How to act if bitten or scratched
A person usually loses the ability to think critically when in shock from being suddenly bitten on the finger by a squirrel in the park, attacked and bitten on the leg by a rat in a private house, unexpectedly scratched to the blood by a cat, or simply when a stray dog suddenly decides to taste him by attacking without warning... How should a person who has been bitten or scratched act to prevent the spread of rabies, which is carried by both wild and unvaccinated domestic animals? What services should be provided to the victim at a medical facility? What restrictions will arise in the life of a person who needs to undergo a rabies vaccination course? For answers to these questions, we turn to the City Polyclinic for Builders. This is the only place in Bishkek where there is a rabies specialist's office – a specialist who studies, combats, and prevents rabies.
Two specialists conduct consultations six days a week. There are only five rabies specialists – infectious disease doctors with a narrow specialization – in all of Kyrgyzstan, and they work in regional centers. However, this does not mean that there is no one to provide assistance in the regions for bites and scratches from animals – in remote villages and small towns, trauma surgeons who have received additional training perform the functions of a rabies specialist. "AiF" addressed the pressing questions to Danagul Asanbekovna ABDYGULOVA, a rabies specialist from Bishkek.
Everyone bites, everyone gets bitten
Rabies specialists have plenty of work. In 2017, 2,733 people initially visited their office at the Polyclinic for Builders, of which 936 were children under 14 years old and 332 were out-of-town patients. This is 50 people fewer than in 2016. Vaccinations were administered to 1,517 people, of which 760 received a conditional course of 2-3 vaccinations, and 750 received a course of 6 vaccinations. The majority of those seeking help were victims of dog bites – 80%, or 2,184 cases out of 2,733 people. Among them, known dogs – that is, strays or those biting their owners, relatives, and neighbors – accounted for 1,725. And 459 people were bitten by stray or homeless dogs. 189 people sought help after being bitten by rats, 285 due to bites and scratches from cats, and 15 people in Bishkek were bitten by squirrels.
The remaining cases occur due to other domestic animals, livestock, circuses, and petting zoos. Because Kyrgyz people do not always strive to follow safety rules and common sense when interacting with domestic and wild animals. However, according to Danagul Asanbekovna, civic awareness among people is growing – thanks to the internet, now bitten and scratched Kyrgyz quickly learn about the consequences of their injuries, despite the fact that recommendations for victims of animal bites vary across different information resources. And they mainly seek medical help and vaccination immediately, which is why there are literally only a few fatal cases of rabies among people in the republic each year.
Urgently to the doctor!
What needs to be done? So, absolutely everyone who has been bitten or scratched must seek medical help. Before that – treating the wound.
- After a scratch or bite from a dog or any animal – known or unknown, stray, you need to examine the wound. If there is blood, you need to stop the bleeding and treat the wound – it is best to wash it with household soap. If soap is not at hand, hydrogen peroxide or 70% alcohol will suffice. Carefully treat the edges of the wound, then apply green antiseptic and cover it with a band-aid if the wound is small; if it is large – cover it with gauze or a bandage. Then, be sure to seek medical help. From the age of 14, everyone goes to the Polyclinic for Builders. Here, in the 24-hour trauma center, help will be provided to both city residents and out-of-town patients. You will receive two vaccinations – against tetanus and the first shot of the anti-rabies vaccine against rabies.
There is always a supply of these medications, and it is constantly replenished. Children under 14 years old must first visit the City Clinical Emergency Hospital – the former 3rd Children's Hospital. There, a pediatric trauma surgeon works around the clock. He will treat the wound, document the case, and then send you here, to the trauma center, as there are no vaccines at the pediatric trauma surgeon in the 3rd Children's Hospital. Typically, vaccination occurs either immediately or the next day after the bite, and the virus does not have time to develop in the body. There are cases when immunoglobulin is also prescribed before vaccination. This happens if you are bitten by a wild animal or if the bite occurred on the head, face, neck, fingers, hands, genital area, and was from an unknown or unvaccinated animal. Even a small wound in these areas from a bite is considered a severe case.
Double barrier
Along with the tetanus vaccine, which is effective for exactly one year, the bitten person receives a second injection – an anti-rabies drug (usually Abhayrab). After that, the bitten person must visit a rabies specialist or trauma surgeon at their place of residence. The specialist collects information about the conditions under which the bite occurred and creates a special card. If there is an opportunity to observe the animal, it is subject to special veterinary observation for 10 days. After this period, when it is determined whether the animal is healthy, the question of the number of vaccinations, which represent a cultured, purified, concentrated vaccine, is finally resolved. Typically, if everything is in order, two or three vaccinations are administered – the so-called conditional course. However, in cases where the dog or other animal is killed prematurely, or it is a stray and cannot be found, the vaccination course is prescribed immediately, consisting of 6 injections in the forearm (0-3-7-14-30 and 90 days after the bite).
The rabies specialist also conducts an initial consultation and issues a schedule according to which the patient must return for control and receive the anti-rabies vaccine strictly on specified days. If the schedule is not followed, and the planned injection is delayed by more than a day, the rabies virus in the body may activate, and then the person may not be saved. Also, those who have been bitten and scratched will have to live with certain restrictions – the vaccine, while protecting a person from rabies, puts a significant strain on the body. Adults are prohibited from consuming alcohol during vaccination and for six months afterward, and they should avoid overheating (saunas, baths, sunbathing on the beach), overcooling, and overexertion (by the way, quick fatigue and muscle weakness can be one of the side effects of vaccination). They should also refrain from serious physical exertion for the first few months; strength training in the gym should be replaced with something gentler – for example, swimming. For some time after starting the vaccination course, it is also prohibited to lift weights over 10 kilograms.
- As for children, the restrictions are the same. For physical education classes or sports sections – wrestling, karate, and other types that require exertion, a one-month exemption is granted for 6 vaccinations. If three vaccinations were given, the exemption will be for 10 days. Additionally, parents of children and teenagers with a high allergy background may face the problem of elevated temperature after vaccination, warns the rabies specialist.
If those who have been bitten and scratched cannot make it to the vaccination during the time frame from 8:00 AM to 5:00 PM without harming their education or work, they are issued a certificate upon request confirming that the absence was necessary. An employer or representative of the educational institution has no right to prevent access to the rabies specialist.