First Aid Guide: Dog Bite (What is Rabies?)

Animal scratches and bites that leaves a break on the skin can sometimes cause infection. Some need stitches while others heal on their own.

Rabies, caused by Rabies lyssavirus formerly known as rabies virus, is a serious viral condition that affects the central nervous system. If left untreated, it can lead to death within a few days of infection.

Rarely, bites from wild animals can lead to rabies. Most cases are caused by infected bats, monkeys, raccoons, foxes, skunks, cattle, wolves, coyotes, dogs and cats.

Key Facts

According to the World Health Organization (WHO),

• Rabies is a vaccine-preventable viral disease which occurs in more than 150 countries and territories.
• Dogs are the main source of human rabies deaths, contributing up to 99% of all rabies transmissions to humans.
• Interrupting transmission is feasible through vaccination of dogs and prevention of dog bites.
• Infection causes tens of thousands of deaths every year, mainly in Asia and Africa.
• 40% of people bitten by suspect rabid animals are children under 15 years of age.
• Immediate, thorough wound washing with soap and water after contact with a suspect rabid animal is crucial and can save lives.
• WHO leads the collective “United Against Rabies” to drive progress towards “Zero human rabies deaths by 2030”.

First Aid Management

After getting bit by a dog, it’s important to attend to the injury right away to reduce your risk of bacterial infection. The type of first aid intervention will be determined by the severity of the bite.

In some instances, administering first aid to yourself is quite easy following below steps:

1. Wash the wound with soap and warm water. This will help flush out germs.
2. Gently press a clean cloth over the wound to stop the flow of blood.
3. If the bite is bleeding, put pressure on it using sterile gauze or a clean cloth.
4. If the bleeding has stopped, put antibiotic ointment on the wound.
5. Cover the area with a bandage or sterile gauze.
6. Monitor for signs of infection. All dog bite wounds, even minor ones, should be monitored for signs of infection until they’re completely healed.

When to seek immediate medical attention?

Whether the dog is yours or someone else’s, you may feel terrified after being bitten. If you need medical attention, call for help rather than driving yourself to the doctor or hospital.

You should seek for a prompt medical care if:

• The bite was from a wild or stray animal or a pet that isn’t up-to-date on rabies shots or an animal that is acting strangely.
• The bite has broken the skin and exposes bone, tendons, or muscle.
• The bite is on the face, head, neck, hand, foot, or near a joint.
• The bite causes loss of function, such as an inability to bend fingers.
• The bite leaks pus or fluid.
• The wound is a deep puncture or you’re not sure how serious it is.
• The skin is badly torn, crushed or bleeding significantly.
• You notice increasing swelling, redness, pain or oozing, which are warning signs of infection.
• You feel feel weak, disoriented, or faint and running a fever .
• You don’t remember having a tetanus shot in the past 10 years or five years.
• Your child is behind on shots or has not had a tetanus shot within 5 years.

If the bite was caused by a wild animal, seek advice from your doctor about which animals are most likely to carry rabies.Bats often carry rabies and can infect humans without leaving obvious signs of a bite. This is why the Centers for Disease Control and Prevention recommends that people in contact with bats — or even those who are sleeping and awaken to find a bat in the bedroom — seek medical advice about rabies shots, even if they don’t think they’ve been bitten.

If your child needs treatment, have the following information on hand:

• the kind of animal that bit your child
• the date of the animal’s last rabies vaccination, if known
• any recent unusual behavior by the animal
• the animal’s location, if known
• if the animal was a stray or wild, or was captured by a local animal control service
• your child’s immunization (shots) record
• a list of any medicines your child is allergic to

What does WHO recommends?

The World Health Organization (WHO) recommends the administration of Post-Exposure Prophylaxis (PEP) depending on the severity of the contact with the suspected rabid animal.

Below table shows categories of contact and recommended post-exposure prophylaxis (PEP).

Categories of contact with suspect rabid animal	(PEP) measures
Category I – touching or feeding animals, animal licks on intact skin (no exposure)	None
Category II – nibbling of uncovered skin, minor scratches or abrasions without bleeding (exposure)	Immediate vaccination and local treatment of the wound
Category III – single or multiple transdermal bites or scratches, contamination of mucous membrane or broken skin with saliva from animal licks, exposures due to direct contact with bats (severe exposure)	Immediate vaccination and administration of rabies immunoglobulin; local treatment of the wound

The vaccine is given as a series of four injections, over the course of several weeks. An additional injection of rabies immune globulin, a medication made up of antibodies against the rabies virus, is also required as part of the treatment.

What are the other things you need to do with the dog?

• Put distance between yourself and the dog to eliminate the chances of being bitten again.
• If there’s no longer an imminent threat, it’s important to determine if the dog has been inoculated/vaccinated against rabies.
• If you are the dog’s owner, note that even a friendly, gentle animal may sometimes bite, make sure to keep up with your dog’s rabies vaccinations.
• If the dog’s owner is nearby, ask for the dog’s vaccination history, making sure to get the owner’s name, phone number, and veterinarian’s contact information. If possible, also ask to see some sort of pet passport or ID.
• If the dog is unaccompanied, ask anyone who witnessed the attack if they’re familiar with the dog and try to find where the owner lives.

What are possible complications from a dog bite?

Dog bites can cause several complications. These include infections, rabies, nerve or muscle damage, and more.

• Infection – Different types of bacteria can live in any dog’s mouth, including staphylococcus, pasteurella and capnocytophaga. The risk for infection may be greater in people with weakened immune systems or people with diabetes.
• Nerve, blood vessels and muscle damage – This can occur even if the wound appears to be small, like from puncture marks.
• Bone Injury – A bite from a large dog may result in broken, splintered, or fractured bones, especially in the legs, feet, or hands. Always seek emergency medical help if you suspect a broken bone.
• Tetanus – a bacterial disease which can be prevented by getting a a tetanus booster shot every 10 years.
• Scarring – Dog bite can also cause scarring which may fade over time. Whereas scars which occur in visible areas such as the face, can be reduced through modern medical techniques such as grafting or plastic surgery.
• Death – (Read on as to be explained…)

When does human death occur?

According to WHO, the incubation period for rabies is typically 2–3 months but may vary from 1 week to 1 year, dependent upon factors such as the location of virus entry and viral load. Initial symptoms of rabies include a fever with pain and unusual or unexplained tingling, pricking, or burning sensation (paresthesia) at the wound site.

If the virus spreads to the central nervous system, then progressive and fatal inflammation of the brain and spinal cord develops.

There are two forms of the disease:

1. Furious rabies exhibit signs of hyperactivity, excitable behavior, hydrophobia (fear of water) and sometimes aerophobia (fear of air). With this, death occurs after a few days due to cardio-pulmonary arrest.
2. Paralytic rabies accounts for about 20% of the total number of human cases which is less dramatic and usually occurs longer than the furious form. Starting from the site of the bite or scratch, muscles gradually become paralyzed. A coma slowly develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the under-reporting of the disease.

How is it diagnosed?

Current diagnostic tools are not suitable for detecting rabies infection before the onset of clinical disease, and unless the rabies-specific signs of hydrophobia or aerophobia are present, clinical diagnosis may be difficult.

Human rabies can be confirmed intra vitam (during life) and post mortem (after death) by various diagnostic techniques that detect whole viruses, viral antigens, or nucleic acids in infected tissues (brain, skin, urine, or saliva).

Prevention

Many animal bites can be prevented in enormous ways through:

• Monitoring children around animals or even own pets. Teach them not to tease pets, to handle them gently, and to stay away from wild or stray animals.
• Get immunization. Human rabies vaccines are recommended for people in certain high-risk occupations such as laboratory workers, professional staff and wildlife rangers who might bring them into direct contact with bats, carnivores, or other mammals that may be infected; travelers to rabies-affected, remote areas who plan to spend a lot of time outdoors involved in activities such as caving or mountain-climbing; and, children living in, or visiting, remote, high risk areas as they casually play with animals.

Conclusion

Dog bites can be petrifying and can cause serious complications if left untreated. Bacterial infections are a common complication from dog bites and it’s highly significant to monitor any signs of infection.

Inoculating or vaccinating your own dog against rabies and staying away from stray dogs and other animals is your best defense from getting bitten.

Never approach a stray dog, no matter how adorable they may look. In addition, avoid playing aggressively with dogs and never disturb a dog that’s eating or caring for puppies.