Dog Bite
And Its
Prevention
Dr. Syed Tafazzul Hyder Zaidi
Assistant Professor,
Community medicine Department
SMC, JSMUK
Dog Bites:
“Dog Bites or
Dog Attacks are
attacks on
Humans by
Stray or
Domestic
Dogs.”
Dog behavior:
• Like humans in Fear and Self-Defense,
dogs react when fearful, and may feel
driven to attack out of self-defense, even
when not in fact being "attacked".
• Speed of Movement, Noises, Objects or
Specific Gestures such as Raising an Arm
or standing up may Elicit a Reaction.
• Specific Fears of Men, Women, Skin
Coloring, and other features that recall
Past Abusers, are common.
Dog behavior/2:
• A dog may also perceive a Hand reached
out toward its Head as an attempt to gain
control of the dog's neck via the Collar,
which if done to a Suspicious Dog by a
Stranger can easily provoke a bite.
Rabies
Acute viral disease of
CNS
Involving
All mammals
RNA Virus Lyssavirus
Rhabdoviruses(Mammals)
Epidemiology
Worldwide distribution
Urban Rabies: Dogs, Cats
Sylvatic Rabies: Foxes, Wolves,
Bats
Distribution Of Rabies Transmitted by Various Mammals
Transmission
•Bite
•Aerosol
•Ingestion
•Transplantation
Pathogenesis
Epidermis, Mucus membrane
Live virus
Peripheral nerve
CNS ( gray matter )
Other tissue (salivary glands,…)
Clinical Manifestations
Non specific prodrome
Acute neurologic encephalitis
Acute encephalitis
Profound dysfunction of
brainstem
Coma
Death Rare Cases Recovery
Clinical Manifestations/2
1 – Non Specific Prodrome
1 - 2 days 1 week
Fever, headache, sore throat
Anorexia, nausea, vomiting,
Agitation, depression
Paresthesia or Fasciculations at or
Around the site of inoculation of
virus.
Clinical Manifestations/3
2.Acute Neurologic Encephalitis
Phase
Furious Rabies
Dumb ( Rage tranquille )
(Landry/Guillain-Barre Syndrome)
Clinical Manifestations/4
2 – Acute Neurologic Encephalitis /2
1 – 2 days to < 1 week
Excessive motor activity, Excitation,
Agitation
Confusion, Hallucinations, Delirium,
Bizarre aberrations of thought,
Seizures,
Muscle spasms, Meningismus,
Opisthotonic posturing
Mental aberration (Lucid period
coma )
Hypersalivation, Aphasia
Clinical Manifestations/5
Pharyngeal spasms
Incoordination, Hyperactivity,
Fever T > 40.6
Dilated irregular pupils
Lacrimation, Salivation and
Perspiration
Upper motor neuron paralysis
Deep tendon reflexes
Extensor plantar responses(as a rule )
Hydrophobia or Aerophobia(50-70% )
Planter Reflex- Babinski's sign
Dog bite Wound;
Signs indicating an infection include:
The wound becomes more Painful.
Redness and Swelling around the bite.
Fluid or Pus leaking from the bite.
A fever with a temperature of 38°C or
above and Shivers.
Swollen Lymph Glands.
Diagnosis
Laboratory finding: ( CBC, CSF )
Exclusion of other etiologies
Pathology:
Formation of cytoplasmic inclusions:
( Negri bodies )
( Ammon’s Horn, Cerebral Cortex,
Brainstem, Hypothalamus,
The Purkinje cells of Cerebellum,
Dorsal Spinal Ganglia )
Diagnosis/2
•Isolation of virus (Saliva,CSF, brain )
•Serology
•Viral Ag detection (infected tissue )
•Viral DNA detection ( PCR )
Differential Diagnosis
Other viral encephalitis
Hysteria reaction to animal
bite
Landry/Guillan-barre syndrome
Poliomyelitis
Allergic encephalomyelitis
( rabies vaccine )
Prevention:
Preexposure Prophylaxis
Postexposure Prophylaxis
Prevention/2
Preexposure Prophylaxis:
• Pre-exposure vaccination against rabies
Simplifies the rabies post-exposure
treatment.
• It may Protect in cases of unrecognized
rabies exposure or when post-exposure
treatment is delayed.
• It does not eliminate the need for
appropriate treatment following a
known rabies virus exposure.
Prevention/3
Who should receive rabies pre-
exposure prophylaxis?
•Veterinarians, Veterinary
Technicians, Animal Control Officers,
Wildlife Rehabilitators, Zoo
Employees, Certain Laboratory
Workers, and others who have
regular contact with potentially
Rabid Animal Species.
Prevention/4
• Initiation of Preexposure Prophylaxis
should not await the results of
laboratory diagnosis or be delayed
by dog observation when rabies is
suspected.
• Pregnancy and Infancy are never
contraindications to Preexposure
Prophylaxis
Prevention/5
Pre-exposure rabies vaccination series
• Three 1.0 mL doses of Rabies Vaccine are
given IM, one injection per day, on days
0, 7, and 21 or 28, in the Deltoid area of
Adults or in the Anterolateral Thigh of
Young Children.
oHuman Diploid Cell Vaccine (HDVC)
oPurified Chick Embryo Cell Vaccine
(PCEC)
Rabies Vaccines
Prevention/5
Postexposure Prophylaxis
• Wound cleaning & treatment
( Tetanus & Antibiotics )
• Passive immunization
• Active immunization
Prevention/5
Wound Treatment:
• Should be immediate
• Is essential even if the person presents
long after exposure
• consists of:
Immediate washing and flushing for 15
minutes with Soap and Water, or water
alone.
Disinfection with Ethanol (700ml/L) or
Iodine (tincture or aqueous solution).
Wound cleaning and treatment/1
Wound cleaning and treatment/2
Wound cleaning and treatment/3
Wound cleaning and treatment/4
Wound cleaning and treatment/3
Active immunization
On Days:
0, 7, 21 (28)
Booster doses
Active immunization/2
• Persons who present for Evaluation
and rabies post-exposure
prophylaxis even months after
having been bitten should be dealt
with in the same manner as if the
contact occurred recently.
Louis Pasteur
developed
Rabies
Vaccine in
1885
Prevention in Animals
Prevention in Dogs
• Dog vaccination is the most cost-
effective single intervention to protect
humans from contracting rabies.
• Dogs are the main source and major
reservoirs of rabies in most infected
developing and emerging countries.
• Controlling rabies in owned dogs and
stray dog populations when possible is
key to preventing human deaths by
rabies worldwide
Prevention in Dogs/2
• In many countries, dog vaccination is
not yet considered as the key
solution to eliminate rabies in
humans.
• Health Education
General Public Health Safety Measures
•Immunize all Dogs and Cats owned
by an individual or by the
community.
•Reduce the number of Stray Dogs.
•Immunize any person with proven
or probable exposure to rabies and
administer rabies Immunoglobulin
in case of Severe Exposure.
General Public Health Safety Measures
• Humans at high risk (e.g. laboratory
personnel, professions at high risk)
must receive pre-exposure
immunization: 3 injections of an
intramuscular dose on days 0, 7, and
28.
• Pre-exposure vaccine regimen:
1 dose on day 0, 7, 14, 28 dose of
a Live Attenuated Vaccine is given to
High Risk Individual
Rabies: Key Facts
• Rabies is a Vaccine-Preventable Viral
Disease which occurs in more than
150 countries and territories.
• Dogs are the source of the vast
majority of Human Rabies Deaths.
• Rabies elimination is feasible by
Vaccinating Dogs.
Rabies: Key Facts/2
• Infection causes Tens of Thousands of
Deaths Every Year mostly in Asia and
Africa.
• 40% of people who are bitten by suspect
rabid animals are children under 15
years of age.
• Immediate Wound Cleansing with Soap
and Water after contact with a suspect
rabid animal can be Life-Saving.
Rabies: Key Facts/3
• Every year, more than 15 million people
worldwide receive a Post-Bite Vaccination to
prevent the disease; this is estimated to
Prevent Hundreds of Thousands of rabies
deaths annually.
• The Average Cost of rabies Post-Exposure
Prophylaxis (PEP) can cost up to US$ 49(PKR
4,900/-) in Asia, where the average daily
income is about US$ 2-4 (PKR 12,000/-)per
person per Month.
