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Rabies: Prevention and Post-Exposure Prophylaxis

What to do immediately after an animal bite in Nigeria

Rabies is virtually 100% fatal once symptoms develop — but it is 100% preventable with prompt post-exposure prophylaxis (PEP) after a bite. Nigeria has an endemic dog rabies problem, with thousands of human deaths annually estimated (most unrecorded). Dog bites are the cause of 99% of human rabies globally. The key message: any dog bite, cat scratch, or bat contact requires IMMEDIATE wound washing and PEP assessment — do not wait for the animal to appear sick.

Signs and Symptoms

✓ Incubation period: usually 1-3 months (range days to years) depending on the site and severity of bite
✓ Prodrome (2-10 days): fever, headache, itching or tingling at the bite site (pathognomonic — highly suggestive of rabies)
✓ Furious rabies: hydrophobia (intense fear of water — pharyngeal spasms on seeing or touching water), agitation, aggression, hallucinations
✓ Paralytic rabies: ascending paralysis similar to Guillain-Barre — less dramatic but equally fatal
✓ Once symptoms develop: death typically within 2-10 days; no treatment is effective; supportive care only

Risk Factors

When to Seek Help

Immediately — within minutes to hoursAfter any dog bite, cat bite, bat exposure, or contact with any animal suspected of rabies — WASH THE WOUND IMMEDIATELY for at least 15 minutes, then go to hospital for PEP assessment the same day; do not wait
Even if vaccinated previouslyA previously vaccinated person still needs 2 booster doses of vaccine after high-risk exposure — do not assume prior vaccination provides complete protection
Any symptomsThe appearance of any symptoms after a potential rabies exposure is a medical emergency — there is no effective treatment once symptoms begin

Tests & Diagnosis

🧪 No tests are needed before starting PEP
PEP should be started immediately based on clinical assessment of the bite — do NOT wait for any test results before beginning treatment
🧪 Animal observation
If the biting dog is available, it can be observed for 10 days — if the animal remains healthy after 10 days, rabies exposure is unlikely and PEP can be stopped (but NOT delayed while waiting)
🧪 Post-mortem brain testing of the animal
Fluorescent antibody test of animal brain tissue — definitive but requires killing the animal
🧪 Human ante-mortem testing
Only available for symptomatic patients — saliva, CSF, skin biopsies; academic interest only as outcome is uniformly fatal

Treatment Options

1
Step 1 — IMMEDIATE wound washing
The single most effective intervention: wash the wound vigorously with soap and water for at least 15 minutes; pour running water over the wound; this physically removes virus before it enters nerves
2
Step 2 — Wound care
Apply iodine solution or 70% alcohol after washing; do NOT close the wound primarily (suturing); debride if needed; tetanus toxoid if not up to date
3
Step 3 — Rabies immunoglobulin (RIG)
Human or equine RIG infiltrated around the wound for Category III exposures (bites through skin); provides immediate passive immunity; must be given BEFORE or with first vaccine dose; not effective if given after 7 days post-exposure; available at NCDC and some teaching hospitals
4
Step 4 — Rabies vaccine series
4-dose intramuscular vaccine series: days 0, 3, 7, and 14; modern cell-culture vaccines are safe and effective; some centres use the Essen schedule (5 doses)
5
Pre-exposure prophylaxis
3-dose vaccine series for high-risk individuals: veterinarians, animal handlers, laboratory workers, travellers to endemic areas; available at travel medicine clinics

Frequently Asked Questions

What should I do immediately if a dog bites me?
1. Wash the wound with soap and water for at least 15 minutes — this is the most important immediate action. 2. Go to the nearest hospital or PHC the same day. 3. Do not kill the dog if it can be safely observed. 4. Start PEP; do not wait to see if the dog gets sick.
Is rabies PEP available in Nigeria?
Rabies vaccines and RIG are available at NCDC Abuja, major federal teaching hospitals, and some state health facilities. Availability can be inconsistent — call ahead. Cost is a barrier; advocacy for subsidised access continues.
Can I get rabies from a scratch?
Yes — if a scratch from an infected animal introduces saliva into the wound (e.g., the animal licked its paws), rabies transmission is possible. Any scratch breaking the skin from an animal that could be rabid should be evaluated for PEP.
What if the dog that bit me seemed healthy?
A healthy-looking dog can be in the early incubation period of rabies and can transmit the virus through its saliva. The only way to determine if the dog is rabid during the incubation period is brain examination after death. Start PEP and observe the dog for 10 days — if the dog is still alive and well after 10 days, PEP can be stopped.
Is there a cure for rabies once symptoms start?
Virtually no — once rabies symptoms appear, the disease is nearly always fatal. The Milwaukee Protocol (intensive care approach) has achieved survival in a handful of cases globally but is not practically applicable in Nigeria. Prevention through PEP is the only effective strategy.

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