Management of Dog Bite Wound and Suspected Rabies Cases

Dr. M. Hammad Hussain, M. A. Hafeez and M. N. Asi

Department of Clinical Medicine & Surgery, University of Agriculture, Faisalabad

m.hammad.hussain@gmail.com

Introduction:

The teeth of a dog can a cause tremendous amount of crushing and tearing of skin and underlying tissues. Moreover, the fear of spread of fatal ‘Rabies’ through bites caused by unvaccinated stray and pet dogs should always be taken into the account while treating a dog bite wound. Rabies is still endemic in Pakistan and most probably will remain so until unless effective policies will be devised and implemented for its control through mass vaccination of stray & wild animals. The purpose of this article is to communicate the first aid management of dog bite wounds, post-exposure treatment of animals suspected to be bitten by rabid animals, management of the suspect (rabid animal) till conformation and future decision about its fate.

 Dog Bite Wound Management:

 Common sources of dog bite include the wounds caused during dog fights, a mongrel (stray) dog biting the household animals (horses, mules, donkeys, cattle, buffalo, sheep, goat and dogs) and humans as well. In case of dog fights the affected animal may be in the state of shock due to the extensive tissue damage and injuries to the vital organs e.g. broken bones, abdominal trauma and bleeding, breached chest and pneumothorax etc. These cases require immediate attention and should be managed accordingly. While in case of other dog bite situations, animals / persons usually have a single bitten area (mostly seen around legs).  

 First Aid Management:

 First hand management usually involves the following steps: 

1. Wound should be washed vigorously with soap (try to apply soap with such a pressure that it enters deep into the wound) 2-3 times and then apply either ethanol (700 ml/ Liter) or tincture or aqueous solution of iodine on it.
2. Penetrating wounds into the abdominal cavity warrants the exploratory laparotomy to investigate the extent of damage.
3. Liberal removal of devitalized (dead) tissue should be done but try to preserve the nerves, blood vessels, tendons and ligaments.
4. After washing and debridement (removal of dead tissue) suturing should be performed. Drains should be used if suturing can’t minimize the dead space.
5. if the condition of wound is very bad (bad smell, lot of puss, exudation) suturing should be delayed for 3-5 days and wound should be cleaned with antiseptic solutions twice and bandaged on daily basis until closure can be performed.
6. In cases of equines (horses, mules, donkeys) prophylactic anti-tetanus serum should be administered @ 3,000 IU intramuscularly / subcutaneously.
7. Broad spectrum antibiotics should be given to check the secondary infections

 In Case of Suspected Rabid Animal Bite:

In cases, where biting animal is thought to be rabid (suffering from rabies) we will have to categorize the threat and then administer the treatment accordingly. The decision to go for post-exposure rabies vaccine depends upon the types of contact described as under: 

1. Category-I – touching or feeding of suspected animal (usually pet dog) and animal licks on the skin (usually owner of that animal)

2. Category-II – suspected animal nibbled over wounded / uncovered skin (pet owners & other animals) & minor scratches or abrasions without bleeding caused by attacking animal (Human & other animals)

3. Category-III – where single or multiple bites are present and skin is breached (deep bite) or scratches caused by attacking dog followed by contamination with his saliva

 The first hand management of these types includes following steps alongside the procedures described for the general bite wound management: 

1. Administration of anti-rabies immunoglobulin by careful instillation around and in the depth of wound
2. For Category-I, only general bite wound management methods are sufficient and there is no need for immunoglobulin administration of post-exposure treatments
3. For Category-II, immediate post-exposure treatment is advocated
4. For Category-III, immediate post-exposure vaccination and administration of rabies immune globulin are recommended.

 Standard Possible Treatments / Vaccines:

 1. Human 

1. Rabies Immunoglobulins
   1. BAYRAB^® (Bayer) @ 20 IU/Kg B. Wt.
   2. BERIRAB-P^® @ 20 IU/Kg B. Wt.

2.      Antiserum

a.       RABIES ANTISERUM @ 40 IU/Kg B.Wt. /IM

3.      Vaccines (Pre & Post-exposure)

a.       LYSSAVAC^® (Berna)

                                                              i.      Pre-exposure /  Immunization @ 3 injections of 1ml administered s.c. / i.m. at 4 weeks interval followed by booster dose annually or 3 yearly (depending upon risk)

                                                            ii.      Post-exposure: see literature enclosed with commercial vaccine

b.      RABIPUR^® (Chiron Biocine)

                                                              i.      Pre-exposure /  Immunization @ one dose (1ml) on days, 0, 7, 21 (or 28)

                                                            ii.      Post-exposure

1.      Persons without previous vaccine history / incomplete vaccine @ one dose (1 ml) on day 0, 3, 7, 14, 30

2.      Fully immunized (having previous vaccine & bitten by suspected animal) @ 1 to 3 shots of 1 ml on day 0, 3, 7 depending upon extent of exposure

2.  Animals:

Pre-exposure

 Dogs

Rabies vaccines can be given from 4 weeks of age, and a second dose is given at 12 weeks of age. If vaccinated for the first time after 12 weeks only one dose is needed. Booster vaccinations are needed every 2 years. Pregnant animals should not be vaccinated.

Cats

Cats are vaccinated from 4 weeks of age and the dose is repeated at 12 weeks of age. Only one dose is needed if they are over 12 weeks of age at the time of first vaccination. Booster vaccinations are advised every 2 years.

Livestock

 Vaccinating all livestock against rabies is practically and economically not feasible. However, vaccination should be considered in all valuable animals/livestock that might have frequent contact with humans and can contract the disease from stray dogs and wild animals.

 In case of cattle, buffalo and equines, they are usually vaccinated at 6 months of age. In endemic areas vaccination can start from 2 month of age and a second booster can be given at 6 months of age. Annual booster vaccinations are required in these animals to maintain protection.

Post-exposure

 Dogs 

Inject 2 ml of post-exposure vaccine at two different locations at day 1. This should follow by injecting 1 ml of vaccine at day 7 and 21 making the total dose of vaccine 4 ml for individual animal (i.e. 2 + 1 + 1 = 4). 

 Cats

Follow the same procedure as in case of dog

Sheep & Goat

 Inject 2 ml of post-exposure vaccine at two different locations at day 1. This should follow by injecting 1 ml of vaccine at day 7 and 21 making the total dose of vaccine 4 ml for individual animal (i.e. 2 + 1 + 1 = 4). 

Cattle & Buffalo

For young calves inject 3 ml of pot-exposure vaccine at 3 different locations on day 1 and then inject 2 ml at two different sites on day 7 and 21 (i.e. 3 + 2 + 2 = 7ml). for the cattle and buffalo inject 4 ml at four different sites on day 1 and follow it by injecting 3 ml at 3 different locations on day 7 and 21 (i.e. 4 + 3 + 3 = 10 ml).

Equines

in case of equines follow the procedure described above for calves i.e. 3 + 2 + 2 = 7 ml on day 1, 7 and 21.

Management of dog that bite humans & animals

 There could be two possible scenarios as described below: 

1. A healthy pet dog (Vaccinated / Non-vaccinated) should be confined and observed daily for 10 days. Administration of rabies vaccine is not recommended during this period. Such animal should be evaluated by a veterinarian at the first sign of illness during this time. If signs suggestive of rabies develop, the animal should be euthanized, its head removed and shipped under refrigeration (not frozen) for the brain tissue examination by a qualified laboratory designated by health department. 
2. Any stray dog that bites human or other animals should be caught and euthanized immediately and head should be submitted for examination.

 Management of Livestock exposed (bitten by suspected rabid animal) to rabies:

1.      Cattle and horses are among the most frequent preys of rabies. In case of those vaccinated animals which are exposed to a rabid animal, they should be revaccinated immediately and observed for 45 days.

2.      Immediate slaughtering the unvaccinated livestock is recommended in developed countries like USA but in resource poor countries like Pakistan immediate wound care as described above and post-exposure vaccination should be performed and the animal should be kept under close observation for 6 months.

Milk & Meat Consumption:

The owners of unvaccinated exposed livestock should take care of following recommendations:

1.      In case if the exposed animal is slaughtered within 7 days of exposure, its tissues can be eaten without risk for infection, provided that a large proportion of the meat around the exposed area is discarded.

2.      Milk from a suspected rabid animal should not be used for human or animal consumption.

For Further Information Try These Links:

      1.      http://www.cdc.gov/mmwr/preview/mmwrhtml/00000460.htm

2.      http://www.who.int/immunization/Refs_Rabies_Apr_2002.pdf

3.      http://www.cavaliersonline.com/health/vaccinenew.htm

4.      http://www.provet.co.uk/health/diseases/rabies.htm

5.      http://www.oie.int/eng/normes/mmanual/A_00044.htm

6.      http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/102300.htm

NOTE: All the contents of this article are for information of owners, veterinarian and animal health related personals. Information described above is compiled from different books as well as updated online resources. I have tried to narrate it in my own words. However, the similarities found should not be taken as any sort of Plagiarization. Before application of these techniques/medicines proper professional help/guidance should be sorted. Author will not be responsible for the damage or untoward affects caused by the application of unauthorized and non-professional use of above mentioned medicines, biologics and methods.