Now Shenzhen | November 14, 2023
Shenzhen United Family Hospital Emergency Department is pleased to announce the launch of a brand new service for managing potential rabies infection from animal bites. This service is available around the clock, 24 hours per day, 7 days a week. A recent case of a 2 year old girl mauled by a Rottweiler dog in Sichuan province is a timely reminder of the importance of this service.
What is Rabies?
Rabies is an infection caused by a group of viruses called Lyssavirus that tends to attack the brain and nerves. It is a zoonosis (caught from animals) and has been around for a long time. In fact, an ancient Chinese text notes that mad dogs were driven out of the state of Lu in 556 BCE. A wide of range of mammals serve as hosts for this infection including cats, bats, sheep, cattle, foxes and ferrets but by far the commonest host is dogs, accounting for 41.8% of cases in one survey. The virus is present in saliva and therefore transmission is by biting or licking of open wounds. Rarely, it can also be transmitted by contact with infected brain tissue
（Wound Irrigated Room）
How Big is The Problem?
In China there are 40 million people injured by dogs every year and up to 99% of cases of human rabies are transmitted by dogs. In one survey, 0.33% of apparently healthy dogs were found to have the rabies virus and up to 3.3% of the brains of dogs sold at dog meat restaurants also had the virus. So unless you can be very confident that you have not suffered any injury or that the animal causing the injury has been vaccinated against rabies and has no possibility of recent exposure to rabies, then there is always a risk that an animal related injury can give rise to rabies infection.
From a peak incidence of 3300 human cases of rabies nationally in 2007, the efforts of the Chinese government have reduced the incidence to only 202 in 2020. In large part this is due to vaccination of domestic dogs kept as pets to reduce the size of the reservoir of virus and also post-exposure prophylaxis – providing treatment to prevent the development of rabies after injury. The provision of post-exposure prophylaxis reaches to almost 100% of potential cases, which is vitally important as there is no effective treatment available once rabies infection has developed and it almost always results in death.
What is Post-Exposure Prophylaxis?
There are three elements to preventing the development of rabies after possible exposure ad what is required depends on the level of exposure you have had.
1. Firstly, if you have just been handling the animal and you have no open wounds or scratches and your mucosal surfaces (eyes, nose, mouth) have not been exposed to any animal fluids, then all that is required is standard hygiene with washing / irrigating with soap or detergent and water.
2. If you have suffered a single superficial bite or wound that has not drawn blood, then the wound should be irrigated with water and detergent for at least 15 minutes. Our Emergency Department has installed a dedicated government standard irrigation room for this purpose to provide thorough wound cleaning in privacy. Rabies vaccination should then be commenced. The vaccination regime used at Shenzhen United Family Hospital is the more modern one consisting of 4 doses of vaccine which are given as an injection usually into the muscle of the upper arm. Two doses are given on day 0 (the day of exposure or attendance at the clinic), usually one dose into each arm. Then one further dose is given on day 7 and day 21. Vaccinations should start as soon as possible although there is no upper limit when it becomes too late except if you have developed any symptoms. The newer vaccines that we use rarely cause any major side effects, other than the usual vaccine related ones such as local pain, redness, swelling as well as mild fever, headache, dizziness and gastrointestinal upset. You will be routinely observed for 30 minutes after the vaccination dose to ensure that you do not have any major side effects from it. The vaccine helps your body to develop antibodies against the rabies virus and it is virtually 100% effective. Since there is a relatively high prevalence of rabies generally in China, it is recommended that you commence the vaccination regime, unless you are very sure that the animal in question has not had any recent contact with other animals and is vaccinated against rabies. There is a 10 day observation rule whereby if the animal causing the injury remains well for 10 days afterwards, then it is highly unlikely that it was infected with rabies at the time of the injury and you can stop the vaccine regime.
3. If you have had a deeper bite, or multiple bites, or have wounds that have been licked, or your mucosal surfaces have been exposed to animal fluids, then in addition to the irrigation and vaccination, you should have rabies immunoglobulin once. This is injected into and around the wound at day 0, with any excess given into muscle (but away from the site of vaccination). It can be given up to 7 days later if not given on day 0, but the sooner it is given, the better. Immunoglobulin is not required if you have previously had rabies vaccination.
The staff at Shenzhen United Family Hospital Emergency Department have all had the required training for assessing and managing wounds caused by animals and are ready and able to guide you professionally and efficiently through all aspects of treatment that may be required following these potentially concerning injuries.