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What to do when a stray dog bites you?

2/24/2014

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In India, there are lots of strays around but you should beware of them as many of them are not immunized and can be infected with rabies. If you are bitten by a stray dog and your skin is broken and exposed to the salaiva of the animal, within 24 hours you should visit the vet to get a rabipur injection course. The rabipur will be injected on the 0, 3, 7, 14 and 28th days in the left arm.

once rabies takes hold on your body, it is impossible to cure and mortality is 100%. So I would highly recommend a visit to a infectious disease specialist, who is aware of the WHO guidelines for rabies treatment.
Many doctors don't know that in addition to the rabipur dosage for a category III bite (broken skin, bleeding, and exposure to animal salaiva), you should also get a dosage of what is known as anti-rabies immunoglobulin ideally within 24 hours or atleast within 7 days. This procedure is described in detail in the WHO Anti Rabies Treatment. This anti-rabies immuniglobulin is not easily available in most pharmacies and needs to be ordered. You need to inject 20 IU per kg of body weight and usually requires about 3-4 vials depending on the body weight. One reason many doctors do not prescribe it is the high cost, at Rs 2500 to Rs 3500 per vial. Ideally this is not required if the animal which bit you can be captured and observed for 5 days for rabies symptoms. This can be done in the USA or other countries with better animal control procedures but might not be possible in India. So if you really want to be safe it is best to get this rather than lose your life over an additional Rs 10,000.

After we met a general physician who recommended a tetanus shot for a dog bite, I am convinced that most GPs are not aware of the treatment scope for rabies. Please note that once rabies takes hold on your body, it is impossible to cure and mortality is 100%. So I would highly recommend a visit to a infectious disease specialist, who is aware of the WHO guidelines for rabies treatment. If you are in Chennai I recommend, Dr. D. Suresh Kumar (MBBS, MD(Gen.Med.), FHIV, ACTMH), who works at the main Apollo Hospital in Greams road and the Vijaya Hospital in Vadapalani.

P.S. Only recently has the union health ministry issued guidelines on use of this immunoglobulin, which is in line with the WHO guideline. I stress that even if doctors do not prescribe you the Rabipur + Immunoglobulin, go and find yourself a doctor who will. Do not blindly trust the doctor, who sometimes do not prescribe anything or even suggest absurd things like tetanus shots.

                                                                                                                                                                                                                   - Aditya Raghav
                                                                                                                                                                                               aditya.raghav@gmail.com

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