Myths about dog bites and rabies: Why even a scratch should be taken seriously

Globally, rabies stands as the tenth-largest cause of death due to infectious diseases. Here's what experts say about the fatal infection.

ByChetana Belagere

Published Sep 10, 2023 | 10:30 AMUpdatedSep 10, 2023 | 6:55 PM

Doctors claim that a majority of human rabies cases in India are due to dog bites.

While an investigation is on in the case of the death of a 14-year-old Ghaziabad boy from rabies, allegedly after a dog bite, the incident has cast a glaring spotlight on myths and misconceptions around dog bites and rabies.

“Mortality rate in human rabies cases is 100 percent. Unfortunately, no cure has been found for rabies. Most cases of rabies occur from not receiving the recommended treatment following a bite or scratch from an infected animal,” says Dr Rajeev Jayadevan, Member, Public Health Advisory Panel, Kerala State Indian Medican Association (IMA), who has been extensively researching dog bites and rabies.

Rabies and dog bites in India 

Remarkably, India bears the grim burden of accounting for a staggering 36 percent of global rabies deaths, an enduring public health challenge that demands our attention.

Dr Jayadevan says that as per data from WHO, approximately 20,000 deaths occur in India every year from rabies. On a global scale, rabies stands as the 10th-largest cause of death due to infectious diseases. Meanwhile, India also shoulders a crushing 65 percent of rabies-related fatalities within the South East Asia region.

“About 30-60 percent of reported rabies cases and deaths in India occur in children under the age of 15 years, as bites that occur in children often go unrecognised and unreported,” says WHO.

Doctors claim that a majority of human rabies cases in India are due to dog bites.

Despite the new animal birth control rules of 2023, which lay down steps to sterilise animals and regulate their population in a manner that complies with various orders by the Supreme Court, the number of incidents of stray dog bites and mauling of children across the country is increasing drastically.

There have been several cases of pet dog bites too.

Despite the norms requiring states to implement birth control and anti-rabies drives simultaneously, Kerala alone, in the year 2022, reported 1.2 lakh dog bite cases. “In the span of one year, 18 people died due to rabies in Kerala, indicating serious concern,” adds Dr Jayadevan.

Meanwhile, Dr NR Ramesh Masthi, Professor and HOD of Community Medicine at Bengaluru’s Kempegowda Institute of Medical Sciences, says, “Bengaluru alone has reported four rabies cases in the last month.”

Also Read: Hyderabad U advisory to ‘avoid’ feeding stray dogs sparks debate

Myths about animal bites

Doctors clarify that the primary misconception is that rabies occurs only due to dog bites. This is not true. While human rabies is mostly transmitted through dog bites, Dr Masthi clarifies that bites from infected cats, monkeys, jackals, or any other animal can also pass on the disease.

Meanwhile, it is also important to know that not just bites, but even infected animal saliva on broken skin, inner mouth, or nose can transmit rabies.

stray dogs

The Kerala government-constituted vaccine policy formulation committee has recommended anti-rabies vaccine shots for children and adults falling in the high-risk category. (Creative Commons)

Dr Jayadevan explains that once an infected dog bites, the dog’s saliva is deposited in the open wound. Then, the infection enters the person’s nervous system and slowly find its way to the brain and spinal cord.

“The speed of travel along the nerve might range from 5 to 100 mm per day. Depending on the conditions, the virus may take several days or weeks to show symptoms of rabies. The end result is death,” he explains.

However, after the dog bite, Dr Masthi says that, in his clinical practice, he has seen many people resorting to the application of turmeric powder and leaves as a measure to prevent rabies. “People use turmeric or some kind of leaves on the wound and let it be. This is dangerous,” he explains.

Dr Masthi adds that people also tend to believe that only if there is visible bleeding, it causes rabies.

“The truth of the matter is that even a single drop of blood means that there is a cut in the skin and the rabies virus can enter the human body,” Dr Masthi explains.

The other major myth is that puppies don’t bite and if they do, their bites do not transmit rabies. The fact is that puppies do bite, even if it is playfully, and they can transmit the disease.

“In many cases, puppy bites are ignored and several times, they are unvaccinated for many months. This leaves them more vulnerable and if they become infected, their bite can lead to rabies deaths,” explains Dr Masthi.

This reinforces the necessity of responsible pet care and vaccination programmes to control rabies.

Also Read: 4-year-old mauled to death by stray dogs in Hyderabad

Can vaccinated dogs transmit rabies?

Doctors explain that a vaccinated dog is unlikely to transmit rabies, but they say that it is essential to understand the nuances of rabies vaccination to get a clear picture.

When a dog receives a rabies vaccine, it stimulates the dog’s immune system to produce antibodies against the rabies virus. These antibodies serve as a defense mechanism, effectively neutralising the virus if the dog were to encounter it.

Rabies

Rabies can spread to people and pets if they are bitten or scratched by a rabid animal. (Creative Commons)

However, there are a few important caveats to consider, explain the doctors. While the effectiveness of a rabies vaccine can vary depending on the type of vaccine used, the dog’s overall health, and the administration process, no vaccine can guarantee 100 percent immunity.

Meanwhile, dogs typically receive rabies vaccinations on a specific schedule, with boosters needed periodically. If a dog misses a booster shot or the vaccine’s potency wanes, their protection may decrease.

Also, if a vaccinated dog is bitten or exposed to a rabid animal, there is still a small risk of transmission. This is because the virus can be present at the site of the bite before the dog’s immune system has a chance to neutralise it.

Highlighting a significant challenge in the field of rabies prevention, Dr Masthi explains, “There are a very few labs available to check the antibody titers in animals, particularly dogs, after vaccination.”

This means that many times, the antibodies required for protection are not detected despite vaccination. It’s a concerning issue that underscores the need for better monitoring and research in this area.

Also Read: A temple where dogs are brought for their naming ceremony

Can humans get rabies even after the vaccine?

While rabies is definitely a vaccine-preventable disease and the vaccine is given free of cost at all government hospitals, Dr Jayadevan says that there are a few undesirable outcomes that could occur despite treatment for rabies.

After reviewing scientific literature from around the world, Dr Jayadevan says that deep bites in areas rich in nerve supply, such as the face and hands, make it easier for the virus to invade the nerves.

Citing one case of a five-year-old from Chandigarh, who had died after she had severe facial wounds caused by a rabid dog bite, Dr Jayadevan says that despite receiving the immunoglobulin vaccine, she died.

Similarly, he says that it is risky if the victim suffers from multiple wounds as the virus may then enter through multiple sites. This might need more care, he adds.

Importantly, a bite on the leg will involve longer travel distance to the brain and spinal cord as it gives time for our immune system to overpower the virus, but a bite on the head or neck can cause it to reach the brain faster.

Also Read: Kerala set to launch month-long vaccination drive for stray dogs

Importance of proper wound care after dog bite

One critical aspect Dr Masthi emphasises is the importance of proper wound care. “Many people resort to local practices, like applying turmeric, which, in reality, acts as an irritant and does not kill the virus,” he explains.

“The most vital treatment is washing the wounds with soap and water, which can eliminate 80-95 percent of the virus,” he says. This simple yet effective measure is often neglected but can make a significant difference.

If bitten by a dog, it is important to thoroughly wash out the wound. (Wikimedia Commons)

If bitten by a dog, it is important to thoroughly wash out the wound. (Wikimedia Commons)

A study from the National Institute of Communicable Disease (NICD) India, done in 2021-2002, shows that about 40 percent of people did not wash the wounds before arriving at the hospital, and even at the hospitals, only a few of them routinely performed wound washing.

Doctors insist that after washing, they must avoid dressing or bandaging the wound.

Meanwhile, the rabies vaccine should be stored in the refrigerator between 2 to 8 degrees and is usually given on days 0 (the day of the bite), day 7, and 21 days. Post-vaccination, a person enjoys complete protection for three years.

After this period, the efficacy might vary. However, it is recommended that if there is a repeat dog bite, after taking a vaccine, it is still important to seek medical assistance.

Another area where misconceptions can have life-altering consequences is the categorisation of exposure. “Wrong categorisation of exposure, such as classifying a Cat-3 exposure as Cat-2, can lead to the denial of life-saving local administration of anti-rabies serum,” Dr Masthi warns. He stressed that local infiltration of rabies immunoglobulin at the site of the bite is crucial for neutralising the virus.

Dr Masthi adds that overconfidence among those exposed to bites, thinking that nothing will happen to them, is a grave concern. Rabies is a relentless disease and early intervention is essential.

Also Read: Asifabad buffalo calf death from suspected rabies

Symptoms of rabies

The symptoms of rabies typically progress in stages and can vary in intensity. According to doctors, the initial symptoms are fever, headache, fatigue, nausea, vomiting, anxiety, restlessness, pain, itching, tingling sensation at the site of the wound.

Symptoms of rabies. (NHP Facebook)

Symptoms of rabies. (NHP Facebook)

For furious rabies, there could be acute neurological symptoms like agitation and hyperactivity, hallucinations, excessive foaming at the mouth, difficulty in swallowing leading to fear of water, seizures, aggression, and erratic behaviour.

Even further, the symptoms could worsen, reaching a stage of paralysis, loss of coordination, respiratory failure, and end in a coma or death.

Meanwhile, doctors insist that people should not sit and wait for the infected animal to exhibit symptoms of rabies. They must seek medical attention immediately after the bite or scratch. “Over-treatment is better than no treatment leading to death,” quips Dr Masthi.

However, infected animals might exhibit symptoms of over-salivating, unnecessarily biting, showing aggression, leading to death in 7-10 days of the bite incident.

Also Read: Kerala panel suggests anti-rabies vaccines for kids

How quickly will symptoms appear?

The incubation period, which is the time between being exposed to the virus and the onset of symptoms, for rabies can vary. On average, it ranges from several weeks to several months, but it can be shorter or longer in some cases.

The incubation period depends on various factors, including the location and severity of the exposure, the type of rabies virus involved, and the individual’s immune system response. In some rare instances, symptoms can appear within days of exposure, while in others, it may take years for symptoms to manifest.

It’s important to note that once symptoms of rabies appear, the disease is almost always fatal. This underscores the urgency of seeking medical attention and receiving post-exposure prophylaxis (PEP) promptly after a potential rabies exposure.

PEP is highly effective in preventing the onset of rabies symptoms when administered before the virus reaches the central nervous system.

To be safe, it is crucial to consult a healthcare professional immediately after any potential rabies exposure to assess the need for PEP, rather than waiting for symptoms to develop.