The truth about rabies – a much-needed wakeup call
The rabies vaccine does not offer full protection so regardless of whether you are vaccinated, if bitten, you still need to wash the wound throughly and seek immediate medical attention.
IT HAS been over a year since the outbreak of rabies in Sarawak, and our situation has only worsened as the deadly virus continues to spread wider and wider into our state.
Since the official declaration of a rabies epidemic on July 1, 2017, Sarawak has identified and declared a total of 41 areas in the state to be rabies infected areas.
The rabies virus, spread predominantly through dogs, is currently one of the worst epidemics our state has ever faced and has officially claimed 12 lives so far.
To mark World Rabies Awareness Day, The Borneo Post has teamed up with Sarawak Health Department and members of the local Dog Bite clinic in Sarawak General Hospital (SGH) to help deliver a message to the public in hopes of raising awareness of the deadly virus – how to protect ourselves against it and the appropriate steps to take in an event of a dog bite.
What do I do in the event of a dog bite?
Already one year down the road in the rabies outbreak, you would think most of us know the appropriate steps to take in the event of an animal bite.
Crowds of people rushing into the SGH’s dog bite clinic after it was opened.
This does not seem to be the case as Dr Chua Hock Hin and Dr Ooi Mong How who both head the dog bite clinic in Sarawak General Hospital shared that many cases during this trying time, indicate many Sarawakians are still very ignorant on how they should manage and look after themselves after an animal bite.
“From our side, we often see poor wound washing by our patients or delayed treatment as they do not come to the hospital to seek treatment.
“During this critical time, it is imperative that anyone who is bitten by a dog or cat should properly wash their wound immediately before heading to the nearest healthcare facility for further washing and treatment,” Dr Chua advises.
Adding to this, Dr Ooi who is a paediatrician, advises that parents or adults, tasked with washing the bite wounds of a child, not to be swayed by the crying of the child.
“At one point, we picked up that our children patients were not receiving proper wound washing right after a bite because the parents could not bear to wash the wound properly due to their child’s crying.
“Washing a fresh wound is bound to be very painful for anyone, so parents tend to compromise and perform a ‘half-hearted’ washing as they are afraid of causing more pain to the child. This is not a very good idea because it places the child’s life at risk.”
Explaining the importance of a thorough wound washing, Dr Chua, who specialises in infectious diseases, explains the rabies virus is found in the saliva of infected animals, hence immediate and thorough washing of the wound is extremely important to reduce the number of virus particles at the wound site.
A young child having her wound treated after an attack by a dog.
“After washing one round, they should head to a healthcare facility immediately to have the wound washed once more to ensure that thorough washing of at least 15 minutes has been performed and to assess whether further treatment is needed.
“Considering how serious the current outbreak of rabies is, I recommend heading to public healthcare facilities as they are more geared towards treating dog bites and have designated clinics for it,” Dr Chua adds.
These designated areas are dog bite clinics, quickly put together over the past year, to cope with increasing dog bite victims in Sarawak.
Right now, there are a total of six clinics in Sarawak, located at SGH, Serian Hospital, Bau Hospital, Klinik Kesihatan (KK) Sri Aman, Sarikei Hospital and KK Midlayar which is near the Betong.
Finite supply of medication and what we can do to help
All of these clinics are supplied with rabies vaccines to treat animal bite victims but only the clinic at SGH is equipped with Rabies Immunoglobin (RIG), reserved for only high-risk patients.
“RIG’s function is to help bridge the gap between rabies vaccination and the onset of an adequate antibody response from the human body and is only reserved for high-risk patients because it is in very short supply.
“It is not a synthetic thing that can be mass-produced, so the World Health Organisation’s (WHO) recommendation is we reserve it only for specific high-risk cases. Otherwise we would end up with zero supply and have to rely solely on vaccines for all cases,” Dr Ooi explains.
Locally, cats have been picked up to be positive for rabies, indicating how widespread the infection has become.
As rabies vaccines and RIG are in limited supply, both Dr Chua and Ooi advise everyone to avoid preventable bites for their own safety while helping the state maintain enough medication to treat all animal bite victims.
“Many cases we see are caused by preventable bites. For example, we have patients who were bitten because they provoked the animal by petting it while it was eating or they tried to separate animal fights, feed a pack of hungry dogs, handle the animals roughly or place themselves in precarious situations with suspected rabid animals.
“These patients are treated like everyone else and it places a strain on our medication stocks as we are also treating patients with non-preventable wounds – victims who are randomly attacked because a dog or a cat has gone rabid.
“So, to ensure these precious resources are used judiciously, everyone should make sure they do not place themselves or their families at risk unnecessarily by avoiding areas with large number of free-roaming dogs and watching children closely as they may provoke animals by hitting or playing roughly with them.
“Additionally, never adopt dogs or cats without a clear idea of their backgrounds as they might already be harbouring the virus. Even new-born animals could have the virus as they may obtain it from their mother,” Dr Ooi elaborates.
What can we do to curb the outbreak of rabies?
With so much said and done, the reality remains that the rabies outbreak is still raging and we need to start taking drastic steps to help curb the outbreak and prevent it from spreading further in the state.
According to Dr Ooi, the path to a rabies-free Sarawak is a multi-pronged approach where everyone has a part to play in changing our mindsets and methods in dealing with dogs.
“As citizens of the state, we need to change our mindsets as responsible pet owners. If we continue to let our dogs roam freely, then there will always be a chance the dogs might get infected and harbour the rabies virus. Owners should make sure their dogs are kept inside their gates and leashed when taken out for walks and exercise.
Owners should make sure their dogs are kept inside their gates and leashed when they are taken out for walks and exercise.
“Owners should also be encouraged to start neutering their pets if they do not want to breed them as we often see some irresponsible owners abandoning their unwanted pets on the streets rather than surrendering them, hence adding to the growing number of strays.
“We need to start educating everyone,especially our children,on the consequences of such callous action so that the young can grow up to be responsible and good pet owners.”
To the relevant authorities, Dr Chua advocates stricter guidelines and enforcement for dog ownership.
“Right now, we do not enforce very strict licensing of dogs, so it is hard to even tell if a dog has been vaccinated or neutered. With stricter licensing, we can help ensure dogs with owners are protected.With stricter enforcement, we can help encourage responsible pet ownership throughout the state.
“For the sake of our children, every Sarawakian should put aside their differences and work together towards the common goal of making Sarawak a rabies-free state again,” Dr Chua stresses.
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Rabies myths
Only dogs carry the rabies virus
Dr Chua: While the natural reservoir of hosts for the rabies virus is in dogs, it is not true that only dogs carry the virus as the virus can infect any living mammals. In previous cases in the peninsula, only dogs have been recorded to be affected but this is not the case in Sarawak. Locally, we have come across cats that are positive for rabies and this is likely due to the virus being so widespread that it has spilled over from our dog population into our cat population. Right now, every one in four cats and every one in three dogs we send off for testing comes back positive for rabies. This implies a very extensive outbreak, so we cannot let our guard down against the potential chance of exposure to the virus.
I have had a rabies vaccine before, so I am safe the virus
Dr Chua: Many people have started to seek rabies vaccines before being bitten by an animal lately, so it is a huge concern that some have a misconception they are safe from any and all bites. While vaccinations are a great way to prevent a person from getting infected by viruses, it is important to understand the rabies vaccines you obtain pre-emptively before any injury, does not mean you do not have to do anything later on if you happen to get bitten. The vaccine does not offer full protection so regardless of whether you’ve had a vaccine beforehand or not, after receiving a bite, you will still need to follow the measures outlined by the World Health Organisation to wash your wounds for 15 minutes with soap and running water and then seek immediate medical attention to get a booster shot and possibly further treatment depending on your health status.
With swift medical attention, rabies is 100 per cent preventable
Dr Ooi: The standard treatment for a dog bite wound after thorough washing is to give the patient rounds of rabies vaccine to help them mount an immune response to the virus. However, the efficacy of this treatment is highly dependent on how severe the dog bite is and where it is located.
Bites to our head and neck region post a higher risk as compared to bites to our hands and legs because our head and neck region is highly innervated with a lot of nerves. There is a higher chance the virus may be directly inoculated to these nerves and reach the brain, causing the patient to develop symptoms of rabies faster. But even if the bite is localised to hands or feet, there is still a danger of developing rabies symptoms if the bite is deep with direct injury to the nerves, albeit at a slower rate. Some people are just not responsive to the vaccine and underlying medical issues like uncontrolled diabetes and other chronic diseases may supress the body’s immune function and prevent the rabies vaccine from helping to mount an adequate immune response to the virus.
Because of this, it is very important that diabetic patients take extra care in their exposure to potential bites from rabid animals. And if you suspect you might be diabetic, it would be good to have yourself checked quickly as diabetes is very rampant in our population with many Malaysians living unaware that they are afflicted with the disease. Even the RIG is not 100 per cent effective because it is injected to the muscle so it does not work on the virus that has been directly deposited in the nerves.
I am free from rabies after I have no developed symptoms
Dr Ooi: Most patients develop rabies symptoms between two and three months after a rabid dog bite, and if the patient remains healthy after a year, the likelihood of developing rabies is greatly lowered. However, this may not always be the case for everyone as the virus can potentially stay in your body for many years, just waiting to strike. The longest incubation period ever recorded was about 20 years. On this point, you can say ignorance is a blessing as some of our more educated and well-read patients end up developing mental health issues as they constantly worry that they might have rabies. While it might be a depressing, I think it is important to highlight this fact because after seeing dog bite patients for the last 14 months, we have come to realise people are taking this matter far too lightly. They assume they will be fine after receiving proper treatment but this is clearly not the case as there is still risk in developing rabies symptoms. Hence, we should be providing our community with proper and accurate information on the rabies virus to allow them to think about rabies more seriously and hopefully reduce their risks of exposure to the virus.
There have been fewer reports of rabid dogs found. The outbreak is dying out
Dr Ooi: It is true we have seen fewer official reports of dogs, testing positive for rabies recently, but this is not due to the situation having improved. Rather this is because of the laboratory testing approach, adopted by the veterinarian department. You see, we only picked up on our epidemic quite late through human cases and as result, the infection was already very widespread when we declared a rabies outbreak. And adding to that, we are very used to letting our own dogs roam freely in our neighbourhoods. While dogs are territorial animals, their moving range is around 10km, which means they are able to mix easily with other free roaming dogs that might be infected, leading to the virus spreading quickly and deeply into our dog populations despite our best efforts at containing it. So, in theory, with the outbreak being so widespread, we do not sample dogs found within a 10km radius of where a rabid dog was previously found. We just have to assume they are actually infected with the virus already. We cannot afford to test every dog because of the overwhelming number of samples that are sent to the veterinarian department. To test every dog will require massive amounts of resources. Another challenge we face in this outbreak is that the laboratory testing these samples is in the Veterinary Research Institute (VRI) in Ipoh. So we face the issues of transportations as well.
Vaccinated dogs are absolutely safe
Dr Chua: Just like in humans, the rabies vaccine will not be 100 per cent effective in all dogs as some dogs may not mount an immune response towards rabies. This is a known fact in any vaccination, be it for human or animal. There is always a chance they might still be infected despite being already vaccinated. The vaccine for dogs lasts only one year and takes four weeks after receiving to work. So vaccinated dogs still remain susceptible to rabies infection if they are exposed to the virus before they are able to mount an immune response. And for dogs already infected, receiving a rabies vaccine will not stop them from becoming rabid and may, instead, accelerate the development of rabies symptoms in the dogs. So, owners should be wary of this fact even after their dogs have received vaccinations.
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