What to do in the emergency room in the case of a suspected rabid dog bite?

Rabies is an acute viral zoonosis that is spread through bites or scratches but usually by saliva. Once the first symptoms develop, it is a fatal disease in susceptible humans and animals.

Currently, Spain is at high risk of suffering a rabies outbreak due to the low rate of canine vaccination as the Autonomous Communities decide the vaccination strategy for dogs, cats, and ferrets. It is compulsory throughout the national territory for these animals to be vaccinated, except in Galicia, Basque Country, and Catalonia. In the case of Asturias, vaccination is only mandatory for potentially dangerous dogs.

In this article, we present the case of a five-year-old girl who came to the emergency service for a dog bite three weeks after the accident had occurred in Cochabamba (Bolivia). The animal had died with a diagnosis of suspected rabies. The girl had the correct childhood vaccination schedule, as well as immunization against hepatitis A and yellow fever. Anti-rabies prophylaxis was not considered before the trip.

The epidemiological characteristics of the accident were evaluated and a physical examination was performed, taking into account the description of the animal (a domestic dog with little hygienic and vaccination care), the place where it occurred (the countryside), the type of bite (on the left side, superficial and with little bleeding) and the immediate action taken (cleaning with water, mud and leaves).

The girl was in good general condition (she was asymptomatic). On the left side there were two hyperchromatic spots, closed and without signs of infection. There was no pain on palpation or limitation to mobilization of the affected area.

The type of accident and the physical examination indicated a low risk of rabies transmission, but it was not possible to rule out contagion. In addition, through the World Health Organization (WHO), it was verified that Bolivia, and specifically the Cochabamba region, had endemic rabies.

Based on the above, the case was considered to be at a high risk of infection and the postexposure prophylaxis protocol was initiated. Human immunoglobulin (20 IU/kg) was administered, half perilesional and half in the deltoid, as well as the first dose of vaccine in an area distal to the immunoglobulin (contralateral deltoid). The girl was discharged to complete the 5-dose vaccination regimen from primary care.

Although this is an exported case, it is very important to educate the population that rabies is a totally preventable disease. Encouraging responsible dog ownership, including rabies vaccination, bite prevention and first aid for bite victims, as well as wound washing and post-exposure injections, is essential in preventing and controlling this zoonosis.

Fernández Prada; M. et al (2013) ¿Qué hacer en urgencias ante una mordedura canina con sospecha de rabia? A propósito de un caso. Lugar: Unidad de Gestión Clínica Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario San Cecilio, Granada, España

 

Link: https://www.analesdepediatria.org/es-que-hacer-urgencias-ante-una-articulo-S1695403313003706