Rabies Q&A: Active Prevention, Rational Response
Recently, there have been multiple cases in the country of ferret-badgers dying from rabies, and even incidents of rabid ferret-badgers biting people, which has stirred up concern and panic about rabies across all sectors. Because the government's currently released information on the rabies epidemic is too scant and updated too slowly, and to avoid excessive panic caused by misunderstandings and the failure to properly carry out preventive measures, Adjunct Professor Yeh Li-sen of National Taiwan University's School of Veterinary Medicine has specially compiled the following rabies Q&A for the public who are concerned or worried to refer to. Corrections are welcome, and reprints are welcome.
(This Q&A is the 2013/7/26 version. If there is related information, it will be continually updated on the Mobil01 Animal and Pet section.)
Although rabies is frightening, it is not more frightening than the harm caused by ignorance or panic. I hope this information will be helpful for epidemic control in Taiwan, China.
Q: Is rabies transmitted from dogs?
A: No! This type of virus not only infects dogs; in fact, all warm-blooded animals can be infected. In many countries, the number of human infections caused by bites from cats, bats, and even wild animals even exceeds infections from dog bites.
Q: If a person is bitten by an infected animal, will they definitely develop the disease and die?
A: No. Compared with other animals, humans actually have relatively better resistance to rabies: without treatment, even when bitten by an infected animal, fewer than 40% of people will develop the disease, but once the disease develops, the mortality rate is close to 100%. By contrast, if treatment can be started early after the bite, almost nothing happens.
Q: How is rabies transmitted between animals?
A: When the virus enters the brain and salivary glands, animals lose the ability to live and move normally and tend to become vicious. It is mainly transmitted by biting or scratching other animals (licking the paws makes the paws carry the virus). Because of animals' social habits, once rabies develops, it will within a period of time kill almost the entire group of the same species, and then continue to spread by biting different species of animals, or within the bodies of a small number of carrier animals that do not die. Therefore, once it enters wild animal populations, it is the most difficult to deal with.
Q: Is the current epidemic situation in Taiwan, China severe?
A: Because the infected ferret-badgers span more than a year and have appeared in different areas, this means the virus has already spread widely among the ferret-badger population on the island, so the situation is very serious.
Q: Will the situation get even worse?
A: When cases appear in animals other than ferret-badgers, the situation becomes more serious, because it means more animals carry the virus. But the worst situation is when dog and cat cases begin to appear.
Q: Will dog and cat cases really appear?
A: Unfortunately, the chance is very high. Taiwan, China has a special situation: besides wild animals and pets (which will not normally come into contact with one another and cause transmission), there are also a considerable number of street dogs and street cats, as well as stray dogs and cats maliciously abandoned in the wild. Once these animals become infected, the chance of transmission to humans greatly increases.
Q: What should be done about pets?
A: By no means abandon your pet cats and dogs at this time; that will only make the situation worse. You should take them to get rabies vaccinations as soon as possible (those that never go outside have almost no risk, but vaccination is still better, at least so neighbors feel more at ease). According to the Statute for Prevention and Control of Infectious Animal Diseases and the Animal Protection Act, registering pets and vaccinating them against rabies is originally the owner's responsibility, but because of the competent authority's laziness and lack of attention, Taiwan, China's pet registration rate and vaccination rate have probably never exceeded 10%, far short of the 70-80% threshold for rabies prevention and control. In addition, according to the Animal Protection Act, when dogs go out, they should be accompanied by their owners, which greatly reduces the chance of them being inexplicably infected with disease or getting lost. Starting today, be a responsible and law-abiding owner.
Q: What should be done about stray dogs and cats?
A: Whether in the past, present, or future, relying only on capture and culling of stray dogs and cats can never achieve the goal of epidemic prevention. Truly reducing the production of stray animals still depends on strict and lasting pet management, including registration, sterilization, and microchipping. Sadly, Taiwan, China has never achieved this, and to this day many counties and cities do not even have full-time animal protection officers, let alone implementation of the law.
For stray animals currently exposed on the dangerous frontline, those fed by people should have the feeders help vaccinate them as soon as possible and put on reliable identification. For dogs and cats with no one caring for them, as well as wild animals, large-scale distribution of vaccine baits should be given priority to increase immune blocking rates. For those suspected of having neurological symptoms, local animal disease control units should be notified so they can be removed, quarantined, or euthanized and examined as soon as possible.
If distributing vaccine baits is not feasible, then in severely affected areas, methods such as local capture, detention for quarantine, and even culling may have to be adopted. However, the professional manpower, materials, detention space, and medicines required for this need complete preparation, and the resulting social costs must also be included in professional consideration. If one day large-scale culling of dogs and cats is needed, it will undoubtedly be the greatest tragedy caused by the Taiwan, China authorities' long-term neglect of epidemic prevention and lazy inaction on pet management, and the Council of Agriculture cannot escape responsibility!
Q: What should be done if you see unusual wild animals, or if you are bitten by a wild animal?
A: During this period, by no means interact in any way with wild animals! In fact, in accordance with the spirit of the Wildlife Conservation Act, the public should never keep or eat wild animals in the first place.
If you see the corpse of a wild animal, or a wild animal wandering around in a place where it should not appear or behaving strangely, you should notify the local animal disease control unit.
If unfortunately you are bitten by a wild animal and the animal is suspected of having neurological symptoms, you should immediately ask the disease control unit to capture it, euthanize it, and send it for testing. Regardless of the result, the bitten person had better begin the rabies immunization treatment procedure as soon as possible. If the animal has no symptoms, the disease control unit should assist in capturing it and quarantining it for at least ten days to confirm that it is disease-free.
If there is any doubt, the bitten person may first undergo immunization treatment.
Q: What should be done if bitten by an unknown dog or cat or one kept by someone else?
A: If the animal shows suspected neurological symptoms, try not to let the animal escape without touching it, and immediately notify the animal disease control unit to test the animal. At the same time, seek from medical institutions whether to begin immunization treatment. If the animal shows no sign of illness, it should still be quarantined (you may ask the animal disease control unit or a veterinary hospital) for at least ten to fourteen days to ensure safety. (Whether, after being bitten by an apparently healthy dog or cat, or during the observation period, immune globulin and vaccine must be administered immediately depends on the animal's behavior, whether rabies exists locally, or the circumstances of the bite.)
Q: What is the immunization treatment procedure after being bitten?
A: According to the World Health Organization's first technical report of the 2004 Expert Consultation on Rabies and the U.S. Advisory Committee on Immunization Practices' recommendations for managing wounds possibly contaminated with rabies virus, the following methods can effectively prevent the disease:
1) Immediately clean and flush the wound: immediately and thoroughly wash the wound with soap and plenty of water for 15 minutes, then disinfect with povidone-iodine or 70% alcohol.
2) After being scratched or bitten by an animal with rabies, as soon as possible infiltrate human rabies immune globulin (HRIG) into the wound to neutralize the virus, and at a different site, administer vaccine to induce active immunity.
3) Human rabies immune globulin (HRIG) should be administered at the same time as the vaccine, no later than 7 days after the first dose of vaccine. It may only be used as a single dose, with a dosage of 20 IU/kg, mainly by infiltration into the wound as much as possible; the injection site for the remaining immune globulin should be as far away as possible from the vaccine injection site. If a child has multiple scratches and bites, rabies immune globulin may be diluted 2 to 3 times with sterile saline so that the volume is sufficient for use on multiple wounds. (This is passive immunization.)
4) If possible, avoid suturing the wound, but when suturing the wound is unavoidable, it should be done several hours after immune globulin infiltration into the wound, so that antibodies can fully diffuse within the tissue before suturing. Other treatments, such as antibiotics, tetanus vaccine, or tetanus immune globulin, should be given as with the management of other scratch and bite wounds.
5) Active immunization: The vaccine is best administered as five doses by intramuscular injection in the deltoid area; the first dose should be injected as soon as possible after being scratched or bitten by an animal with rabies (administered at the same time as the single dose of immune globulin, but must be injected at a different site), and the rest should be given on days 3, 7, 14, and 28 after the first dose.
Q: What should be done if bitten by your own dog or cat?
A: If you are a responsible owner and the dog or cat has not been let out to run around, even if it has not yet been vaccinated, the risk is still very small; you only need to see a doctor for ordinary wound treatment. But you should still carefully observe the animal's health condition and take it to get vaccinated as soon as possible.
Q: Does everyone need to get the rabies vaccine?
A: Do not think that rabies vaccination for humans is easy; its primary vaccination requires three consecutive doses, and it is actually quite painful, and some people will experience side effects. In fact, although Taiwan, China has been declared an epidemic area, only personnel who will have intensive contact with wild animals need to be vaccinated on a priority basis. Based on the particularity of Taiwan, China's environment, stray dogs and cats have a considerable chance of becoming infected, so I suggest the government should now begin vaccinating groups such as veterinarians, animal disease control personnel, dog catchers, animal shelter workers, fire departments, and animal rescuers.
※A well-meaning reminder checklist for the government
o Quickly establish a central rabies prevention and control center in accordance with the law, unify authority, set various standard operating procedures, and effectively make them publicly known.
o Announce the latest monitored epidemic information.
o Announce the telephone number for the public to report epidemic cases.
o Understand the severity of the epidemic; preventive measures must stay ahead, not follow behind the epidemic.
o Monitor and investigate the epidemic in wild animals, find the initial prevention gap, and quickly reinforce it.
o Quickly understand the feasibility, advantages, and disadvantages of distributing vaccine baits to wild animals, and quickly import and distribute them.
o Frontline disease prevention personnel and professionals who come into contact with animals should quickly receive rabies vaccination.
o Maintain sufficient animal vaccines at all times and increase injection stations.
o Dog tags in many counties and cities are mostly not secure and fall off very easily; this should be improved quickly, especially for providing identification for vaccinated street dogs and street cats.
o Hold training sessions for veterinarians, shelters, and animal rescuers or provide information teaching standard procedures for identifying and handling suspicious animals.
o SOP for handling situations by frontline disease prevention personnel(fire departments, animal protection officers, disease prevention officers).
o Prepare space and manpower for housing and quarantining animals.
o Promulgate standard procedures for safely capturing animals and humane euthanasia, and confirm stocks of euthanasia drugs.
o Standard handling procedures for the remains of suspicious animals.