How To Treat a Dog Bite
Key Facts
Rabies is a vaccine-preventable viral disease that appears in more than 150 countries and territories.
Dogs mainly cause deaths from human rabies and contribute to up to 99% of all rabies infections transmitted to humans.
Rabies can be eliminated by vaccinating dogs and preventing their bites.
Each year, infection kills tens of thousands of people, mostly in Asia and Africa.
Children under the age of 15 represent 40% of people exposed to the bite of animals suspected of being infected with rabies.
Prompt and thorough cleaning of wounds with soap and water following contact with animals suspected of having rabies is critical and can save lives.
The World Health Organization, the World Organization for Animal Health, the Food and Agriculture Organization of the United Nations and the Global Alliance to Control Rabies have set a global goal of "achieving zero deaths from human rabies by 2030".
Rabies is a contagious viral disease that almost always causes death following the onset of clinical symptoms. And the rabies virus is transmitted to humans through domestic dogs in up to 99% of cases, but rabies can infect domestic and wild animals alike. Human rabies spreads after being bitten or scratched, usually through saliva.
Rabies is spread on all continents except Antarctica, and more than 95% of human deaths are recorded in Asia and Africa.
Rabies is a neglected tropical disease that mainly affects poor and vulnerable populations residing in remote rural areas. There are effective human immunoglobulins and vaccines against rabies, but they are not available or readily available for people who need them. Deaths from rabies are rarely reported, and children between the ages of 5 and 14 are often victims of rabies globally. With the average cost of post-exposure prophylaxis treatment of rabies is 40 US dollars in Africa and 49 US dollars in Asia, exposure treatment to rabies can represent an enormous financial burden for affected families whose average daily income ranges from approximately US $ 1 to US $ 2 per person.
It feeds more than 15 million people worldwide every year after being bitten. It is estimated that this will prevent hundreds of thousands of deaths from rabies every year.
Protection
Eliminate canine rabies in dogs
Rabies is a disease that can be prevented with vaccines. Dog vaccination is the most cost-effective strategy for preventing people from contracting rabies. Dog vaccination reduces the number of rabies deaths and the need for post-exposure prophylaxis in the care of patients who have been bitten by dogs.
Rabies awareness and dog bite prevention
Dog behavior education and bite prevention activities targeting both children and adults are an essential extension of a rabies vaccination program and can reduce human rabies rates and the financial burden resulting from treating dog bites. Increased awareness activities regarding rabies prevention and control in communities include education and information about pet owners' responsibilities, ways to prevent dog bites, and immediate care measures after a bite. Participation and ownership of the program at the community level increases the impact and use of key messages.
Preventive immunization in humans
Human rabies vaccines exist to be used prior to exposure. These vaccines are recommended for people in certain occupations with a high risk of contracting the disease, such as laboratory workers who take live viruses from rabies viruses and viruses associated with rabies (canine virus); And people (such as people involved in animal disease control and forestry) whose professional or personal activities may lead them to direct contact with bats, carnivores, or other potentially infected mammals.
Pre-exposure immunization is also
recommended for travelers who travel to remote affected areas and intend to spend a long time outdoors for activities such as exploring caves or climbing mountains. Expatriates and people traveling for long periods of time to areas of high risk of rabies should be immunized if access to biological anti-rabies products is limited. Finally, consideration should also be given to the immunization of children who reside in or are visiting remote high-risk areas. These children may experience more severe bites or may not report such bites when playing with animals.
Symptoms of the disease :
The incubation period for rabies usually ranges between one and three months, but it may also range from one week to one year depending on factors such as the location of the virus entry and the viral burden. Initial symptoms of rabies include fever accompanied by pain and an unusual or unexplained feeling of tingling, tingling, or burning (paresthesia) at the site of the wound. As the virus spreads in the central nervous system, a progressive and fatal infection appears in the brain and spinal cord.
The disease appears in the following two forms :
Irritant rabies, in which people with it show signs of hyperactivity, excitable behavior, and hydrophobia (fear of water) in addition to aerophobia (fear of air currents or open air) sometimes. Death occurs as a result of my heart and breathing having stopped after a few days.
Paralytic rabies, which accounts for about 30% of all human cases. This form of rabies generally develops less noticeably and is longer lasting than its irritable form. The muscles gradually become paralyzed from the site of the bite or scratch. The state of coma slowly progresses and the patient eventually dies. The paralytic form of rabies is often misdiagnosed, which contributes to underreporting.
Diagnose the disease :
Current diagnostic tools are not adequate for detecting rabies infection before clinical symptoms of disease appear, and clinical diagnosis of rabies may be difficult unless signs of hydrophobia or aerophobia specific to the disease are present. A person can confirm rabies during his life and after his death through various diagnostic techniques that detect viruses as a whole, viral antigens or nucleic acids present in the infected tissues (brain, skin, urine, or saliva).
Infection :
A person usually becomes infected after being bitten or deep scratched by an animal infected with rabies. The infections transmitted from dogs with rabies to humans represent 99% of cases. Africa and Asia bear the largest human burden of rabies and account for 95% of rabies deaths worldwide.
In the Americas, bats are now the leading cause of death from human rabies, as most dog-borne infections in this region have been stopped. Bat rabies is also an emerging public health threat in Australia and Western Europe. It is very rare for people to die as a result of exposure to foxes, raccoons, skunks, jackals, mammoths and other types of host wild carnivores, and there are no known cases of rabies infection transmitted by rodent bites.
And the infection can also be transmitted when it comes into contact with a contaminated substance, i.e. saliva, usually in direct contact with the human mucosa or recent skin wounds. Interpersonal transmission through biting is theoretically possible, but it has never been confirmed.
Rarely, a person becomes infected with rabies by inhaling droplets containing the virus or transplanting contaminated organs. No cases of rabies infection were ever confirmed through the consumption of raw meat or animal tissue in humans.
Preventive treatment after exposure to rabies :
Post-exposure prophylaxis is the immediate treatment available to a person after being exposed to rabies from a bite. This treatment prevents the virus from entering the central nervous system, causing imminent death.
The treatment is as follows :
Good washing and topical treatment of the wound as soon as possible after exposure;
Give a series of doses of an effective and effective anti-rabies vaccine that meets WHO standards;
Give anti-rabies immunoglobulin if recommended.
Providing effective remote treatment for rabies allows for the prevention of symptoms and death.
Good washing of the wound :
This involves providing first aid for a wound that includes rinsing and thoroughly washing the wound within at least 15 minutes with soap and water, a cleanser, povidone iodine, or other rabies virus killers.
The vaccination status of the suspected animal should not be the decisive factor in considering whether to initiate preventive treatment after exposure to rabies or not if this situation is in doubt. This can happen if dog vaccination programs are not organized or followed sufficiently due to lack of resources and low priority given to this.
WHO continues to promote human rabies prevention by eliminating dog rabies, adopting dog bite prevention strategies, and the wider use of preventive intradermal therapy after exposure to rabies, thus reducing the volume and cost of the cell culture-based vaccine as a result by between 60% and 80%.
Integrated management of bites :
If possible, the veterinary services should be alerted and the animal that caused the bite should be identified and isolated under health supervision (for the sake of healthy dogs and cats). Instead, it would facilitate the animal's death for immediate examination in the laboratory. Prophylaxis should be continued in the 10-day observation period or while waiting for laboratory results. Treatment may be stopped if it is established that the animal does not have rabies. If the suspect animal cannot be caught and tested, then preventive treatment should be given in full.
Organization response :
Rabies is on the WHO Neglected Tropical Diseases roadmap. As a zoonotic disease, this disease requires close coordination between sectors at the national, regional and global levels.
Activities at the global level :
In December 2015, the World Health Organization (WHO) and the World Organization for Animal Health (OIE), in collaboration with the Food and Agriculture Organization of the United Nations and the Global Alliance to Control Rabies, launched a global framework for achieving zero deaths from human rabies by 2030. This initiative represents the first opportunity that meets Under which the sectors concerned with human and animal health to adopt a common strategy to combat this devastating and severely neglected disease.
Disease surveillance and surveillance activities should be a central component of every rabies control program. The declaration that a disease must be reported is crucial to establishing practical reporting, which should include mechanisms for transferring data from the community level to the national level and to the World Organization for Animal Health and the World Health Organization. This will provide feedback on the effectiveness of the program and allow for actions to be taken to improve vulnerabilities.
Reserve stocks of vaccines against human and canine rabies have had a catalytic effect on efforts to eradicate this disease. WHO is working with its partners to predict global needs for vaccines for humans and dogs and for anti-rabies immunoglobulin, realizing global manufacturing capacity and exploring options for purchasing large quantities for countries through WHO / UNICEF mechanisms (human vaccine and anti-HIV immunoglobulin). Dog) and the World Organization for Animal Health / World Health Organization (animal vaccine).
In 2016, the WHO Strategic Advisory Group of Experts on Immunization (SAGE) established a working group on vaccines and anti-rabies immunoglobulins. The working group is currently reviewing the scientific evidence and relevant programmatic considerations with a view to using it, identifying the best vaccination measures and assessing the potential impact of new biological products. The Strategic Advisory Group of Experts on Immunization (SAGE) will consider proposed recommendations resulting from this work in October 2017 to update WHO's position on rabies immunization.
Selected countries in Africa and Asia, with support from WHO, are conducting prospective and retrospective studies to collect data on dog bites, rabies cases, post-exposure prophylaxis, follow-up, vaccination needs and options for implementing the program. This information will provide additional evidence to support the need to invest in rabies control programs and guide the GAVI Alliance strategy to invest in vaccines in 2018.
Regional and country examples :
Countries in the Region of the Americas have reduced rates of rabies by more than 95% in humans and by 98% in dogs since 1983. This success has been achieved mainly thanks to the implementation of effective policies and programs that focus on regional coordinated dog vaccination campaigns and on raising public awareness and access to treatment. Preventive after exposure to rabies is widespread.
Several countries in the WHO South-East Asia Region have launched rabies elimination campaigns in line with the goal of regional eradication by 2020. Bangladesh launched an eradication program in 2010 and deaths from human rabies decreased by a factor of 20. 50% between 2010 and 2013 as a result of management of dog bites, widespread dog vaccination and increased availability of free vaccines.
Significant progress has also been made in the Philippines, South Africa and Tanzania, where proof-of-concept projects under the Bill & Melinda Gates Foundation project led by WHO have also shown that human rabies cases can be reduced thanks to a combination of interventions involving large-scale dog vaccination and improved access to preventive treatment. Following exposure to rabies, increased surveillance, and public awareness.
In order to ensure the sustainability of rabies control programs and extend them to neighboring geographical areas, it was essential to start on a small scale and stimulate local rabies control programs through a set of incentives, demonstrate success and cost effectiveness, and ensure the participation of government and affected communities.
WHO is working with its partners, the Food and Agriculture Organization of the United Nations, the World Organization for Animal Health and the Global Alliance to Control Rabies to develop a costed action plan to achieve zero deaths in humans by 2030. This plan includes policy, human and animal interventions, awareness-raising activities, advocacy and capacity-building. And the special resources needed to eradicate the disease in countries still suffering from rabies.
