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Rabies

Leon LI, Associate Chief Medical Officer
Department chair of Emergency Medicine at Shanghai United Family Hospital and Clinics
Department chair of the Emergency and Critical Care Center of Shanghai Market

Clinics in the city are seeing an increasing number of patients suffering from bites or scratches by dogs or other animals in the summer, compared to in cooler seasons. Dog bites or scratches may cause rabies, a life-threatening but preventable disease. Today, our emergency department chair Leon Li will talk about the risk of rabies and the correct way to prevent the disease.

Q: What is rabies?

A: According to the World Health Organization (WHO), rabies is a vaccine-preventable viral disease that occurs in more than 150 countries and territories. It spreads through the saliva of animals infected with the rabies virus. People are usually infected following a deep bite or scratch from an animal with rabies.

The virus destroys neurons and leads to brain inflammation. Early symptoms of rabies include weakness, fever, headache, anxiety, sore throat and cough, which are very flu-like. They may develop into aggression, convulsions, hallucinations, coma and death.

When people develop symptoms of rabies, there is no cure, and the fatality rate is almost 100 percent. Infection causes tens of thousands of deaths every year, mainly in Asia and Africa.

But this can be prevented with vaccines. With proper treatment, people suffering dog bites can be fully protected. Therefore, we suggest that people go to clinics and get vaccinated as soon as possible after being injured by pets as there is no guaranteed safe period for waiting.

Q: Do all pets or animals carry the rabies virus?

A: The rabies virus only spreads among mammals, such as dogs, cats, sheep, cows, bats and mice. Dogs are the main source of human rabies deaths, contributing up to 99% of all rabies transmissions to humans. There are few cases of rabies transmitted by mice, but as a precaution, we suggest that people receive the rabies vaccine even if they were bitten by a pet mouse. However, if you were bitten by a turtle, you don’t have to worry about being infected with the rabies virus.

Q: Why is summer a peak season for dog bites?

A: Animals are more irritable and more inclined to attack people on hot days. Also, in hot seasons like summer, people wear fewer clothes, so it’s easier to get injured. Therefore, although dog bites happen all year round, the incidence is higher in summer.

Q: How can rabies be prevented?

A: Vaccinating dogs is the most cost-effective strategy for preventing rabies in people. Dog vaccination reduces deaths attributable to dog-mediated rabies and the need for post-exposure prophylaxis for people.

Q: What do you suggest people do if they are bitten by a dog?

A: There are basically three steps to observe:

  1. Don’t panic. Keep calm, and observe the conditions carefully. Take note of what type of animal it is, whether it’s a pet or a wild animal and whether the bite was provoked or unprovoked. Usually, if the animal is wild and the bite is unprovoked, you are at higher risk of contracting the rabies virus. Provide the doctor with all the information, which will help them to assess the risk and decide on your
  2. Go to a hospital or clinic capable of treating dog bites as soon as possible. There are dozens of such facilities in Shanghai, and you can search for the nearest one online conveniently. All of them operate around the clock.
  3. Take the rabies vaccine if necessary.

Q: What is the treatment for dog bites?

A: At dog bite clinics, medical staff will wash the bite wound and decide on the degree of its severity, according to a three-level assessment system before taking corresponding actions.

Depending on the severity of the contact with the suspected rabid animal, administration of a full post-exposure prophylaxis course is recommended by the WHO as follows:

Categories of contact with suspected rabid animal Post-exposure prophylaxis measures
Category I – touching or feeding animals, animal licks on intact skin (no exposure) Washing of exposed skin surfaces, no PEP
Category II – nibbling of uncovered skin, minor scratches or abrasions without bleeding (exposure) Wound washing and immediate vaccination
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) Wound washing, immediate vaccination and administration of rabies immunoglobulin

Q: What are the options for rabies vaccines?

A: The vaccines at Shanghai United Family Hospital are supplied by the Shanghai Center for Disease Prevention and Control, and they are all developed by Chinese producers. Some of them require four shots, and some need five. What patients get depends on the supply from the center.

Q: Are there any precautions to take when receiving rabies vaccine inoculations?

A: People are advised not to change vaccine brands for the same bite. They should follow the vaccination schedule prescribed in the vaccine instruction book. If you have health problems and need to postpone an inoculation, please get permission from your doctor.

Q: Do the vaccines cause any adverse side effects?

A: Like other vaccines, adverse reactions to rabies vaccines can include swelling in the place of injection and fever. These symptoms go away for most people without medical intervention.

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