Reality Bites

After many years of creating and providing dog bite prevention curriculum and materials for children, I had to bring all my rabies knowledge to the fore during a recent trip to Nepal.

Let me explain, I am a communicable disease health educator in North Carolina. I write educational materials in English and Spanish about a myriad of diseases, one being rabies. I had the wonderful opportunity to go trekking in Nepal this spring. One of the first things that got my attention while traveling in Nepal was the number of dogs in the streets that seemed to have no owners. We might call them “feral” dogs, but that usually makes us think of dogs traveling in packs and looking scary. These mutts were mostly scrawny, docile animals which could be found sleeping in the streets of Nepal’s cities and towns.

One day, when we were about 10 days walk away from any roads, one of these sleeping ownerless dogs that I had seen in the villages, suddenly jumped up and bit ME in the rear as I walked by. None of my training in dog bite prevention could have helped me since this dog was seemingly fast asleep as I walked by. We usually teach children to: Ask before petting a dog; Keep their faces away from dog’s faces; Be like a tree or like a rock (stay still) if a loose dog approaches them; And never bother a dog when it’s eating, sleeping or with puppies.

Fortunately, my understanding of rabies was able to help me decide what course of action to take. My guide immediately wanted to have me helicoptered out to begin rabies post exposure prophylaxis. After planning for this trip for so long and saving the money needed to go, I was reluctant to give up the trip half way through – besides we still hadn’t reached the pass and we had several days before our return to Kathmandu. I was thinking that I should have considered Pre-exposure vaccination before I left! We quickly asked the villagers if they knew the dog and learned that it had bitten frequently over the past year, the last time being 3 weeks prior. Since the dog was still alive, I hoped that it was just a biting dog and not a rabid one. I also knew that if the dog remained healthy for 10 days, it would not have had rabies virus in its saliva when it bit me. I decided to continue on my trek since we would be at a major medical center within a few days. We washed the wound well with warm soapy water for 15 minutes, used an antiseptic and bandaged the bite well. Immediately upon return to Kathmandu, I visited a local clinic and was able to start post exposure prophylaxis before leaving the country and finished my rabies vaccine series within a month.

While the memory of the bite is fading quickly, my love for the people I encountered, the beauty of the place and the thrill of finishing my trek will stay with me a lifetime.

Contributed by Carla Piedrahita, Health Educator in the Communicable Disease Program, Wake County Human Services. Her children's coloring book on dog bite prevention and rabies prevention flyers are available from the WRD Education Bank.

 

The observation period for biting dogs is set at 10 days because if the dog had rabies virus in its saliva at the time of a bite, within 10 days it would be showing clinical signs of rabies, or be dead. WHO recommendations are that PEP should be started immediately after a bite, but that if the biting dog remains healthy after 10 days, PEP can be discontinued.