Post exposure rabies treatment

In my last post, you left me bitten by a dog.

It had all kicked off when I was walking towards my hotel in Chum Phae around 6pm on Sat the 13th of Feb. I was minding my own business, wondering if it was too early for a beer when I heard loud barking and felt teeth going into my calf. When I turned round I saw a mangy dog running away and load of locals with a "Oh my Buddha" look on their faces.

My hotel was round the corner so I went in and washed the wound ASAP, first with soap and water then I used an alcohol based wipe. Talking of alcohol I downed a can of beer whilst I was doing this (I had decided it was definitely beer o'clock now).

Next stop was the hospital, which proved to be a mere couple of hundred metres away. I was there being seen within less than an hour of being bitten. The English of the people on the Saturday night shift was better than my Thai although not by that all that much.

On questioning I told them I'd been vaccinated in 2009 but didn't think I'd had a booster. OK they said, we'll clean the wound with ipodine (an iodine based solution), give you a tetanus booster and a rabies shot. Fantastic. Within two hours I was out of there inoculated and with a bag of antibiotics to ward off any of that nastiness.  Job, as they say, is a good 'un.

Now, let me regale you with some interesting info on rabies. It's a virus and it's fatal within 2 to 10 days once it crosses the "blood brain barrier" (that is enters the central nervous system). Treatment at that point is industrial grade sedatives and pain killers until you die of respiratory failure (OK, turns out this isn't entirely true: the Milwaukee treatment has been tried on 42 people since 2005, and 6 of them have lived albeit with varying degrees of severe neurological damage: the treatment consists of inducing a coma for a couple of months and hoping the disease runs it's course).

So, you need to catch the virus before it crosses that barrier and enters the CNS, which is where the vaccine comes in. Vaccines, as I'm sure we all know, work by stimulating the body to produce the antibodies it needs to fight a bacteria or virus by using a noninfectious variety of the genetic material (in this case of rabies). By having a prevaccination my body had some antibodies and a memory, a template to work from, that would be stimulated further by the vaccine pumped into me, so my body would be rocking well before the pesky rabies proper kicked off in my system! Hurrah!

I woke up at four the next morning in a cold sweat. I hadn't had any booster, I could've have sworn. If so this meant my prevaccination was as good as useless. I checked the internet and I was right, if I wasn't prevaccinated I needed human rabies immunoglobulin (HRIG) as soon as possible and definitely within 24 hours of being bitten... This is a solution of the antibodies the human body produces to fight the rabies virus. It's needed to fight the infection whilst the body ramps up to produce it's own antibodies. The World Health Organisation page is probably the best reading here.

So. It was 4AM on Sunday morning. If I hadn't had a booster four years ago I needed immunoglobulin. If I had, it was all fine. But I couldn't find out for sure until Monday afternoon my time, which was way too late. As I lay waiting for dawn and the hospital to open I looked into the likelihood that the dog had rabies. As a stray I had to assume it did but what were the actual odds? Well, in Asia India has the most cases of rabies in humans followed by Vietnam and then Thailand, with the prime vector being stray dogs. I read some estimates that indicate 1 in 10 strays in Bangkok have rabies. I read other estimates that in the country 15% have it. Then there was the actual nature of the attack: complete random with no "cause"... just what you need going through your head in the hours before dawn.

I was back at the hospital for 7AM. Unfortunately there was no English speaking doctor in until 8 and despite the best efforts of Google Translate and myself nothing was going to happen until then.

Cometh the hour, cometh the doctor. A little after eight I was back and talking to the doctor about getting the immunoglobulin. And the word was no. I had had a vaccination previously therefore all I needed were two shots and that was all. I pointed out it was no longer active to no avail. I said it can't do any harm, she said no. We argued back and forth: search results were shown on the phone. Finally she made a call to a more senior doctor and the word was yes. So at a little after 9AM I was having a skin reaction test and at 9.25 I was finally being injected with immunoglobulin, half into the wound and half intramuscularly (in the buttocks).  

If, if, that dog had rabies I may have just saved my life. If it hadn't? I'd just spent £60 for no reason. 1 in 10 chance that I die painfully in the next month against £60? What would you do?

I was shattered after this. Checked into a very nice hotel and spent the rest of the day sleeping and relaxing at the pool.

That was the HRIG and the "day 0" vaccine shot. That left days 3, 7, 14 and 28 for a total of 5 shots of vaccine. But that's quite enough for one post as it is.