether or not it had a current rabies vaccination (not likely).
The doctor deemed me an intermediate risk although the above article would classify me as category
The good doctor stated my chances of getting rabies from the bite was 50% so I had to make a choice of going the full monte or just the vaccination. I found the choice quite easy and went with the full monte. However the good doctor never explained what the full monte implied. He did tell me the nurses would handle me. I later figured out he probably did not want to inject me with the 44 needles. OUCH, OUCH, OUCH.
20 injections went around and into each of the two puncture wound for a total or 40 needles. Now, the human body does not have pain nerves everywhere but I figure at least 15 of the injections hit a nerve. This took about 20 minutes. This was the injection of the immunoglobulin.
I then had 2 shots in the shoulder and 2 shots in the ass. Over the next 28 days or so, I get 4 more shots to finish the treatment. Apparently it will be difficult to get rabies in the future as I will only need a booster shot to protect me if I am bitten again.
All this brought back memories of my first bite in Thailand about 6 years ago:
At that time I knew the dog owner and its vaccination history and I avoid rabies treatment.
I am including all this info as a warning to visitors in Thailand to be a little weary of soi dogs.
TTYL
No comments:
Post a Comment