Why immunoglobulin is the best for dog bites

Overview

Most dog bite injuries are minor. However, because dogs carry different bacteria in their mouths, infection is a serious concern.  The rabies vaccine is not sufficient to keep you safe; you need more. After a dog bite, a person needs more than just ARV vaccination. Experts insist on the importance of immunoglobulin.

We’ll cover what to do after a dog bite, when to get medical attention, and what treatment options are available.

What causes rabies

• The infected animal can transmit saliva, the fatal virus, to humans, which causes rabies. The canines of the infected animals bring 99% of cases and aim at the central nervous system of humans.
• The death rate has been declining over the past few years. However, it is found that 5726 human rabies deaths occurred annually, as per The Lancet.  
• Because of death, medical assistance is very crucial after a dog bite or scratch. Many people generally believe that the rabies vaccine is enough for dog bites. But doctors make a point of 
• On some occasions, rabies immunoglobulin is also a must to prohibit the virus from spreading.

Rabies

Immediate medical aid is essential.

• The cancer doctor stressed the importance of rabies. “Rabies has a 100% death rate.” Hence, immediately after a dog bite, consult your doctor and don't be afraid. Taking chances will lead to fatal.
• Even a little scratch from a probably rabid animal needs to be treated right away. For severe instances, rabies immunoglobulin is needed for providing protection, as stated by Dr. Neha Rastogi Panda, Consultant-infectious Diseases at Fortis Memorial Research Institute, Gurugram.

Dog bite infection symptoms 

• Swelling
• Fever
• Increasing pain
• Redness 
• Pus drainage    

When does a dog bite cause infection?

Up to 20% of dog bites cause illness.  Like all animals, dogs contain loads of dental germs that can cause infection.  But other factors enhance infection risk, like:

• Bites on the hands, feet, and genitals are more likely to cause infection.  These regions catch bacteria due to their multiple levels and compartments.  
• Medical conditions: Diabetes, heart disease, and impaired immune systems can impair wound healing and infection resistance. 
• Cleaning the wound too slowly might also increase the risk.  
• Crush or puncture wounds: The risk increases with severe dog bite injuries.
• Close the wound with stitches: Infection is more common following wound closure, especially if the wound is older than 8–12 hours (or 24 hours on the face). 
• Keeping a dog bite open after first aid allows the wound to drain and air out.  This can reduce infection risk.

The majority of face bites heal without infection.  Because the face has good blood flow. 

How the vaccine for rabies works.

• In response to activation by the anti-rabies vaccine, the immune system produces antibodies against rabies. Since the virus is present in an inactivated form, the body will be better equipped to recognize and fight it if exposed.

Rabies Vaccination Type

• Pre-exposure prophylaxis, or PrEP, is useful for those at high risk like veterinarians, animal handlers, and tourists visiting rabies-endemic regions, who may develop immunity well in advance. PrEP is administered to prohibit  the virus from entering the nervous system.  It consists of many doses of the vaccine and, in some conditions, RIG.

The necessity of rabies immunoglobulin.

• Instant protection against rabies.
• The rabies virus is neutralized at the wound site.
• The illness is controlled from spreading to the neurological system
• Immediate protection was given to those who were not vaccinated earlier.
• In extreme circumstances, it is essential since it produces antibodies.
• Neutralize the virus at the site of exposure.

Many people have confidence that receiving rabies vaccination is enough following a dog bite. As stated by Dr. Neha Rastogi Panda, if RIG is not injected, the virus has an opportunity to generate since the vaccination itself takes 7-14 days to boost the body’s immune response.

If RIG is not vaccinated, there is a chance that the virus will spread to the central nervous system, which may lead to rabies death.

The standard treatment after a dog bite.

The video about what causes rabies

According to World Health Organization guidelines.

• Immediate care for wounds
• Clean the wound for at least fifteen minutes thoroughly
• Clean with soap and running water
• Apply antiseptics with 70% alcohol or iodine to reduce the virus impact
• Seek medical attention immediately
• Rush to the medical facility to ascertain whether RIG and the vaccine are needed.

Classifying the dog bite into different categories

• Category 1: Licks on plain skin, warming or giving food; no medical attention is needed.
• Category 2: Vaccination is a must if there are small scrapes or nibbling on the plain skin.
• Category 3: Deep bites, wounds, or mucous membrane contamination; immunoglobulin and vaccination are necessary.

Schedule for Rabies Vaccination.

Suggested by The World Health Organisation 

• A 4-dose intramuscular regimen for PEP on the first day, 3rd day, 7th day, and 14th day. The fifth dose is on the 28th day for immunocompromised patients.
• If the individual got pre-exposure prophylaxis earlier, just two doses  (day 0 and day 3). RIG is not necessary.

Administration of RIG

• For good result. RIG should be administered into and on all sides of the wound

Timetable for the best result of RIG

• After seven days, the initial administration of vaccination works. 
• No more vaccination is required because the vaccine itself generates adequate antibodies.

If there is any delay in RIG administration.

Within seven days: 

• It is still effective and should be administered immediately.
• It is typically not required after seven days because the vaccine has started to work.
• There is a higher risk that the virus will infiltrate the nervous system and make rabies fatal after seven days without RIG.

Is there a high demand for immunoglobulin in India?

• Obtaining rabies immunoglobulin (RIG) is still challenging in India, especially in rural areas.  As Dr. Panda stated, " Though rabies vaccinations are available, RIG is expensive and often unavailable."  Even though equine rabies immunoglobulin (ERIG) is less costly than human rabies immunoglobulin (HRIG), obtaining it is still more difficult.
• While the cost of a standard rabies vaccine ranges from Rs 300 to Rs 400, an immunoglobulin injection costs between Rs 4,000 and Rs 6,000.
• "Cold chain logistics for proper storage and transportation of RIG are challenging in remote areas, and many healthcare workers are not fully trained in WHO-recommended post-exposure prophylaxis (PEP) protocols," Dr. Panda said.
• Raising awareness and increasing access to RIG requires public education campaigns about vaccination, wound care, and its significance.

Also, read https://www.herberttrial.com/the-10-most-dangerous-dog-breeds/.

How to Stop Dog Biting

• Without knowing how to engage with dogs and respect their space, most dog bites occur.  To prevent dog bites, you must understand, socialize, trust, and communicate with your dog.
• Consult a canine behaviorist if you need help handling a dog bite.  Behaviorists can discover the problem and advise you on behavior modification and reactive leash training.  They can train you to read and respond to your dog's body language.
• Smith recommends seeing a vet if your dog is acting strangely to rule out medical issues.  Dog bites are scary, but they don't have to be disastrous.  Many professionals can advise on training, counter-conditioning, and desensitization to calm them.

Conclusion

Dog bites are scary and can cause significant problems if neglected.  Dog bites often cause bacterial illnesses; therefore, any symptom of infection should be checked out immediately.  Inoculating your dog for rabies and avoiding unknown dogs are your best defenses against dog bites and problems.  Never approach an unfamiliar dog, no matter how cute. Avoid roughhousing or playing aggressively with dogs, even your friends.  It makes sense to “let sleeping dogs lie” and never interrupt a dog feeding or caring for puppies.