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When the 8-year-old son, of the then Gambian President-elect Adama Barrow, died after a dog bite. Most Nigerians were dumbfounded. A correspondence war started. One Kenneth from Abuja blamed the now Gambian President outright, for non-vaccination of his dogs. When I told him it could be a case of stray dog, that was rabid, he blamed the President more.
How could the son of a then President-elect, be left to wander about, knowing how deadly the former President Yahya Jammeh was. Then he asked the questions most of my patients asked – how do we identify a rabid dog, and why does its bite kill so quickly.
Surprisingly, I agree with Kenneth, no owner of a dog should leave it un-vaccinated. Again nobody should be allowed to die of a dog bite. What I do in my hospital, when anybody is rushed in because of a dog-bite or scratch. I assume the worst, that the dog is rabid, and trigger the whole mechanism that involves the treatment of rabies. Instead waiting for the advised medical-10-days, observing the dog. I usually err on the side of caution.
The whole hog of a dog-bite treatment is commenced. Wash the bite site and scratches thoroughly with soap water, dettol, savlon or whatever antiseptic is available, what I jokingly call “saponification” of the wound. Give Anti-Tetanus-Serum(ATS), muscle relaxants, antibiotics etc. I am yet to lose anybody with a dog-bite, rabid or non-rabid.
I have always told Health officers, Nurses, Laboratory Scientists or Junior Doctors – that no child bitten by a dog deserves to die under our care, because of medical protocol. Where instead of treating the child as a case of rabid-dog-bite, we send out Environmental Health Officers to go and track down the involved dog, and observe it for 10 days. Balderdash, humbug. What if after 10 days, the dog is found to be rabid? And we have left out the basic routine things, we should have done to save the child’s life. Can we turn back the hand of the clock?
Do you know what? Research according to Prof. E H O Parry, has shown that children aged 5 – 15 years are most often the victims of dog bites, because they provoke animals by teasing them, and are not able to defend themselves, should the dogs become aggressive.
I repeat, the President of Gambia’s son – Habibu Barrow Jnr, wouldn’t have died, if the grandmother he was staying with had reported the child’s dog-bite immediately, or if the Gambian health officials had adopted the cautionary approach, of assuming the “culprit dog” to be rabid until proven otherwise.
Now a message to all parents, before I even discuss rabies, knowing that children are usually the victims of dog bites. Whenever your child reports an incidence of a dog-bite or scratch, you are now the first doctor in the line of treatment. So take up any available soap and water, wash the area thoroughly immediately, before rushing him to see any health official, chemist or pharmacist. Since usually in the village a doctor is not readily available.
Tell them, your doctor said, in case of any dog-bite, the area should be washed immediately with soap, water, dettol, savlon etc. To also give ATS, before rushing the child to see the nearest doctor which usually takes hours. Listen, this is no time to put your two hands on your head and lament as if the world is coming to an end. Again this is no time to dismiss your child’s encounter with a dog as an ordinary scratch, and then do nothing.
Do you know what killed the President’s son, the grandmother whom he was staying with, dismissed the dog scratch as nothing. The singular act, of taking immediate action, by washing his wounds with soap and water, could save your child’s life. Or call me instead of panicking, if there is no doctor immediately available, and I shall direct you, on what to do. If one life is saved by this interactive act, then we shall give God the glory. Now let us discuss rabies.
What is rabies?
Rabies is a viral(rhabdovirus) encephalitis, transmitted by infected saliva, that gains entry into a body by a dog-bite or an open wound. In Nigeria an estimated 5 – 10,000 deaths occur annually from rabies, these usually go unreported, because the cases are usually misdiagnosed.
This is because the child might forget to report the incident the time it happened, or might be afraid he will be punished for venturing into restricted neighbourhoods, so he will just cover the wound with sand and keep on playing.
Route of infection and pathophysiology.
Rabies virus do not penetrate an unbroken skin. Infection results from the wound made by a dog-bite. After a dog-bite, the virus enters nerve endings, ascends through peripheral nerves to the spinal cord, to the brain – multiplies in central nervous system – spreads through autonomic nerves to reach – salivary glands, eye and heart. This takes about 10 days to one year,which is the incubation period of rabies, depending on the site of the dog-bite.
Many animals can transmit rabies to people, dogs are the most frequent, other rural or sylvatic reservoir species include – cats, bats, jackals, hyanas, lions, leopards, various small canivores of the family Viverridae (mongoose, meercats,civets and genets).
Next week we shall discuss clinical features, diagnosis and treatment of rabies. Andrew lways watch out for stray dogs.
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