Dr. Macapagal takes on the myths, one by one
By Emmanuel D. Macapagal D.V.M
Virus, Not Venom
First of all, I would like my readers to understand that rabies is an infectious disease that is caused by a virus, and not venom. It has a vector. It has an established transmission pattern and a definite disease outcome that comes with it. It has a definite consequence that is always fatal. Only one person has survived rabies and not without medical intervention. I have personally belabored and engaged physicians in intensive dialogues, disputations with regarding this disease. The intention is to encourage a correct and truthful understanding of an ancient disease.
As a veterinarian, I am persuaded that despite the advancement of medical knowledge in other countries, the Philippines seems to lag behind in efforts to control and prevent mortalities due to this disease. A lot of energy and effort must be exerted to explain to our friends and colleagues as well as countrymen about the great backward effect, short of saying, this is a misunderstanding of rabies. We veterinarians, have been treated as though we were second-class doctors in our own country.
The opinion from doctor to doctor varies; however, the prevalent thought as far as transmission and subsequently, infection, is much the same. Knowledge is verifiable nowadays despite the fact that the internet is filled with disinformation and misinformation as well as half-truths.
As an honest skeptic, I am driven by a passion to persuade my clients, neighbors, and all stakeholders who are willing to listen and learn from a veterinarian. By the way, by definition, a veterinarian is a doctor who practices medicine on animals. Furthermore, let us dissect the etymology of the word “veterinarian.” “Veterinae” is the neutral plural of the Latin word that means pertaining to animals; hence, a veterinarian is a doctor of animals. Henceforth, I shall call them “the other doctor.”
There are credible and legitimate websites that give us reliable information about the disease such as the Center for Disease Control in Atlanta, Georgia, and the World Health Organization (WHO). These sites give us up-to-date information that will lead us to a proper understanding of rabies.
Why is there a need to discuss an ancient disease in the current Philippine setting? It is my opinion that wherever there is widespread lack of awareness or ignorance regarding a matter that is life-threatening, full attention is a must. These are things I do in my practice to avoid unnecessary emotional pain and psychological vexation of people that have been scratched, bitten, or licked by a dog or cat, and put them in their most appropriate context as a veterinary medicine professional.
THEY SAY: Rabies is more virulent when it is contracted from a bite, scratch, or lick from a puppy, and dogs are the major transmitters of rabies.
As a veterinarian who hears this from long-time clients as well as those who are panic-stricken first-timers, it never fails to make me roll my eyes in amazement. Let me answer it this way: the dog is not a reservoir, species-adapted, or “true carrier” of the rabies virus.
To put it simply, dogs are not born with rabies incubating (multiplying) in its central nervous system (CNS). This is the reason why it is 100% preventable through vaccination. For why should I vaccinate an already infected or rabid dog? Therefore, post-exposure prophylaxis (PEP) is neither mandatory nor obligatory if the dog that licked you was vaccinated with records to prove it and these are signed by a board-certified veterinarian. Otherwise, avail yourself of PEP if you can afford it.
THEY SAY: PEP is entirely harmless and can be done even if a previous PEP was less than a year ago.
I disagree. Vaccinations are warranted strictly when an exposure has been determined by public health authorities.
At this point, I would like to make it clear that in my 20 years of clinical experience in companion animal medicine, I was never consulted by a physician to verify records of a particular dog, a client of mine, regarding the truthfulness as well as correctness of our records regarding its vaccine entries, date, manufacturer, and serial number, as well as the expiry dates of said vaccines. This is a matter I find very unethical, distasteful, and not objective. If vaccine associated sarcomas (cancers in the connective tissues) happen in a dog or cat, how much more in an immune-compromised human being getting indiscriminate vaccinations? (Editor’s note: The author is referring to PEPs for those who were bitten, scratched, or licked by vaccine-compliant dogs and does not apply to the same from strays or those without verifiable vaccination records.)
THEY SAY: Herbal and folk medicine recommend “sungay ng usa” (deer horns) against rabies.
Once again, the rabies virus is not neutralized or rendered inactivate by these useless “cures,” I’m sad to say. The rabies virus, if exposed to sunlight, soap, and detergent, is easily deactivated. You don’t have to go Quiapo to buy the items listed above. It’s a waste of time and precious money to buy folk cures; worse, those things do not work. Also, rabies is strictly in vivo (inside a living organism) for the virus to be propagated or multiplied, and transmitted. This virus cannot survive nor multiply outside of a susceptible host.
THEY SAY: Rabies is acquired by a dog through eating garbage.
No, definitely not. Rabies is almost always contracted from the bite of a rabid mammal. The transmission is very clear since this disease is ancient and has been studied thoroughly by veterinarians. It is an anthropozoonosis or a disease of animals transmissible to humans.
THEY SAY: Rabies is not a medical emergency but an urgency.
The literature on this varies but from the veterinarian’s as well as the physician’s standpoint, it seems foolish to point out the obvious: rabies does not develop overnight in a dog or in a cat; hence the term “incubation period.” Again, let me challenge the naysayers to post a peer-reviewed journal article intended to clarify or refute the intentions of a PEP besides the usual “psychological peace of mind” when one is bitten, scratched, or licked by a puppy, or a vaccination-compliant (on an annual basis) dog.
CLARIFICATION: Why is the rabies vaccine administered in the third month of a puppy’s life?
It is for the simple reason that at this point, dogs begin to socialize with other dogs, therefore increasing the chances of exposure to this 100% fatal disease.
CLARIFICATION: Who defines exposure?
In the United States of America, collaboration is stressed. Institutions like the CDC, the National Association of State Public Health Veterinarians (NASPHV), and WHO help define what exposure means. By definition, we veterinarians are also public health authorities due to the fact that we practice medicine on animals.
If you were bitten by a cat, dog, or any warm-blooded animal that appeared healthy at the time you were bitten, it can be confined by its owner for 10 days and observed. No anti-rabies prophylaxis is needed. There is no need to panic, especially when the dog stays indoors and has little or no contact at all with any other dog, cat, or any other mammal, especially if it is a vaccine-compliant dog. Always remember that rabies kills the dog or cat suspected to have the disease first, and not you.
Clinical Presentation (what the signs of the disease look like: disease forms/subtypes, history, chief complaint in the animal)
- Prodromal form – the change in behavior lasts 2 to 3 days; it displays anxiety, a preference for solitude, and apprehension or fear
- Paralytic or dumb form – describes the majority of canine cases and a minority of feline cases; lasts 1-7 days
- Furious form – describes the majority feline cases and a minority of canine cases; is seen as aggression, biting, changed voice, paralysis, seizures, and loss of balance; may be seen in all three forms.
These signs last two to four days from onset of clear signs to death.
VERY IMPORTANT: in the quarantine or confinement area
Clinical signs appearing in the animal within one week of the appearance of the bite wound are extremely unlikely to be related to rabies infection via the said wound.
What about other small mammals?
Consult public health officials. Bites of squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, other small rodents, rabbits, and hares almost never require rabies PEP.
- Centers for Disease Control and Prevention (http:www.cdc.gov/ncidod/dvrd/rabies/)
- National Association of State Public Health Veterinarians. Compendium of Animal Rabies Prevention and Control
- Greene CE, Dreesen DW. Rabies. In: GreenCE, ED Infectious diseases of the dog and cat, 2nd ed. Philadelphia: Saunders 1998: 114-126.
- Cote, Etienne. Rabies. Clinical Veterinary Advisor: dogs and Cats. Mosby, Inc., an affiliate of Elsevier Inc. © 2007: 939
- Tilley, LP, Smith Francis W.K., Jr. Rabies. The 5-Minute Veterinary Consult, 3rd Edition., Lippincott Williams & Wilkins ©2004:1112-1113.
ABOUT THE AUTHOR:
Emmanuel D. Macapagal, D.V.M. is the former PAHA president (2000-2001) who also served as the chairman of the Council on Ethics for the PVMA as its and Speaker Pro Tempore.
This appeared in Animal Scene’s September 2016 issue.