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Giving rabies a shot


DHANVANTARI by BUDDHA BASNYAT, MD


Human rabies is a fatal illness. Unfortunately, about 75 per cent of human rabies cases in the world (about 55,000 annually) is found in South Asia. Rabies is caused by a virus and transmitted in the saliva by the bite of rabid animals. In the US bats are often implicated for transmitting the deadly infection. In Nepal the most commonly infected animals that transmit rabies to humans are dogs followed by cats. What about rabies from monkeys?

Many people in Swayambhunath and Pashupatinath are bitten or scratched by monkeys on a daily basis. As mammals, monkeys should be able to easily transmit rabies, but probably because they are too clever to be bitten by dogs, there is almost no documentation of rabies being caused by monkey bites. But clearly no one wants to be the first on this list. So the precautions prescribed below may be useful.

Children are particularly vulnerable to rabies because they may not tell their parents after they have been bitten or nicked by a rabid dog. This may turn out to be fatal because after a usual incubation period of about a week to two months, the child may come down with rabies. Rabies is under-diagnosed because of poor documentation and lack of proper diagnosis in our part of the world. Furthermore, the complete manifestation of rabies with hydrophobia (fear of water) and terror- stricken behaviour that are depicted in movies may be absent.

So what can be done? Taking care of stray dogs would be a great idea, but this requires tremendous political will. The second best thing in Nepal is to be properly vaccinated with human rabies vaccines which are available especially around Teku Hospital area in Kathmandu. In case of a bite, regardless of prior (pre-exposure) vaccination, the wound needs to be properly cleaned daily with liquid iodine or soap and water as the virus hangs around the site of bite for a long time. A 'top off' shot or two to boost the immunity will be required even if prior vaccinations have been taken.

If prior vaccinations have not been taken and especially if the bite is severe, then immunoglobulin (a kind of 'pre-emptive response' medicine, different from the vaccine) needs to be administered. Although immunoglobulin is available around Teku, supply is erratic and expensive. Hence 'pre exposure' vaccination is best. Luckily after a bite by a potentially rabid animal, the Nepali government does usually administer rabies vaccination for free at Teku Hospital.



LATEST ISSUE
638
(11 JAN 2013 - 17 JAN 2013)


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