Rabies, how serious is this in real life on Bali?

[mat]

Here is the link to the latest story I have seen on rabies.

Radio Australia:Connect Asia:Story:Bali authorities failing to control rabid dogs

[tintin]

Quoted in Bali Updates of March 1, 2010,

Concerning to Dr. Wirasandi is the fact that at least 5 of those who have died of rabies received two of three treatments with anti-rabies serum, with one having received the complete regime of 3 shots. Post-mortem studies revealed that two of the patients receiving two sets of serum did, in fact, died of rabies.

When will the Bali doctors learn that the protocol for a proper post-exposure anti-rabies vaccination is not 3 shots.

First of all, the wound cleansing is most important in rabies prevention since, it has been shown that wound cleansing alone, without other post-exposure prophylaxis, markedly reduces the likelihood of rabies. Tetanus prophylaxis should also be administered if you have not been immunized in ten years.

Second, for persons who have never been vaccinated against rabies previously, post-exposure anti-rabies vaccination should always include the administration of BOTH the combination of human rabies immune globulin (HRIG) and vaccine for both bite and non-bite exposures.

Rabies Immune Globulin

Human rabies immune globulin (HRIG) is administered only once, at the beginning of anti-rabies prophylaxis, in order to provide immediate antibodies until they responds to the vaccine by actively producing antibodies of their own.

Rabies Vaccine

A regimen of FOUR, 1-mL doses of HDCV vaccines should be administered intramuscularly. The first dose of the four-dose course should be administered as soon as possible after exposure. Additional doses should be administered on DAYS 3, 7, and 14 after the first vaccination. Please note that a fifth dose on Day 28 used to be administered until recently, but is no longer judged necessary.

Persons who have been previously vaccinated or are receiving pre-exposure vaccination for rabies should receive only the vaccine.


Finally,

There is also a growing problem securing a sufficient supply anti-rabies serum. A 5 year old boy died of rabies in Bali on Sunday, February 21, 2010. The child, who came to the hospital for treatment after being bitten in the face by a dog, did not receive the needed serum, apparently because officials had no supply of the serum to give the child.

How can this be possible in Bali? Bali is not exactly the backwater of Indonesia…What about worrying a little less about the spirits of the departeds and more about the spirits of the livings?

[Jesse]

I haven't thought about rabies vaccination is quite complicated in other terms. Maybe that's the reason why doctors have to be careful with the dosage especially if the risk is quite minimal.

[tintin]

"rabies vaccination is quite complicated?" You must be kidding. What's complicated about giving a 1ml shot to a patient 4 times over a 2-week period? One does not even need a medical doctor; a nurse can do it, and, in most cases, probably better. As for the risk being "quite minimal", think again...a bat, a dog, or any other rabid animal bits you, and you're a goner unless you get the anti-rabies treatment.

And this was the point of my first comment. The anti-rabies treatment, according to every medical sources I have consulted, including CDC, is 100% effective, when used in time.

[MiSO]

First of all, the wound cleansing is most important in rabies prevention since, it has been shown that wound cleansing alone, without other post-exposure prophylaxis, markedly reduces the likelihood of rabies.

The advice 'cleansing the bite with running water' (Bali Advertiser) confuses me. Is tapwater clean enough not to infect the wound?

How can this be possible in Bali? Bali is not exactly the backwater of Indonesia…What about worrying a little less about the spirits of the departeds and more about the spirits of the livings?

Nicely put.

[tintin]

MiSO,

The advice 'cleansing the bite with running water' (Bali Advertiser) confuses me. Is tapwater clean enough not to infect the wound?

I have not read the recommendations of the Bali Advertiser, but just water would not be sufficient. First, one needs to wash the bite with water AND soap, and do a thorough job.

The point is to dilute and clean the wound from as much of the rabies virus as possible. Any other bacteria contained in the running water should be the least of your problem at the time.

[MiSO]

MiSO,

I have not read the recommendations of the Bali Advertiser, but just water would not be sufficient. First, one needs to wash the bite with water AND soap, and do a thorough job.

The point is to dilute and clean the wound from as much of the rabies virus as possible. Any other bacteria contained in the running water should be the least of your problem at the time.

:-) You're so right about this...

[MiSO]

This week it was my turn... I got bitten by a dog. Gladly I wore trousers made of thick fabric, so it is only swollen and purple.
It wasn't one of the streetdogs that was chasing after me when I was on my sepeda, push-bike. It was the dog of my house owner. An other lucky thing: the dog had been injected (anti rabies)

[Markit]

Crunchapuppy score: Markit 5, Puppies 1 (Miso?) If it was me I'd get the vaccine...anyway!

[MiSO]

That doggie has been licking the whole family, so I am not worried. I do feel sick, feverish, sore throat, nautious, but that's because I used th AC against the mozzies (catched a cold) I hate the AC. But I have mozzies even more.