Do not ignore a dog bite
Jul 26, 2005
Stephen Kalungi, a retailer in Seeta trading centre, left for home as usual at 11:00pm. At the junction to his home, he was attacked by a dog, which bit him twice.
By Jovita Mirembe
Stephen Kalungi, a retailer in Seeta trading centre, left for home as usual at 11:00pm. At the junction to his home, he was attacked by a dog, which bit him twice.
He got first aid at a nearby health centre from where he was advised to go to Entebbe grade B Hospital for rabies treatment.
According to Dr. Ellys Tumushabe, the Mukono district director of Health services, any suspicion of a dog bite should be followed by an anti-rabies serum injection. “This is because most of the dogs are not vaccinated against rabies and you cannot be sure of which dog can spread the disease,†he said.
Rabies has no cure. Even Dr. Jjuuko Ndawula, a consultant for herbal therapy, says he knows no herbal cure for rabies.
Uganda’s immigration entry requirements include a rabies vaccine for all people intending to stay in Uganda for over three months and for all dog bites or scratches while in the country to be medically evaluated. But in Uganda, a rabies vaccine for all is too expensive for the Ministry of Health. It can only be availed to high-risk groups like game rangers.
Without any treatment, a victim may not develop any clinical signs of rabies for seven to 12 months. According to Dr Patrick Mugwisa, who treated Kalungi, symptoms will begin to show later and may start with fever, malaise (a generally ill feeling), muscle aches and sore throat. “There will also be a twitching sensation around the area of the dog bite, which is evidence of rabies infection.†he says. Then the person worsens with symptoms that look like those of an encephalitis (inflammation of the brain).
“Fever rises to as high as 40.6oC, with irritability, hallucinations, abnormal thoughts and convulsions. Slowly, one’s health deteriorates through inability to speak, double vision, and difficulty in breathing and swallowing,†Mugwisa said.
“Finally, the person foams at the mouth, gets deranged and tries to bite others and barks like a dog before dying Anybody bitten also gets infected.â€
According to a 2003 medical journal, Doctor’s Reference, rabies is a viral infection that attacks the nervous system. The rabies virus is carried in the saliva of infected animals and is usually transmitted to humans though a bite. In rare cases, the virus may also spread to humans when an infected animal’s saliva touches someone’s mucous membranes (moist skin surfaces, like the mouth or inner eyelids) or contacts an area of broken skin –– a cut, scratch, bruise, or open wound.
“Once the rabies virus enters the human body through an animal bite, it begins multiplying in the surrounding muscle. This is why the first dose of anti-rabies medicine is usually injected right into the area around the animal bite,†said Dr Mugwisa.
Eventually, the virus travels up a nearby nerve to the brain where it infects brain areas, causing death.
According to Dr Patrick Luwaga of Kampala International Hospital, treatment assumes that the dog was rabid.
“Usually, the patient is asked to monitor the dog that bit him. If it does not die within 10 days, the patient can discontinue the treatment,†he said.
Tumushabe said after a dog bite, one should wash the wound with plenty of water and soap without solacing it. Then allow it to dry before applying an antiseptic.
He was surprised that Kalungi was advised to go to Entebbe. “Each district has identified health centres where the anti- rabies serums are availed free of charge,†he said. Kalungi has now taken two injections –– one per week. He will take the last one after 21 days.
Dr. Herbet Mutumba, the Mukono district deputy health officer, said animals likely to carry the rabies virus include dogs, bats, wolves and foxes. He advised dog owners to immunise them annually because the vaccines are given free of charge in villages. “You only pay sh1,000 to the veterinary officers for the immunisation certificate.†Lusaze local councillor Isaac Kiyimba confirms this. “We normally host immunisers twice a year at a parish or zone level. Those who are not aware probably don’t attend meetings. In my area, I make sure most of the dogs get immunised,†he said.
According to the Ministry of Health, 2,220 cases of suspected incidents were reported in 1999. Kampala had the highest (594) followed by Rakai (271) and Bundibugyo (242). July had the highest incidents (576) and August the lowest (16). Districts which did not report any incidence are Tororo, Rukungiri, Ntungamo, Pallisa, Mbarara, Mbale, Kitgum, Kasese, Kamuli, Kalangala, Kabale, Gulu and Busia.
Additional reporting by Hilary Bainemigisha
Stephen Kalungi, a retailer in Seeta trading centre, left for home as usual at 11:00pm. At the junction to his home, he was attacked by a dog, which bit him twice.
He got first aid at a nearby health centre from where he was advised to go to Entebbe grade B Hospital for rabies treatment.
According to Dr. Ellys Tumushabe, the Mukono district director of Health services, any suspicion of a dog bite should be followed by an anti-rabies serum injection. “This is because most of the dogs are not vaccinated against rabies and you cannot be sure of which dog can spread the disease,†he said.
Rabies has no cure. Even Dr. Jjuuko Ndawula, a consultant for herbal therapy, says he knows no herbal cure for rabies.
Uganda’s immigration entry requirements include a rabies vaccine for all people intending to stay in Uganda for over three months and for all dog bites or scratches while in the country to be medically evaluated. But in Uganda, a rabies vaccine for all is too expensive for the Ministry of Health. It can only be availed to high-risk groups like game rangers.
Without any treatment, a victim may not develop any clinical signs of rabies for seven to 12 months. According to Dr Patrick Mugwisa, who treated Kalungi, symptoms will begin to show later and may start with fever, malaise (a generally ill feeling), muscle aches and sore throat. “There will also be a twitching sensation around the area of the dog bite, which is evidence of rabies infection.†he says. Then the person worsens with symptoms that look like those of an encephalitis (inflammation of the brain).
“Fever rises to as high as 40.6oC, with irritability, hallucinations, abnormal thoughts and convulsions. Slowly, one’s health deteriorates through inability to speak, double vision, and difficulty in breathing and swallowing,†Mugwisa said.
“Finally, the person foams at the mouth, gets deranged and tries to bite others and barks like a dog before dying Anybody bitten also gets infected.â€
According to a 2003 medical journal, Doctor’s Reference, rabies is a viral infection that attacks the nervous system. The rabies virus is carried in the saliva of infected animals and is usually transmitted to humans though a bite. In rare cases, the virus may also spread to humans when an infected animal’s saliva touches someone’s mucous membranes (moist skin surfaces, like the mouth or inner eyelids) or contacts an area of broken skin –– a cut, scratch, bruise, or open wound.
“Once the rabies virus enters the human body through an animal bite, it begins multiplying in the surrounding muscle. This is why the first dose of anti-rabies medicine is usually injected right into the area around the animal bite,†said Dr Mugwisa.
Eventually, the virus travels up a nearby nerve to the brain where it infects brain areas, causing death.
According to Dr Patrick Luwaga of Kampala International Hospital, treatment assumes that the dog was rabid.
“Usually, the patient is asked to monitor the dog that bit him. If it does not die within 10 days, the patient can discontinue the treatment,†he said.
Tumushabe said after a dog bite, one should wash the wound with plenty of water and soap without solacing it. Then allow it to dry before applying an antiseptic.
He was surprised that Kalungi was advised to go to Entebbe. “Each district has identified health centres where the anti- rabies serums are availed free of charge,†he said. Kalungi has now taken two injections –– one per week. He will take the last one after 21 days.
Dr. Herbet Mutumba, the Mukono district deputy health officer, said animals likely to carry the rabies virus include dogs, bats, wolves and foxes. He advised dog owners to immunise them annually because the vaccines are given free of charge in villages. “You only pay sh1,000 to the veterinary officers for the immunisation certificate.†Lusaze local councillor Isaac Kiyimba confirms this. “We normally host immunisers twice a year at a parish or zone level. Those who are not aware probably don’t attend meetings. In my area, I make sure most of the dogs get immunised,†he said.
According to the Ministry of Health, 2,220 cases of suspected incidents were reported in 1999. Kampala had the highest (594) followed by Rakai (271) and Bundibugyo (242). July had the highest incidents (576) and August the lowest (16). Districts which did not report any incidence are Tororo, Rukungiri, Ntungamo, Pallisa, Mbarara, Mbale, Kitgum, Kasese, Kamuli, Kalangala, Kabale, Gulu and Busia.
Additional reporting by Hilary Bainemigisha