For the past week, government has been running an anti-rabies campaign by vaccinating for free all dogs across the country. Rabies is an infection of the brain and is one of the fatal medical conditions whose deaths are under reported in the country. It is 100 percent preventable but once its signs begin to show there is no cure and the patient dies. In this interview Weekend Nations’ News Analyst LUCKY MKANDAWIRE engages associate professor Macpherson Mallewa, a neurologist and vice principal of College of Medicine (CoM), a constituent college of University of Malawi (Unima), for more.
How serious is rabies in the country?
Rabies encephalitis is a serious public health problem in Malawi. Mainly it is also because death is 100 percent in those with rabies infection. Again many deaths from rabies occur than we are able to document.
What are the first signs and symptoms of rabies in a human being and how long do they take to show?
They are non specific. They include agitation, unusual movements, confusion and aggressiveness. They may have strange thoughts, convulsions or seizures and may paralyse. The features above can be interspaced with seemingly looking normal in early stages of the disease. Later on, in advanced stages, they have fear of water and/or air blown on their face, termed as hydrophobia and aerophobia respectively. They then drift into unconsciousness and then death ensues soon after.
There is no specific period for the signs to begin showing because it depends on the distance from site of bite to the brain, the further away from the brain the longer it takes for the dog bite to show symptoms. Bites in the feet can take months or [rarely] years. However, on average it takes about three months. Once the virus has been deposited in the flesh it attacks the local nerves then moves slowly through nerves heading towards the brain. Once the virus reaches the brain it multiplies rapidly. Bites in the face or head may take only few days or weeks.
How would a person bitten by a dog quickly know that he or she has rabies?
The best is not to wait to know you have rabies. As explained above once one starts showing features of rabies, it is too late. However, there are signs showing that a dog that has bitten a person has rabies. These include, but not limited to, the following: no provocation [a dog biting without being provoked], a dog that goes on to bite several other people, stray dogs [if the bite is more than just a scratch]. All these factors mean one must seek medical help immediately.
How long would it take for a person who has started showing signs of rabies to die?
Once a patient starts showing signs of rabies infection, death follows within two to three days, rarely one week.
Is anti-rabies vaccine easily accessible in the country?
Human rabies vaccine is not very readily available because it is very expensive. Animal rabies vaccine on the other hand is by far cheaper. Therefore, the best prevention is to vaccinate our dogs and cats.
How many patients succumb to rabies monthly or annually?
No reliable data is available. Not all rabies deaths are reported, not all rabies deaths occur in health facilities and some rabies deaths are mistaken for other infections like malaria because some may not have the typical features. Because of these reasons we don’t know the true picture of rabies deaths that occur in Malawi.
What remedy would you advise people to immediately do after a dog bite?
One must do the following: clean the bite wound with lots of soap and water then clean with lots of spirit, if spirit is not available one can use any strong distilled alcohol like kachasu or midoli. After doing this, the casualty must rush to the nearest health facility for anti-rabies vaccine.
Why do dogs with rabies die after biting a person?
Rabies is fatal in both humans and dogs. A dog biting is a sign that they have features of rabies infection, therefore the moment they start showing these features they die within a few days just like in humans.
Do you have any other comment in relation to the issue?
Rabies deaths are under reported in Malawi. It is a very serious fatal medical condition but preventable. The main method of prevention is vaccination of dogs and cats. Those that can afford the vaccine should vaccinate themselves and family before being bitten by a dog. Unfortunately, majority of Malawians cannot afford this means of prevention. Treat every dog bite as a potential rabies bite unless if it is one’s own dog with a known history of up-to-date anti-rabies vaccination. If it is a neighbour’s dog and they are certain about vaccination and you are able to observe the dog for at least 10 days then you can observe. If you choose to take this approach make sure that the moment the dog disappears you must seek medical help immediately.
If one was bitten by a dog it’s never too late to get anti-rabies vaccine as long as one doesn’t have features of rabies infection as earlier described. In other words, if you were bitten by a dog several months ago and you never sought help then [for whatever reason] do so now and as long as no features of rabies have started to show the medical personnel should provide anti-rabies vaccine if the dog cannot be traced and the circumstances are very suspicious of a rabid dog bite. If in doubt at all seek medical help. Don’t hesitate to seek second opinion if not satisfied by the advice given by the medical personnel.