A relation of mine had a dog bite. He went to a private Dr who gave him a shot within the first 3 hours. I don't actually know the actual shot cos I wasn't there but he said it was anti rabies. I advised him to still go to the University general Hospital so that a group of dr's can look at him and also to make sure he got the complete anti-rabies vaccination cos the dog sure does have rabies. what else does he need to do and what's the complete vaccination dosage for anti-rabies in Nigeria now. The doctor told him that the present dosage is given once and not like 5 times as previously. How true is that.

There are quite a lot of questions i would like to ask:
1. How do you know the dog has rabies?, if u can get it across to a vet,fine,but on your own u can try and quarantine it for at least 7days.
2. How long was the time between the attack and the time your relation got to the Dr?, has it been over 48hrs?

i know the dog has rabies cos it dies the next day on its own. and yes its been more than 46 hrs the incident took place. Though he was able to get anti rabies vaccine within the first 3 hrs. my question is with the dosage of the vaccine. how many shots should he get? whats the most current antirabies vaccine in nigeria now.

Well, Whether the dog even had rabies or not,the proper thing was what your relative did,seeking medical attention promptly. But then, the human diploid anti-rabies vaccination post exposure therapy is given at days 0,3,7,14,30, (and sometimes 90), I do not know about this "one-shot" therapy the Dr is using, it might be the newest around.I am a veterinarian,not a human medic,so i can only speak on my turf. All the best.

do not let it bite you.

Ask the next calabar man you see for anti-dote

@ OP

Impress on your relation this fact.

RABIES HAS A CASE-FATALITY RATIO OF 100%.

The reason why people get the shots when bitten is that even if the possibility of getting rabies is slim to non-essential, once contracted Rabies Kills.


Irrespective of whether or not the dog is displaying signs of rabies or not, it may still have transmitted the virus to him.

Once you get it, you die. There's no cure, and no treatment. Just suffering and deterioration in health till death. It's a very painful way to die. I suggest you tell them to tell your relation that. Death is as sure as putting an AK-47 to your head and pulling the trigger.

Only one person alive has ever survived rabies, and her life was never the same.

@OP, and @Jensinmi,

Fine,we know the case fatality ratio of rabies is 100%, but that does not mean you have to kill the individual psychologically even before physical death by confirming their suspicisions, The patient has already done the right thing by seeking medical attention and that is a lot better than doing nothing at all, fine, what the OP wants to know is the validity of what her relative has done. She is doubting the one-shot injection and that is where the issue is.

Sitting the patient down to scare him with what rabies is and is not, or what it will do to him is highly unethical and unprofessional and any individual with sound medical training would know that,

When it comes to handling zoonotic infections especially of a viral nature the last thing you need is a complication in form of a cardiac imbalance.
All the patient needs right now is re-assurance and being calmed.

JaiyeJeje:

@OP, and @Jensinmi,

Fine,we know the case fatality ratio of rabies is 100%, but that does not mean you have to kill the individual psychologically even before physical death by confirming their suspicisions, The patient has already done the right thing by seeking medical attention and that is a lot better than doing nothing at all, fine, what the OP wants to know is the validity of what her relative has done. She is doubting the one-shot injection and that is where the issue is.

Sitting the patient down to scare him with what rabies is and is not, or what it will do to him is highly unethical and unprofessional and any individual with sound medical training would know that,

When it comes to handling zoonotic infections especially of a viral nature the last thing you need is a complication in form of a cardiac imbalance.
All the patient needs right now is re-assurance and being calmed.

Rabies is preventable after a dog bite. Just get the necessary shots (injections) within a short time frame after the bite.
I apologize if I did not state that in my post.

My advice to poster: take your friend to a teaching hospital for expert attention. Too may doctors in private hospitals do not know their left from their right.

jensinmi:

@ OP

Impress on your relation this fact.

RABIES HAS A CASE-FATALITY RATIO OF 100%.

The reason why people get the shots when bitten is that even if the possibility of getting rabies is slim to non-essential, once contracted Rabies Kills.


Irrespective of whether or not the dog is displaying signs of rabies or not, it may still have transmitted the virus to him.

Once you get it, you die. There's no cure, and no treatment. Just suffering and deterioration in health till death. It's a very painful way to die. I suggest you tell them to tell your relation that. Death is as sure as putting an AK-47 to your head and pulling the trigger.

Only one person alive has ever survived rabies, and her life was never the same.

He who has ears, let him hear!

dunno

OP.
I would suggest he travels out of the country for proper treatments if affordable.

Hello Poser! I am a medical doctor. You are probably right that the dog has rabies. However you are still in good time to ensure your cousin do not get rabies which has been rightly described to have a 100% mortality.
The number of doses of anti rabies vaccine required depends on whether the victim has been previously immunized or not and the time of last dose. if he has not been previously immunized against rabies, he needs 5 doses of the anti-rabies vaccine. you can get this from May and Baker at Ikeja as they are the main if not the only manufacturer of antirabies vaccine in Nigeria to the best of my knowledge. It is critical he knows what he was given; i hope it was not just tetanus toxoid which is usually given as a single shot.
for more clarification, I encourage him to go to any of the govt hospitals for proper management.

Did the dog look like any of the following?

desholah:

OP.
I would suggest he travels out of the country for proper treatments if affordable.

If it is a matter of just shots or medicines then they can get a medical doctor friend overseas to mail it to them

I think its high time we have a "very punitive law" that stipulates severe penalties for owners of "mad dogs" (l dont mean Ghadafi! ) who negligently or otherwise, fail to keep them under leash and proper supervision!
Some of these brutal dogs are worse that being faced with a loaded gun!

I have seen owners who deliberately use these "unfriendly dogs" to scare others!

Mind you, l am a dog lover myself (l do have have a Roth and an Alsatian) but l dare not leave those dogs to roam around (especially where children can be scared or bitten) except in the dead of the night, within the walls of my fence
Again, l vaccinate them and take them for "check-ups" like family members.

To allow your dog to bite someone else (and with a possibility or risk of death) is just criminal.

@Ops: Please take the advices very seriously, take nothing to chance.

thanks everyone for ur answers. He tried getting the name of the medication he was given from the private Dr so that he could go to General Hospital for follow up, The Dr refused to give him the name and said he was undermining his expertise and was mad at him and started shouting. anyway, he will still go to general hospital with or without a note from the private DR. They may have a way of checking him out and folowing up. Thanks everyone.

@ topic, sorry about your relation. like someone pointed out, the fatality is unfortunately pretty high, though i disagree its 100%. As long as the symptoms are yet to manifest, there is a fair chance of recovery.

If your relation has never received vaccination before, the complete treatment would consist of both [/b]the vaccine, given on days 0, 3, 7, 14, 28,  [i][b]and [/i]the immnoglobulin, usually given once; although, I must confess getting the latter may be pretty difficult in this country, which perhaps explains why all the posters seem to be concentrating on just the vaccine.

If he/she has received prior vaccination, then the vaccine is usually given in about 2-3 doses.

that the Doctor--if, given his attitude, you can call  him that-- gave him just one shot, and refused to disclose what he had given is deeply suspicious. I suspect its probably just tetanus toxiod, which of course is useless as far as rabies is concerned.

He doesn't need to get any note from the so-called doctor. He should go to the nearest hospital asap

Please do what has been asked abeg. Can you also post the name of the doctor and his hospital address. For my own amusement. Thank you

a vet doc once told me that its better to confirm that the dog in question has rabies before giving the anti rabies treatment. usually the dog will die before one month and if the dog is not infected and one takes the anti rabies vacines, the person may end up having rabies

ufumes:

a vet doc once told me that its better to confirm that the dog in question has rabies before giving the anti rabies treatment. usually the dog will die before one month and if the dog is not infected and one takes the anti rabies vacines, the person may end up having rabies

The poster said the dog died the very next day. This is not good; means the dog must have already been badly infected. I wonder why the poster's friend is still delaying going for proper treatment.

WOOF! WOOF! Make im no begin bark like dog for your front o!

ufumes:

a vet doc once told me that its better to confirm that the dog in question has rabies before giving the anti rabies treatment. usually the dog will die before one month and if the dog is not infected and one takes the anti rabies vacines, the person may end up having rabies

KAI! wetin be zees? abeg, the next time you carry your pet to that vet, ask to see his license!  kidding!

First, its not one month; its usually just about 10 days. Note that the incubation period is actually about a month, so if the person is to wait that long, symptoms would have started manifesting after which death is certain.

second, the rabies vaccine [i]cannot [/i]cause rabies, please get it right.

What i suppose your vet was talking about are the reactions that may accompany administration of the vaccine and/or the immunoglubulin. Yes, some folks have been documented as presenting certain neurological symptoms which may resemble rabies, and unfortunately have proved fatal in most cases. . .but it wasn't rabies. Its important to note, however, that these reactions are very rare.

I don't want to go into too many details; this is, after all, the family section (wetin this thread dey do here sef?).

Bottom line is, its a lot safer to go for post exposure vaccine after a bite than to worry about the possible s/effects. however let the doc decide

Princessjo:

thanks everyone for your answers. He tried getting the name of the medication he was given from the private Dr so that he could go to General Hospital for follow up, The Dr refused to give him the name and said he was undermining his expertise and was mad at him and started shouting.

The "doctor" is a quack.

Princessjo:

anyway, he will still go to general hospital with or without a note from the private DR. They may have a way of checking him out and folowing up. Thanks everyone.

^Your relation is gambling with his life--He should seek treatment immediately. In my practice I have encountered individuals who were bitten by rabid dogs and delayed getting the anti-rabies shots. They died.

Not all bite from dogs that result into rabies,especially well kept dogs with good vaccine record.Cat and bat are the source of rabies,any dogs that is bitten by either cat or bat will have rabies .How do you know your dog has this rabies.It changes everything about the dog,it changes the way it barks instead of woof woof you will hear ooooooooooooooooh.Also it will be restless and bite on everything it could lay his sight on.saliva comes out from its mouth.once this is observe in your dog it will take few days before the dog passes away because the virus is deadly.the dog will not be able to eat,or drink water .
in human once you are bitten by dog if its your dog and you have the regular vaccine (anti rabie vaccine) given by vet doctor to the dog you may not care to take the rabies injection ,but if you observe all the traits of rabies in the dog action take a bold step to visit a vet and a medical doctor.
you get sharp pains where you are being bitten by the dog,you feel fever(high temperature),you hate water and hallucination set in,you misbehave like a drunken man,the virus control all your body system and at the end you go into coma and finally give up.
I am not a vet or medical doctor but read more on dogs ,i have been bitten by dogs but not rabies one.i guess its an aggressive dog who is dominance in nature.even the owner cant control it because he caged the dog without finding time to play with the dog or exercise with it.

Princessjo: thanks everyone for ur answers. He tried getting the name of the medication he was given from the private Dr so that he could go to General Hospital for follow up, The Dr refused to give him the name and said he was undermining his expertise and was mad at him and started shouting. anyway, he will still go to general hospital with or without a note from the private DR. They may have a way of checking him out and folowing up. Thanks everyone.

Nigerian doctors and secrets! Even anti malaria drugs they will still hide d name from d patients! So unethical!
@op,ur cousin made a mistake most patients in nigeria make,even d educated ones! He is supposed to ask d dr what he is givin him before d treatment.in a case where he don't want to disclose anything,go to another hospital. When something happens now heaven forbids,he will deny u.any time I go to hospital,before anything is done to me u must explain d procedures,drugs involved and d side effects.its d patients right to know.u will always c a clear opposite when u visit foreign hospital or a foreigner is ur dr. Let me ask,what r they hiding?

Postexposure Prophylaxis

Optimal postexposure treatment consists of local cleansing, administration of passive antibody, and active immunization. All 3 elements are essential, since rabies has occurred when 1 of the elements was omitted.

The choice of cleaning solution is probably less important than the copiousness of the fluid administered. Soap and water are fine, although 0.1% benzalkonium chloride, 70% alcohol, or 1% povidone-iodine may be usefully applied to the wound after washing. Tetanus vaccine, tetanus antiserum, and antibiotic treatment should be provided as indicated.

After a wound has been cleansed, the physician can decide whether the threat of rabies justifies vaccination. The factors influencing that decision include the following:

If there is high suspicion that the biting animal has rabies on the basis of compatible clinical signs, prophylaxis should be started immediately.

If the biting animal has always been a domestic pet, such as a dog, cat, or ferret, it can be quarantined and observed for rabies for 10 days. Dogs and cats are still potential vectors in a few areas of the United States, particularly along the southern border. If the animal remains healthy, no vaccination is needed. In countries where dog rabies is enzootic, prophylaxis should be started immediately and should be discontinued if the animal remains healthy.

If the biting animal is wild and has been killed, the brain can be examined for signs of rabies. This step is particularly important for raccoons, skunks, foxes, bats, and woodchucks (groundhogs). The fluorescent antibody test for rabies virus antigen in the brain is highly sensitive and specific.

If the biting animal has escaped, reference to veterinary authorities should be made to determine whether the species involved may possibly be infected with rabies in that particular geographic area.

If the biting animal was a bat, prophylaxis for rabies should always be given (see the section on bats below).

Provocation of the bite or lack of it is not a good criterion for decision.

Exposure of mucous membranes to secretions of a rabid animal is not as dangerous as a bite but is associated with the risk of rabies. Exposure of intact skin is not a risk (see the section on bats below).

If a decision is made to proceed with prophylaxis for rabies, rabies immune globulin (RIG) should be administered. Two forms of RIG exist: human RIG and equine RIG. However, only human RIG is available in the United States. The currently used equine RIGs are purified products and are associated with relatively few allergic reactions and only rarely with anaphylaxis. Unfortunately, because strict regulation to eliminate extraneous viral contamination, human RIG is in short supply.

The dose of human RIG is 20 IU/kg, whereas that for equine RIG is 40 IU/kg. United States and WHO recommendations call for local infiltration of the total dose at the site of the bite to the extent that is anatomically feasible, rather than 50% of the dose formerly recommended. The change in recommendation was made because blood levels of antibodies to rabies virus are not high after parenteral administration of RIG, and local neutralization of the virus is key.

Active immunization against rabies should be started simultaneously with administration of antiserum. Although no effort should be made to induce active immunization and passive immunization at different times, if one product is available before the other, it should be administered promptly, and the second product should be given when it becomes available. However, if RIG is available >1 week after vaccination has been started, it is probably unnecessary as an active antibody response will have begun.

A 5-dose schedule for postexposure vaccination against rabies is internationally accepted, and im injection is the only route acceptable in the United States. (However, see the section on intradermal vaccination below.) Doses are given at 0, 3, 7, 14, and 28 days (table 4). After the fifth dose, antibodies are always present, usually at a titer of >10 IU. Another vaccination schedule, called 2-1-1, is used in some countries, but this schedule is not as immunogenic if used together with human RIG. Vaccine and antiserum should never be mixed or injected in the same limb.

In the United States, there is a choice of 3 vaccines (table 5): HDCV, purified chick embryo cell culture vaccine, and fetal rhesus lung cell culture vaccine (or rabies vaccine adsorbed, which is temporarily unavailable). They are interchangeable, but it is normal practice to use 1 for the complete vaccination series. Outside of the United States, there are other choices, including primary hamster kidney cell culture vaccine, monkey vero cell vaccine, purified duck embryo vaccine, and numerous nerve tissue vaccines. If a traveler returns to the United States after having received 1 of the cell culture vaccines, the vaccination schedule may be completed with 1 of the 3 licensed vaccines, but if the patient has received a nerve tissue vaccine, rabies vaccination should be started without reference to the prior doses.

culled from oxford journal(Postexposure Prophylaxis

Optimal postexposure treatment consists of local cleansing, administration of passive antibody, and active immunization. All 3 elements are essential, since rabies has occurred when 1 of the elements was omitted.

The choice of cleaning solution is probably less important than the copiousness of the fluid administered. Soap and water are fine, although 0.1% benzalkonium chloride, 70% alcohol, or 1% povidone-iodine may be usefully applied to the wound after washing. Tetanus vaccine, tetanus antiserum, and antibiotic treatment should be provided as indicated.

After a wound has been cleansed, the physician can decide whether the threat of rabies justifies vaccination. The factors influencing that decision include the following:

If there is high suspicion that the biting animal has rabies on the basis of compatible clinical signs, prophylaxis should be started immediately.

If the biting animal has always been a domestic pet, such as a dog, cat, or ferret, it can be quarantined and observed for rabies for 10 days. Dogs and cats are still potential vectors in a few areas of the United States, particularly along the southern border. If the animal remains healthy, no vaccination is needed. In countries where dog rabies is enzootic, prophylaxis should be started immediately and should be discontinued if the animal remains healthy.

If the biting animal is wild and has been killed, the brain can be examined for signs of rabies. This step is particularly important for raccoons, skunks, foxes, bats, and woodchucks (groundhogs). The fluorescent antibody test for rabies virus antigen in the brain is highly sensitive and specific.

If the biting animal has escaped, reference to veterinary authorities should be made to determine whether the species involved may possibly be infected with rabies in that particular geographic area.

If the biting animal was a bat, prophylaxis for rabies should always be given (see the section on bats below).

Provocation of the bite or lack of it is not a good criterion for decision.

Exposure of mucous membranes to secretions of a rabid animal is not as dangerous as a bite but is associated with the risk of rabies. Exposure of intact skin is not a risk (see the section on bats below).

If a decision is made to proceed with prophylaxis for rabies, rabies immune globulin (RIG) should be administered. Two forms of RIG exist: human RIG and equine RIG. However, only human RIG is available in the United States. The currently used equine RIGs are purified products and are associated with relatively few allergic reactions and only rarely with anaphylaxis. Unfortunately, because strict regulation to eliminate extraneous viral contamination, human RIG is in short supply.

The dose of human RIG is 20 IU/kg, whereas that for equine RIG is 40 IU/kg. United States and WHO recommendations call for local infiltration of the total dose at the site of the bite to the extent that is anatomically feasible, rather than 50% of the dose formerly recommended. The change in recommendation was made because blood levels of antibodies to rabies virus are not high after parenteral administration of RIG, and local neutralization of the virus is key.

Active immunization against rabies should be started simultaneously with administration of antiserum. Although no effort should be made to induce active immunization and passive immunization at different times, if one product is available before the other, it should be administered promptly, and the second product should be given when it becomes available. However, if RIG is available >1 week after vaccination has been started, it is probably unnecessary as an active antibody response will have begun.

A 5-dose schedule for postexposure vaccination against rabies is internationally accepted, and im injection is the only route acceptable in the United States. (However, see the section on intradermal vaccination below.) Doses are given at 0, 3, 7, 14, and 28 days (table 4). After the fifth dose, antibodies are always present, usually at a titer of >10 IU. Another vaccination schedule, called 2-1-1, is used in some countries, but this schedule is not as immunogenic if used together with human RIG. Vaccine and antiserum should never be mixed or injected in the same limb.

In the United States, there is a choice of 3 vaccines (table 5): HDCV, purified chick embryo cell culture vaccine, and fetal rhesus lung cell culture vaccine (or rabies vaccine adsorbed, which is temporarily unavailable). They are interchangeable, but it is normal practice to use 1 for the complete vaccination series. Outside of the United States, there are other choices, including primary hamster kidney cell culture vaccine, monkey vero cell vaccine, purified duck embryo vaccine, and numerous nerve tissue vaccines. If a traveler returns to the United States after having received 1 of the cell culture vaccines, the vaccination schedule may be completed with 1 of the 3 licensed vaccines, but if the patient has received a nerve tissue vaccine, rabies vaccination should be started without reference to the prior doses.


culled from Postexposure Prophylaxis

Optimal postexposure treatment consists of local cleansing, administration of passive antibody, and active immunization. All 3 elements are essential, since rabies has occurred when 1 of the elements was omitted.

The choice of cleaning solution is probably less important than the copiousness of the fluid administered. Soap and water are fine, although 0.1% benzalkonium chloride, 70% alcohol, or 1% povidone-iodine may be usefully applied to the wound after washing. Tetanus vaccine, tetanus antiserum, and antibiotic treatment should be provided as indicated.

After a wound has been cleansed, the physician can decide whether the threat of rabies justifies vaccination. The factors influencing that decision include the following:

If there is high suspicion that the biting animal has rabies on the basis of compatible clinical signs, prophylaxis should be started immediately.

If the biting animal has always been a domestic pet, such as a dog, cat, or ferret, it can be quarantined and observed for rabies for 10 days. Dogs and cats are still potential vectors in a few areas of the United States, particularly along the southern border. If the animal remains healthy, no vaccination is needed. In countries where dog rabies is enzootic, prophylaxis should be started immediately and should be discontinued if the animal remains healthy.

If the biting animal is wild and has been killed, the brain can be examined for signs of rabies. This step is particularly important for raccoons, skunks, foxes, bats, and woodchucks (groundhogs). The fluorescent antibody test for rabies virus antigen in the brain is highly sensitive and specific.

If the biting animal has escaped, reference to veterinary authorities should be made to determine whether the species involved may possibly be infected with rabies in that particular geographic area.

If the biting animal was a bat, prophylaxis for rabies should always be given (see the section on bats below).

Provocation of the bite or lack of it is not a good criterion for decision.

Exposure of mucous membranes to secretions of a rabid animal is not as dangerous as a bite but is associated with the risk of rabies. Exposure of intact skin is not a risk (see the section on bats below).

If a decision is made to proceed with prophylaxis for rabies, rabies immune globulin (RIG) should be administered. Two forms of RIG exist: human RIG and equine RIG. However, only human RIG is available in the United States. The currently used equine RIGs are purified products and are associated with relatively few allergic reactions and only rarely with anaphylaxis. Unfortunately, because strict regulation to eliminate extraneous viral contamination, human RIG is in short supply.

The dose of human RIG is 20 IU/kg, whereas that for equine RIG is 40 IU/kg. United States and WHO recommendations call for local infiltration of the total dose at the site of the bite to the extent that is anatomically feasible, rather than 50% of the dose formerly recommended. The change in recommendation was made because blood levels of antibodies to rabies virus are not high after parenteral administration of RIG, and local neutralization of the virus is key.

Active immunization against rabies should be started simultaneously with administration of antiserum. Although no effort should be made to induce active immunization and passive immunization at different times, if one product is available before the other, it should be administered promptly, and the second product should be given when it becomes available. However, if RIG is available >1 week after vaccination has been started, it is probably unnecessary as an active antibody response will have begun.

A 5-dose schedule for postexposure vaccination against rabies is internationally accepted, and im injection is the only route acceptable in the United States. (However, see the section on intradermal vaccination below.) Doses are given at 0, 3, 7, 14, and 28 days (table 4). After the fifth dose, antibodies are always present, usually at a titer of >10 IU. Another vaccination schedule, called 2-1-1, is used in some countries, but this schedule is not as immunogenic if used together with human RIG. Vaccine and antiserum should never be mixed or injected in the same limb.

In the United States, there is a choice of 3 vaccines (table 5): HDCV, purified chick embryo cell culture vaccine, and fetal rhesus lung cell culture vaccine (or rabies vaccine adsorbed, which is temporarily unavailable). They are interchangeable, but it is normal practice to use 1 for the complete vaccination series. Outside of the United States, there are other choices, including primary hamster kidney cell culture vaccine, monkey vero cell vaccine, purified duck embryo vaccine, and numerous nerve tissue vaccines. If a traveler returns to the United States after having received 1 of the cell culture vaccines, the vaccination schedule may be completed with 1 of the 3 licensed vaccines, but if the patient has received a nerve tissue vaccine, rabies vaccination should be started without reference to the prior doses. culled from oxford journal

stagger:
Did the dog look like any of the following?

Lols