Fatal bite 

Cats and dogs are familiar sightings wherever you go. While some may lead very comfortable lives, a majority are still left to wander the streets and cats particularly have a way of integrating themselves into a household, oftentimes welcomed as guardians against dreaded four-legged visitors.

“Doktora, isumbong ko yung kasama ko, nakagat ng pusang ligaw at hindi nagpabakuna,” one of my favorite pharmacists told on a co-employee. Putting on my stern you-better-follow-me-or-else doctor look, I firmly advised him to seek consult with a bite center or their barangay health center. As it was closing time, he promised to attend to it first thing in the morning.

An experience such as this serves as a reminder that though there is awareness about the virus, the gravity of failing to get immediate protection for a disease that is guaranteed to be 100 percent fatal may still need to be impressed on the public in general. There is no wiggle room allowed for such a serious disease. We have to remember that vaccination is only effective if given within the incubation period, which is from the time of exposure and before symptoms manifest. This may vary from a few days to months and, from literature, even years, and influenced by several factors such as the category of exposure, the severity and site of the bite, and the immune status of the individual who was bitten or exposed. While most of us know that it affects the central nervous system and are more familiar with the symptoms of encephalitic type or furious rabies, there is also the paralytic form or dumb rabies which is harder to recognize. During the early years in training, this was personally experienced when a cute little boy was referred to the infectious disease service for evaluation and was initially diagnosed with Guillain-Barré syndrome because of ascending paralysis. Upon a more thorough interview, we were able to obtain a history of the patient being bitten by a neighbor’s dog close to a month before his confinement.

Sept. 28 was World Rabies Day. Provided below are bite-size answers to some of the more frequently asked questions.

Is rabies a cause of concern in the Philippines?

Yes, it is. Though there have been reports of some parts of the country being rabies-free, according to the Epidemiology Bureau of the Department of Health, there was a notable increase in reported cases from 2022 to 2023. Most human cases came from dogs followed by cat bites. Based on a recent report from a major referral center in 2023, a third of those who consulted involved individuals who were less than 15 years of age.

How can I protect myself?

Avoid trouble. Never approach a dog or a cat whom you are unfamiliar with, even if severely tempted. Months back I saw a group of tourists petting a stray cat who had made its way into the mall. Marveling at their bravery, two things came to mind: one was that they probably came from a rabies-free country, and two, they must have been blissfully unaware of the incidence in the country.

Get vaccinated if you are at a high risk of coming into contact with the rabies virus by virtue of your profession, or if you engage in activities that increase the possibility, including travel to endemic areas. This is called pre-exposure prophylaxis. The benefits are immeasurable as not only does it afford protection for both recognized and unrecognized exposure, but it simplifies management. Full receipt of this regimen, however, should not be a reason for complacency and a consult is still warranted in the event of a bite, scratch, or mucosal exposure from a suspected rabid animal for proper assessment, including the need for boosters.

Have your pets vaccinated. This remains to be an effective means to help eliminate rabies and is part of responsible pet ownership. According to the World Health Organization manual, dogs obtained from reliable breeders can be vaccinated as early as three months of age followed by another at nine months, and annually thereafter. For those who adopt adult street dogs, vaccination is recommended at the soonest possible opportunity. Since this is beyond my expertise, I prescribe a referral to a veterinarian for proper guidance.

What should I do if I get bitten or exposed?

Immediately and thoroughly wash the area with soap and water for 10 minutes and avoid applying any cream, ointment, or wound dressing. Antiseptics such as alcohol and povidone-iodine may be applied. Do not delay. Proceed to the nearest health facility for the required immunization against rabies and, if indicated, tetanus shots and an antibiotic. Follow instructions to the letter and do not miss subsequent scheduled visits.

If the biting animal is available, keep it under close observation for the next 14 days.

Is there any contraindication to vaccination?

There are no contraindications to receipt of the vaccine as rabies is a fatal disease and immediate action is warranted. Available vaccines are safe and effective and have no potential to revert to their pathogenic form as it is inactivated.

Rabies is preventable and elimination is still possible if we take definite action.

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