Rabies is the most lethal disease known to man. It tortures and torments its victims horrendously for many days before finally killing them. Having rabies is like entering ‘hell on earth’ before crossing the bridge of death. It is definitely one of the worse ways to die.
Rabies is 100 percent preventable if a proper vaccination programme is followed meticulously before and after exposure when one is bitten by a rabies-infected dog or animal. For a disease that is most lethal with a vaccination programme that is 100 percent effective, death due to rabies is most unfortunate. People in Cambodia must get themselves vaccinated against rabies. After all, the cost of vaccination is many times cheaper than in many countries (about 5 times cheaper than my country of origin, Malaysia).
Rabies is endemic in Cambodia. In simple layman’s term, it is very common. There are about 5 million dogs in Cambodia with rabies circulating widely among them. Dog bites are pretty common, about 600,000 incidents per year. That works out to about 1 in every 25 people in Cambodia. Tourists and backpackers may be at an increased risk of dog bites during their travels.
Deaths due to rabies in Cambodia are certainly far more than its neighbouring countries. About 800 people die of this disease every year in this ‘Land of Smiles’. The appearance of the first sign of rabies is like a sentence to the horrendous torture chamber first, followed by a definite life sentence. In the provinces, people presenting with the first sign of rabies to the doctor are often sent back home – akin to receiving a death sentence, with no chance of surviving.
All of these victims would survive if they had visited a good doctor immediately after being bitten, scratched or licked by a rabid dog or animal. The doctor should institute and follow through the vaccination programme that is proven to be 100 percent effective.
It is important to stress that vaccinated individuals should also present themselves for a follow through post exposure vaccination regime if they are licked, scratched or bitten by a rabid dog or animal. It is recommended that the dog-bite wound be thoroughly washed with soap and water for approximately 5 minutes followed by an application of povidone iodine or alcohol to reduce the number of viruses in it.
Despite reading the above, some may still think that rabies vaccination is unnecessary as they are unlikely to be bitten by a dog. Perhaps the case report of a recent incident reported in the Journal of Travel Medicine should be highlighted here to further encourage unvaccinated individuals to take immediate action towards this important prevention.
A 25 year-old French national who was an 8-month resident in Kep province, Cambodia, sustained a dog bite on her right middle finger while feeding a stray dog in early May 2015. The dog then disappeared. The bite victim had not undertaken pre-exposure rabies vaccination before moving to rabies-endemic Cambodia.
She consulted a local doctor immediately after the bite in nearby Kampot for wound cleansing and management. Evidence collected from a thorough case investigation suggested that rabies vaccination was not given. The patient returned to the clinic on June 13 because her wound had become infected. On June 19, the patient developed fever and inability to swallow fluid due to muscle spasms of her throat.
She was admitted to Sonja Kill Memorial Hospital in Kampot with diarrhoea, vomiting, difficulty swallowing, high fever, excessive saliva secretion and an extreme fear of water (hydrophobia). The presentations were consistent with the diagnosis of rabies. She was immediately transferred to Calmette Hospital, a national referral hospital in Phnom Penh. There, the patient was hospitalised and managed in the Emergency Medicine Unit. She died on June 20, 2015 of cardiorespiratory arrest.
Generally, the first symptom of rabies typically appears between 1 to 3 months. However, this incubation period can be as short as 4 days or as long as 6 years depending on the location and severity of the infected wound and the amount of virus introduced into the wound. The initial signs and symptoms are often nonspecific such as fever and headache that are also common presentations of other diseases.
As rabies progresses, it causes infection of the brain that manifest clinically as muscle paralysis, anxiety, difficulty sleeping, confusion, agitation and abnormal behaviour. The victims may hallucinate, become paranoid, disorientated or slip into coma. They may have extreme fear of water (hydrophobia) or sensitivity to light (photosensitivity). Death usually ensues 2 to 10 days after the emergence of the first symptoms.
In Cambodia, the estimated death due to rabies is more than deaths due to malaria or dengue.
My next column will be on ‘Exercise is medicine’
Dr. Victor Ti, MD, MFAM (Malaysia), FRACGP (Australia), Dip P Dermatology (UK), Dip STDs/AIDS (Thailand), Dip. AARAM (USA), LCP of Aesthetic Med.(Malaysia) is an experienced expat specialist generalist (Family Physician) of BH Clinic, Phnom Penh. As a specialist generalist, he is skillful at diagnosing all general diseases and excluding the sinister ones. Apart from the general diseases, Dr. Victor is also known for his skill in skin diseases, sexually transmitted diseases, minor surgery and aesthetic medicine. He can be contacted via email [email protected] Tel: 023900446 or Whatsapp: +60164122977