Dog Bites

DR BITHIKA SHUKLA
 Why worry ?
• Dog Bite has two types of risk

a) Like any other wound it can

get infected and cause
complications

b) It may lead to a dreaded

disease - Rabies
 What is Rabies ?
• Rabies is an acute, highly fatal disease of the
Central Nervous System

• Its caused by a virus called Lyssavirus type I

of the family Rhabdoviridae

• It is basically a disease of warm blooded

animals, but humans are highly susceptible
to it.
 How does someone get Rabies ?
• The virus is present in the saliva of the
infected animal.

• When the animal bites, it gets transferred.

• It may be present in the saliva for usually 3 to

4 days , but even up to 6 days BEFORE the
animal shows any signs of the disease
 Modes of Transmission
• There are 4 modes of transmission
A) ANIMAL BITE : In India majority cases are due to dog bite.
Other animals like monkeys , cats, goats etc may also be
involved
B) LICKS : Licks on cut skin on intact mucous membrane of
mouth/ eyes etc
C) PERSON TO PERSON : Rare but can happen by 1)
transplanted cornea or other organs 2) The saliva, urine,
vomitus etc of an infected patient are highly infectious
D) AEROSOLS : Rarely respiratory transmission can occur if a
person enters a cave housing infected bats.
 Are All Bites the same ?
• Class I ( slight risk)
- Licks on healthy, unbroken skin
- Scratches without oozing of blood
- Consumption of unboiled milk of infected animal
• Class II ( Moderate Risk)
- Licks on freshly cuts on skin
- Scratches WITH oozing of blood
- Minor wounds less than 5 in number
• Class III ( Severe Risk)
- All bites / scratches with oozing of blood on HEAD, FACE, Neck, Palm or
Fingers
-Lacerated wounds on any part of the body
- Multiple wounds MORE than 5 in number
- Bites by wild animals
 Symptoms of Rabies
• Begins with vague symptoms – headache,
fever , sore throat, body ache
• Gradually patient becomes irritable and even
the mildest stimulation may precipitate fits.
• The patient may either die abruptly during
one of the fits
OR
may proceed to paralysis , coma and death.
Treatment for Rabies

NONE !
 Treatment for Rabies
• There is NO specific treatment
• Case management includes various
supportive measures like
- isolation, sedation, hydration, diuresis,
curarisation & cardio respiratory support

• Treatment has a very low rate of success

 So……

The main thrust of Rabies management is on

PREVENTION !
 Prevention of Rabies
Two major components

A) Treatment of the wound

B) Immunisation
 Local Treatment of the wound
Local Treatment of the wound is the first and
most important step.

Purpose : Remove as much of the virus from

the wound site as possible BEFORE it can attach
to the nerves

Timing : It is most effective within a few

minutes of the bite. However even if some time
has passed, it should still be done.
 Local Treatment of the wound
A) Cleansing :
Immediate flushing
and washing of
wound under a
running tap for at
least 5- 10 minutes
is of paramount
importance.
 Local Treatment of the wound

B) CHEMICAL TREATMENT
• Thorough cleaning as above, can
remove up to 70-80% of the virus from
the wound.
• Whatever virus content remains
behind can then be inactivated by
irrigation with a virucidal agent –
alcohol tincture/ iodine solution

• Cetavlon/ Savlon etc are NOT

recommended for this purpose.
 Local Treatment of the wound
C) SUTURING :
• Immediate suturing of dog bite
wounds is NOT recommended
because the trauma of suturing helps
the virus to spread faster.

• If suturing is absolutely necessary , it

will be done in a special way under
cover of anti rabies serum and with a
modified technique.

• Your Doctor is the best judge

 Local Treatment of the wound

D)Medicines :
Antibiotics and tetanus
prevention measures
must be taken as for any
other lacerated wound.
 IMMUNISATION
• Aim : to produce an immune status as quickly
as possible so before the virus can spread.

• Timing : First dose must be taken as early

possible after the bite.

• In BHEL hospital the emergency vaccine is

available round the clock. So please come to
the hospital as soon as possible.
 IMMUNISATION
• Type of Vaccine : It is an injection.

• Where is it injected ? : In your upper

arm

• How many injections to be taken ? :

6 doses of 1 ml each
 IMMUNISATION
• When to be taken ?
Day zero : Day zero is the date of the first
injection NOT the day of bite
Day 3
Day 7
Day 14
Day 28
Day 90 : Booster
• Your doctor will draw up a schedule for you –
please follow it
 IMMUNISATION
• The vaccine must be stored in the
refrigerator. Once taken out the efficacy
rapidly deteriorates

• Any restrictions on food ? :

None. You can take normal diet during the
period of vaccine intake. Alcohol must be
avoided for the duration.
 IMMUNISATION
What if I am bitten by a pet dog/ very small dog/
vaccinated dog ? :
• In such cases too you need to do the local
wound treatment as above.
• You must take the first three doses of the
vaccine .
• If by the 10th day the dog is showing no
abnormality & has been cleared by a veterinary
doctor – you can discontinue after that
 Take Home Message
• Do NOT neglect dog bites
• As soon as bitten, wash the wound under
running water with soap for at least 5- 10
minutes
• Go to the hospital as soon as possible after a
dog bite
• Follow the immunisation and other advice by
the doctor very strictly
 REMEMBER..

Prevention is the ONLY effective weapon we

have against the deadly disease Rabies.