Rabies

Doesn’t give a dog’s chance of survival:

By Manjula FERNANDO

‘Never take a chance with Rabies. It is deadly and there is no cure. ‘ How many times have we heard this warning, as a child, an adult or an elder. But, have we given enough thought to the prospect.

Virologist  Dr. Omala Wimalaratne

Rabies can cause one of the most painful deaths human civilisation has ever experienced.

But we still ignore the possibility of contraction. About 50 children and young adults in Sri Lanka perish annually due to this preventable disease. The most vulnerable group is between 5-15 years.

A true story: Nilanthi watched as her two year old bundle-of-joy laugh as he looked out at some group of older boys in the neighbourhood playing on the street. She lived in one of the line houses at Dematagoda with her husband.

Despite financial difficulties, they were content and the child was the centre of their happiness. He was their only hope.

While her husband was away making a living, Nilanthi set about her afternoon ritual of feeding the toddler. She kept a close eye on the child and never allowed him to be looked after by a friend or relative as many women did in her neighbourhood.

Then her gaze drifted far as she heard a commotion outside. The children started to scream and dash about. When she ran towards the door she saw a small puppy trying to snap at some of the running children. Several children were bitten by the small animal but the injuries were not so serious. The puppy was chased away.

Due to its unusual behaviour the people were observant. When the puppy died a few days later, the head of the carcass was sent to the MRI for laboratory tests. The puppy had Rabies, the reports confirmed.

Alarmed parents took the five children who were bitten by the dog to the Lady Ridgeway Hospital and they were prescribed anti rabies post exposure treatment. None of the five children contracted the disease. Although shaken by the news Nilanthi took no serious notice since luckily her child was not bitten. He was inside the house the whole time.

Some weeks later the baby developed high fever and was rushed to the Lady Ridgeway Hospital. There the doctors suspected viral flu. Within hours the child began to show symptoms synonymous with Rabies.

The case was referred to the Medical Research Institute (MRI). The mother swore that the baby was never bitten or scratched by a dog or cat, which was the commonest form of contracting the disease worldwide.

The baby was never left out of her sight since birth.

The doctors were puzzled as to how the child developed the disease. Finally the puzzle was solved.

The mother recalled the incident which occurred one and a half months back, the incident of the stray puppy which bit some children who were playing outside.

The baby had several scars of healed wounds on his lower limbs. He was allergic to mosquito bites and had developed a rash. The doctors’ believe the infected puppy would have licked the baby’s fresh wounds on the lower limbs, before it developed the disease. Since no treatment was taken at that time, the virus had toddled to the brain from the point it had entered the wounded skin and six weeks was the time it had taken for the journey.

The distraught mother was rolling on the ground, she was unconsolable. She refused to undergo treatment as per the medical advice following her very close contact with the child during his illness just before his death.. She did not want to live another day without her baby son. But all her crying was in vain. It was all too late.

Medical Virologist and Vaccinologist and Head of the department of Rabies and Vaccines of the Medical Research Institute (MRI) Dr. Omala Wimalaratne, says it is unfortunate to witness young lives being snatched away like this.

Rabid patient

“No one wants to see a rabid patient. Even the trained medical staff who attends to rabies patients dread every new experience.”

One reason is that the victim is most often a child or a young person, the other is that we can’t do anything about his suffering, he is going to die before your eyes.”

She says, the patient until he goes into a coma, struggles on the bed knowing fully well that he is going to die and that he is having rabies. In Sri Lanka the commonest form of transmission of rabies to humans is through dogs (97%) and cats (2%) bites. The other animals account for just one percent.

Therefore, it is most important that the mothers inculcate responsible pet ownership in their children and they themselves be responsible owners to help eradicate this deadly disease.

Sri Lanka recorded 300 rabies deaths in the 1970s and it has gradually come down to 150 cases in 1990s and 56, 52 and 58 reported cases in 2007, 2008 and 2009. Dr. Wimalaratne said this figure is expected to drop further this year.

“One reason is... awareness among the people. I also think the dengue fear has also been a contributing factor. People don’t dump garbage recklessly now.

Garbage dumps are also breeding places of stray dogs.”

Vaccination is the key. Pet owners must vaccinate their pets from six weeks . The proper schedule is - first vaccination in six weeks second dose in three months and then once every year. This applies to all domesticated pets, even cats or rabbits. The veterinary surgeon could give them the proper guidance.

She says not only the uneducated but even the educated and the affluent do disregard this critical bit of advice.

“A gentleman from a well to do family once argued with me that he did not vaccinate his pure bred, because the dog was never allowed outside the home garden.

“But a creeping mongoose (Mugatiya), a monkey or a bandicoot (Uru meeya) could transmit rabies to this dog.”

In another instance a four-year-old girl was bitten by a neighbour’s dog, a pure bred. When the distressed mother inquired about the vaccination records, the owner asserted that the dog had received his shots on schedule. But the pet’s vaccination records were misplaced.

After several months the child complained of headaches, she developed fever and then the doctors diagnosed her illness as Rabies. The child died ultimately.

When the parents confronted the neighbour, he confessed that the dog died several days after the child was attacked. But it never crossed his mind that the death should have been notified and the animal’s head sent to MRI for testing.

“Such incidents are so pathetic. Rabies death is a preventable death. It is such a horrific experience so parents must never allow children to play or handle stray animals. A tiny scratch on the skin is enough for the virus to enter the body. The dogs may appear completely healthy during the incubation period.”

Even when the animals develop the disease 20 per cent of them who develop dumb rabies/paralytic rabies will not show the common symptoms such as red eyes, pouring saliva, ferocious look, biting at everything and everyone. These animals would prefer to get to a dark place and will show difficulty in taking food and water and also walking. They often show symptoms, as if a bone has got stuck in the throat. One must never attempt to remove it without getting a veterinarian’s advice.

Only 80 percent of the animals develop the aggressive type that is called ‘ furious rabies’ who manifest these symptoms.

If your dog bites a child, you should never try to con people no matter how sure you are of your pet. Always come out with the truth or else the result will be irreversible.

The post exposure treatment for patients bitten by suspected animals depends on the type of animal, site and the severity of the bite injuries . This may include immediate administering of the rabies immunoglobulin (anti rabies serum) and starting on the five dose (injection) vaccine course if the injuries are severe.

If the bite wound is in a sensitive area, like palm, fingertips, mouth where there are a lot of nerve cells or places closest to the brain like the face or the head, the patient will be first given the anti rabies serum.

They will be prescribed the vaccine treatment subsequently upon individual assessment. But it is vital that the patient is brought to the hospital as soon as possible if the dog or the animal appears to be rabid. If the wound is superficial only the anti rabies vaccine is recommended.

In the Government sector the schedule of administration lasts up to three months as against the Private Hospitals which complete the full dose in one month.

State and private sectors use the same vaccines.

There is this misconception that an expensive single dose treatment is available in private hospitals. These are mere hearsay. The medication that is being used in the private hospitals and state hospitals are the same, only the route of administration and the treatment schedules differ. Both types of treatment are safe and effective. Sri Lanka is using the WHO recommended treatment method.

Thus there is no cause for alarm to receive the post exposure treatment in any hospital in the country.

The MRI which has a WHO accredited rabies diagnostic laboratory to test rabies suspected brain samples both animal and human conducts daily special advice clinics for the public from 8.00 am to 4 pm from Monday to Friday. Saturday and Sunday and public holidays the clinics are conducted from 8 am to 12 noon.

They do not accept live specimens but they take in any type of animal head which is suspected of rabies for testing.

The specimen should be sent within eight hours of its death in a leak proof container and if not it has to be packed in ice.