-one of the readers who answered the rabies question
Zu Shuxian
1 What do you mean by "healthy dog"?
"Healthy dog" refers to a dog with normal or healthy appearance, or a dog with no obvious abnormality or pathology. For example, from the appearance and shape (such as the appearance of fur, walking gait, sitting posture), appetite, spirit, reaction and other aspects, it is the same as a healthy dog, and it is the same as usual in the eyes of its owner. If a systematic clinical examination is carried out, it is not difficult for veterinarians and careful owners to find obvious signs such as no fever, no red eye (no congestion), no secretion, no yellow sclera (no jaundice), no salivation, wet nose, no dyspnea, clean anus and no diarrhea. So "obviously healthy" means that the dog has no obvious symptoms and signs. For rabies, "healthy dog" refers to a dog that has no rabies symptoms and does not need to be tested to prove it.
How to judge the clinical manifestations of dogs bitten by suspicious dogs?
If dogs and cats are suspected to have rabies (veterinarians or related professional medical personnel), generally speaking, they should be executed immediately (euthanized) and the brain tissue should be sent to a conditional laboratory for pathological and virological examination of rabies. Conditional, can also be isolated observation.
A research institute in Thailand took in 2 152 dogs and cats, which were delivered within 1-4 days after their owners found their behavior abnormal and were bitten, and kept them in captivity for observation. It was found that all dogs proved to be rabies died within 10 days after being taken in [note 1]. Up to now, professional books at home and abroad also say that dogs suspected of rabies should be observed in isolation 10 day. If the dog does not get sick and die within 10 days, it is not rabies and the bitten person is not exposed.
However, in recent years, some readers in some health science newspapers often ask that they were bitten by dogs several months or years or even more than ten years ago. The dog was not killed as a mad dog, but was healthy. The reader's question is: Is it possible to get sick? Do you still need vaccination now?
However, doctors in infectious diseases or rabies clinics usually answer that healthy dogs will also carry viruses, and the incubation period of rabies is very long, which can be as long as ten, twenty or even thirty years, so it is possible to get sick. Therefore, in order to vaccinate rabies vaccine, it is best to determine the antibody level of rabies virus in serum to know whether the vaccination is effective. This answer is the main reason for the public's unwarranted panic about rabies. In the city, children are often bitten or licked by domestic healthy puppies, and the family is busy, so they hurriedly escort their children to the epidemic prevention station for vaccination. I have received calls from more than a dozen relatives, friends or strangers asking such questions. In fact, this panic is unnecessary.
The incubation period of rabies refers to the time from contact with rabies virus (mainly dog bite) to onset. Generally 20-90 days, occasionally as short as 10 days, 1 year is rare. If a person is bitten by a dog and becomes ill within 5, 6 days or less, it can't be rabies. It is reported somewhere that a woman was bitten by someone else's dog for 2 days and fell ill, tearing her clothes and cramping all over her body. In fact, this is hysteria or hysteria.
Most people who ask this kind of question are sensitive and nervous, and get the answer from the doctor above, and they are anxious and even desperate all day. I met a suspected rabies patient who has been ill for several years. He was injected with five rabies vaccines and tested twice for antibodies. First, he wrote me a long letter. Then he interviewed me and called me four or five times. It takes a long time every time, and it's useless for me to explain. I suggested that he go to a psychiatric clinic. He didn't seem interested in it, and later I learned that he had been to the psychiatric department many times.
3 Six criteria for diagnosis of rabies in live dogs [Note 2]
If this is too simple, we can make a preliminary diagnosis of suspicious dogs according to the following six clinical standards, which is helpful to deal with bitten people.
[1] How old is the dog?
① Less than 1 month, not rabies.
② If the age is greater than 1 month or unknown, look down [2];
[2] Dog's health?
① People who are healthy (have no disease symptoms) or have been ill for more than 10 days are not rabies.
② If the illness is shorter than 10 days or unknown, look down [3];
[3] What is the disease state?
(1) was in good health and suddenly became ill, not rabies.
(2) gradually onset or unknown, look down [4];
[4] What was the clinical situation in the last 3-5 days?
(1) The condition is stable or improved, and it is not rabies.
(2) If the disease progresses or is unknown, look down [5];
[5] Can dogs "circle"?
When a dog stumbles or walks in a cage, it always turns in one direction and hits its head on the fence as if it were blind.
① Yes, not rabies (mostly canine distemper).
(2) No, or unclear, look down [6];
[6] Did the dog have two or more of the following 17 symptoms and signs one week before his death?
(1) drooping chin.
(2) Abnormal sound.
(3) The tongue is protruding and the surface of the tongue is dry.
(4) lick your own urine.
5] Not drinking water leads to an increase in drinking water.
[6] Throat obstruction and retching.
(7) Eating abnormal things (pica).
(8) Behavior change.
(9) aggressive behavior.
⑽ bite for no reason.
⑾ Run aimlessly.
⑿ Stiff posture when running or walking.
[13] fidgety
[14] Bite things in the cage (such as fences and food plates).
⒂ sleepy.
It showed paralysis of hind limbs and unbalanced gait.
⒄ Always sit in the posture of a dog.
Yes, it is rabies.
② None or only 1 species is not rabies.
Note: When the answer to any question in [1] to [5] is ①, rabies can be ruled out, so there is no need to continue reading.
Thailand is an epidemic area of rabies, where there are good laboratories and well-trained researchers who have conducted many valuable field studies on the clinical, epidemiological and preventive aspects of rabies. The data of Thailand [note 1], six criteria for diagnosing rabies in live dogs [note 2] and photos of rabies cited in this paper are provided by Dr. Tepsumethanon, a veterinarian of the Queen Saowaha Memorial Institute of the Thai Red Cross (WHO Rabies Research Cooperation Center). I have discussed many practical questions about rabies with him by email, and he has answered them patiently and meticulously. Thanks to Dr. Tepsumethanon. [Note 2] The signature of this article is the same as that of Dr. Meslin of WHO.
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Examples of false statements about rabies in the media
-Answer the reader's second question about rabies.
Zu Shuxian
There are many inaccurate or wrong statements in news reports or knowledge articles about rabies in the media, which is one of the reasons leading to public fear. Most of these articles are written by journalists, and some are based on interviews with professionals. Some mistakes may be caused by misunderstanding of journalists and editors or catering to the public's reading interest. When I was interviewed by reporters, I asked them to read it after writing, but it was rarely accepted, so my words were often taken out of context and lost accuracy and gist. But some untrue statements are made by professionals, because although the development of rabies vaccine in China ranks in the forefront of developing countries, the epidemiological research is relatively backward. There are many wrong statements in online articles. Here are a few representative examples to comment on, and readers can draw inferences. The text of the question is basically online quotations, and I will extract its main points.
1. You can get rabies without being bitten by a dog.
(1) Sleeping in the same bed with your cat for a long time, the kitten is safe and people die of rabies.
Comments: In developing countries, dog bites are the main route of transmission of rabies, accounting for more than 95%. Some authors use the title "You can get rabies without being bitten by a dog" just to attract attention and grandstanding. Sick cats can spread rabies through bites, and scratched wounds can also be infected through saliva containing viruses, but infections caused by scratches are rare. People died of rabies, but cats are "innocent", so it can be completely denied that they were infected by cats. Healthy cats will not be infected with rabies.
② A farmer in rural Hebei was infected with rabies while handling duck feathers. The duck was bitten by a rabid pig, and the pig was bitten by a mad dog.
Comments: In earlier years, some foreign researchers said that birds might be infected with rabies, which has now been denied. Rabies virus only infects mammals, and it is impossible for birds to be infected naturally except that chickens and ducks can be infected experimentally. There is also a saying that poultry infects people in domestic epidemiological books and periodicals. The doctor in charge of rabies in an epidemic prevention station in an autonomous region recorded an example of chicken infecting human rabies in an article. I called him to verify it. He said that he just heard that there was no investigation, and he couldn't remember the details. In any case, contact with duck feathers will not infect rabies.
There was a young man in Guangxi who touched the stick of a mad dog and died of rabies five months later.
④ In Heilongjiang Province, a person accidentally touched the pole that beat the dog, and rabies broke out 19 days later.
Comments: Rabies virus is weak, easily killed by sunlight, heating, drying and general disinfectants, and cannot survive in the environment. Dry saliva virus loses its infectivity. In the above two cases, it is only when the dog stick or pole has just been polluted by the saliva of the mad dog that it is possible to come into contact with fresh saliva immediately. This kind of coincidence is hard to happen.
⑤ A woman in Guangxi died of rabies because her child's leg was bitten by a dog and she bit the seam with her teeth when mending her pants. .
Comment: It is puzzling: Did the woman immediately mend the bloody trousers after the child's trousers were bitten by the dog? This situation seems unreasonable. If you wash the pants contaminated by dog saliva, or dry the blood stains and mend them, it is impossible to be infected. These "special cases" need sufficient evidence and detailed investigation reports, and they must be accurate in facts, scientific and common sense and stand the test.
A farmer's dog in Jiangsu was bitten by another dog. Out of pity, his master touched his wound and died of rabies.
Comment: The description is too simple to be true. Excuse me: Does the biting dog have rabies? Did the bitten dog get rabies and die? Even dogs with rabies are unlikely to be infected. Believing in rumors is a sign of lack of thinking ability.
It used to be thought that rabies could only be transmitted from animals to people, not from person to person. But now there are some examples of people infecting people.
① 1982, a farmer died of rabies three months later because he gave artificial respiration to a drowning child bitten by a rabid dog. (I didn't say if the child has rabies! )
② A mother in Taiyuan, Shanxi Province suffered from rabies after breastfeeding her daughter for 7 months.
(3) A 26-year-old farmer in Anhui Province fell ill because of contact with his brother who suffered from rabies, and died one month later.
Comments: The virus can be isolated from cerebrospinal fluid, eye secretions and urine sediment of rabies patients, so it is necessary to take certain isolation measures for patients. There have been 10 cases of rabies caused by misuse of donor cornea and solid organs for transplantation abroad. Only Ethiopia has reported two cases that may be transmitted from person to person: one case was that the mother got sick after being bitten by her 5-year-old son who was suffering from rabies, and the other case was that a 5-year-old boy kept in close contact with his mother when she was suffering from rabies, and she kissed him on the mouth many times. Ethiopia is a high incidence area of rabies, and there are many stray dogs. Although the patient's family denied the history of dog bites, it seems that it is still difficult to rule out. In addition, there is no investigation report of rabies infection due to accompanying patients or family contact. In order to confirm the authenticity of cases ①-③, detailed investigation is needed to obtain sufficient evidence. Linking two seemingly related events can only be regarded as anecdotes, which cannot be taken for granted.
4. A doctor in an infectious disease hospital said that the incidence of people being injured by dogs was 15%-30%.
Comment: There is no explanation as to why there is such a high incidence of dog wounding. If it is bitten by a rabid dog, it is entirely possible. If it means that healthy dogs bite people in the city, then her own experience does not support it. She is a doctor in the infectious disease hospital of a provincial capital in the south. There are not many dog bites of different degrees in that city every year, but there may be no reports of rabies in this city for many years.
5. Expert warning: 15%-30% of healthy dogs also carry viruses, which can spread rabies. Even healthy dogs that have been vaccinated have 4% carrying the virus. Once the disease occurs, the mortality rate reaches 90%.
Comment: These words are groundless, or the basis is wrong. The reason can refer to my article published in the Beijing News last year or my blog post-against the statement that healthy dogs carry rabies virus. After the onset of human rabies, it is impossible to survive, and the mortality rate is 100%, not 90%! (Note: Mortality and mortality are two different concepts. It is incorrect to use mortality here. )
This year, Professor Zhang Yongzhen of China Center for Disease Control and Prevention and other experts wrote in the article "Epidemiological Characteristics of Rabies in China and Preventive Suggestions": "The author recently observed suspected healthy dogs in Hunan and Guizhou for more than six months, and detected whether there are rabies virus antigens and viral RNA in saliva and brain tissues in the laboratory. Studies have found that these dogs have no clinical symptoms of rabies, and there is no rabies virus in their brains and saliva. This shows that healthy dogs will not spread rabies virus. Chinese Journal of Preventive Medicine, May 2007, Volume 4 1 No.3, Page 165- 168.
Simply put, a healthy dog doesn't have that thing you said. I often get bitten and bleed by my dog. I will do a simple treatment (soap cleaning) on the wound. I have no symptoms. I was worried when I was bitten. After collecting some information, I realized that ignorance is terrible. I hope you live with peace of mind. Teacher Zu Shuxian wrote an article about rabies. You can find more relevant information.
There are two dogs in my family. I was bitten. I just disinfected it. I didn't get an injection. I believe the above research results, and I am still alive. You can refer to the above information.