Rabies, Zombies and Headless Dogs
There may not be a disease out there in this bacterial breeding ground that is our world whose virulence and sheer nastiness causes more distress than Rabies. You might argue that Ebola, or the lesser well known, Harlequin Type Ichthyosis (infantile disease in which the skin is replaced by scales that usually smother the unfortunate child in a few hours) are just as frightening, but in reality - and fiction - rabies is verily the heavyweight of horrible ways to go. The fact your doctor tells you, that you need a rabies shot when you visit Thailand - and just about any other Asian country for that matter - is reason enough to have it stored as a worthy fear somewhere on your mental hard drive.
Just as Jaws had us all wary of the water in the 70s and 80s, there have been a few rabies inspired flicks that have instilled a keen dread of roaming mutts and errant bats. A classic rabies horror was 'Cujo' a film about a huge St. Bernard gone bonkers after contracting rabies - he then goes on to infect, maim and kill most of the cast. Then there was David Cronenerg's 'Rabid', or the recent-ish 28 Days Later, that both see humans contracting animal borne, rabies-like diseases that compels them to bite people's faces off. It's likely that tales such as Dracula (bats are a well known carrier) and the early zombie stories got their inspiration from the disease.
In Britain filmmakers took a bite of the rabies plum with a short information film in the 70s, and then a better known advertorial hit in 1983 with the BBC and Ministry of Agriculture's information film - Rabies Kills - that showed insidious canines skulking about in foreign streets; this gave rise to many proud Brits never venturing any further than Blackpool for their annual outing, while protesting the construction of the Chunnel and boycotting Spain. Part of the dialogue in this over-blown infomercial tells the viewer, "If you're bitten, or scratched, or even licked by any animal when you're abroad, take no chances - it could have rabies. Wash the wound immediately, and then get urgent medical aid. If you wait until the symptoms of rabies appear, you've left it too late. Rabies kills!" It's true when we use a modicum of sense, rabies does kill, but it doesn't kill many people and shouldn't really turn you off touching a foreign hound again. The film omits the fact that the last known case of the disease on the isle was in 1902 and there've only been 22 rabies deaths of Brits abroad since 1946; there have probably been more deaths related to heavy things falling from the sky.
So why bother with information films when there are a multitude of diseases and ways to die that merit movie making more than rabies? Possibly, just because of the excruciatingly unpleasant way you die, has created a celebrity disease status around rabies; it's quite unforeseeable that any time in the future we'll be watching thrillers with plots based on spinal meningitis or government-funded documentaries on mumps.
If you do contract rabies and you don't seek medical help you are in for - without doubt - the worst trip of your life. That's the bad news. The good news is, rabies is preventable. The disease is transmitted through mammals, often from a bite, and the main culprits are dogs, cats, cattle, bats, foxes and raccoons. If you're bitten by an infected animal, symptoms will usually manifest within a few days, although the incubation period of the disease can last up to a few years. You could actually contract rabies, live a blissful half-decade, and then one dark day the viral ball starts rolling. CDC (Centre for Disease Control) explains that many factors are attributed to the onset of symptoms including disease variants, the dose of virus inoculum, the route and location of exposure, as well as individual host factors, such as age and host immune defenses. When the disease does decide to wreak physiological havoc, you will first feel agitated, get a fever and a headache and generally feel like crap. As the diseasemeth into your brain along with consuming a sheet of acid blotters. You become partly paralysed, then delirious, insomniac, paranoid, can't swallow, froth at the mouth, and are also rendered hydrophobic (fear of water) and ancraophobic (fear of wind). After the onset of severe symptoms you inevitably die after a few days. CDC informs us, "Non-lethal exceptions are extremely rare. To date only six documented cases of human survival from clinical rabies have been reported and each included a history of either pre- or post-exposure prophylaxis."
The antidote to the misery and madness of rabies is the fact that if you seek medical attention after being bitten by an animal then there's not much need to panic. Even if the animal is rabid you can get post-prophylaxis treatment. The WHO estimates that 10 million people every year throughout the world are treated after being exposed to animals that may have rabies. In most countries rabies cases are on the decline, although not all. Australia and New Zealand have never had rabies while in the United Kingdom, Ireland, Taiwan, Japan, Hawaii, Mauritius, Barbados and Guam the disease has been wiped out. There are about 30,000 - 50,000 (WHO) deaths a year worldwide with most cases in Africa, South America, and of course our own dear Asia, especially China where there has been a recent pet boom.
Close to home, close to the bone
In Thailand the number of cases of rabies has been decreasing for years due to a nationwide government funded initiative to vaccinate dogs. Between 1990-1994, 1995-1999 and 2000-2004 there were reported 640, 334, 257 cases respectively, throughout Thailand, while in the north there have been only a handful of cases over the last few years. Tinmanee Tippanya, a zoonosis (animal diseases transmissible to humans) expert in the prevention and control of diseases at Chiang Mai Public Health Centre told me that the last rabies cases in this area were in Om Koi, a district in Chiang Mai. Three people, at separate times, were infected and died of rabies; the first was in 2004 and the other two in 2005. In the first case an elderly man was bitten in the neck by a 1 month old puppy. Even though he went to the doctor and received a vaccination, anti-toxoids and anti-biotic, ten days later he returned to the doctor complaining of headache, fever and nausea; the next day he couldn't swallow and neural symptoms manifested. He was transferred to Nakorn Ping hospital in Chiang Mai but died soon after. As he was bitten in the neck so close to the brain and was 71 years old his anti-bodies were easily overwhelmed by the virus.
Tinmanee explained that only about 5% of street dogs in Chiang Mai are thought to carry rabies, though the percentage is hard to calculate. Most domestic pets are now vaccinated, even out in the country where mobile hospitals will vaccinate for free. "The problem was in the past people in the villages didn't know about rabies and so didn't vaccinate their pets, this way the disease spread," said Tinmanee, although another problem is that a dog cannot receive a vaccination before it reaches two months of age and many cases of rabies in the past were thought to be spread by puppies. It's also often difficult to tell if your dog is rabid as rabid dogs are not necessarily mad dogs, the disease may still be incubating.
At present in Thailand you cannot receive a vaccination as a preemptive, although if you are bitten you can receive a series of vaccination shots if the dog's history is not available and the wound is serious enough. CDC recommends, "All unvaccinated individuals with animal bites should receive immediate treatment with human rabies immune globulin (HRIG) injected into and around the wound followed by rabies vaccination." Unfortunately in Thailand this is not possible at the moment because immune globulin (anti-bodies) is not available due to its expense, so we have to make do with the vaccinations, which are not always adequate, according to CDC. Over 3000 vaccines were administered in the north last year and there were no human rabies cases, although The International Journal of Infectious Diseases writes, "Recent well-studied rabies vaccine treatment failures have demonstrated that rabies immune globulins are essential biological products that save lives." In 2003 a Thai girl passed away after being bitten in the face by a dog, even though she received post prophylaxis treatment, it wasn't enough and fifteen days later she was dead. This case was discussed at a WHO meeting on rabies where the need for immune globulin was reaffirmed. In February this year Dr Thiravat Hemachhudha of Chulalongkorn University Hospital told the world how his team had managed to develop a micro RNA rabies prototype which could stop the growth of rabies . . . when the cells were in a test tube. They'll start animal testing soon and if that works they'll use the prototype on humans.
"Prevention is the way forward," says Tinmanee, who swears by the five precepts: Don't mistreat dogs; Don't break up fights; Don't pull food away; Don't push with feet; Don't wind up the mutt - and you won't get bitten in the first place. If you do get bitten, clean the cut immediately with soap and water, wipe all saliva away and if the wound is deep see a doctor, preferably with the dog . . . or the dog's head.
Dr. Wittaya Timsard, who works for the Veterinarian Bureau of Animal Hygiene Chiang Mai also recommends decapitating hounds that look like they might be infected. "Just cut off its head and bring it to us," said Wittaya, who didn't seem to find the prospect of impromptu surgery off-putting . . . or even darkly amusing. According to the doctor quite a few heads are sent each year to the Veterinary Laboratory of Development in Lampang, either by vets or the public. The number of infected heads in 1997 was around 50, in 2007 they didn't find any infected heads. Although there have been some fruitless beheadings, the initiative to vaccinate dogs in Thailand is working. Possibly in the future we will be rabies free, and we might even persuade a few more of those zoophobic Brits to cross the Channel.
The DLD (Department of Livestock Development) drives around in buses and visits schools, temples, etc and administers vaccines for free. This takes place in March and April. www.dld.go.th
Mobile vaccination clinic for animals: 081 595 1107
The Public Health Centre for information about human rabies is on the corner of Nimmanhaemin Rd. and Suthep Road
For information or queries on animal rabies or how to 'take care' of a rabid dog, go to the Zoo Office opposite Chiang Mai Zoo
Rabies vaccinations for pets cost B60 and can be given at the Animal Hospital on the Irrigation Canal Rd. at the CMU Gate