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China Health Watch: Rabies

Whether or not the dog that bit you was vaccinated is not enough to protect you from rabies.


 

Health Watch: Rabies

 

Did He Have His Shots?

If you’re reading these words, odds are good that you come from a country with a reasonably rigorous rabies vaccination program for pets. North Americans in particular hardly need to worry about exposure to the fatal virus when dealing with domesticated animals at home, but the situation in China is different. Here, even a vaccinated animal may not have the proper antibodies (or any protection at all), a situation made all the more dangerous because while in the U.S., the rabies vector population is wildlife—bats, raccoons, and other wild mammals—here the virus stronghold is in man’s best friend.

 

Dangerously Common

For confirmed rabies deaths in China, “more than 95 percent of these people became infected after exposure to a dog,” explains Mary Peng, founder of the International Center for Veterinary Services. “Exposure” includes both bites and when the saliva of an infected animal comes into contact with any cuts or scrapes, or even nostrils, lips, and eyes. To explain how easy this can be, Peng says, “Have you ever met a puppy that didn’t lick your face? This is what puppies do. And if that puppy were to be infected with the rabies virus, that is absolutely a route of transmission, and absolutely an exposure risk.”

“Rabies is dangerously common here in China,” emphasizes Dr. Richard Saint Cyr, a family medicine physician at Beijing United Family Hospital and Clinics. “China is in second place, only behind India, in the number of deaths per year from rabies—usually around 2,000 persons, and many of them are children. For comparison, in the USA, only one-to-two people die each year from rabies.”

 

Protecting Pets to Protect People

The agricultural bureau is the exclusive importer and distributor of animal rabies and other vaccines to animal hospitals, but Peng notes not all hospitals are designated equally. This is also true for human hospitals; not all have the certification to legally procure and administer the rabies vaccine. Authorized animal hospitals have a large plaque identifying their designation as a rabies vaccine hospital, proving they’ve met stringent standards.

 

“All the animal hospitals throughout China who are designated to give legal rabies and other vaccinations must have that plaque displayed in their front office. You need to look for that,” Peng emphasizes.

 

To maintain certification, the requirements are substantial: “You have to have a separate vaccination room, you have to have a separate computer system to track the inventory and do the online reporting. Every time we do a rabies vaccine it has to be reported and registered to the online system that’s part of the animal husbandry bureau’s database.” As of January 2015, all dogs vaccinated at authorized hospitals and clinics receive a bright-red heart-shaped tag certifying their rabies-vaccination status.

Additionally, all the animal vaccines are imported so that the bureau can ensure local dogs and cats receive high-quality, globally recognized vaccines, Peng says.

 

China Loopholes

Yet in the land of melamine milk and gutter oil, there are always those looking to make a buck through deceptive means. While kennels, pet shops, groomers, dog training schools, and breeders claim with regularity to offer the rabies vaccine, none of them can legally procure it from the animal husbandry bureau.

 

“As a pet owner and as a member of the community, you must ask yourself, ‘Where are they getting these vaccines from?’” Peng says.

 

The only possible sources are unsecured illegal channels, which can include the illegal reselling of vaccines and the trading of unregistered vaccines in the black markets. In such cases, even if a breeder or groomer has procured a real vaccine, they have not received the necessary medical training in handling it, and there is no way to know if it has been stored properly. Vaccines are sensitive, and without careful temperature maintenance, can quickly lose their efficacy, putting both animals and the humans at risk.

As a result, unless you’ve had your pet vaccinated at a hospital or clinic with all the proper certification displayed, there is simply no way of knowing if an animal received the real vaccine, an expired or ineffective vaccine or even a fake one. Thus, a bite or scratch from any animal requires vaccination to ensure protection from a disease that cannot be diagnosed until an autopsy is performed. This is why local people who are scratched or bitten by a domestic pet in China—even one that was vaccinated—still go for the series of rabies shots.

 

Once Bitten

If exposed, both veterinarians and doctors advise seeking post-exposure treatment (PET), typically five vaccines administered over the course of 28 days. For serious bites from an animal whose medical history is unknown, doctors also advise an injection of human rabies immunoglobulin (HRIG) with the first vaccination, which is administered as close to the site of the wound as possible to neutralize the virus at the point of exposure while your antibodies have time to build up. HRIG protects you in the interim, but it’s both expensive and in constant short supply; you can’t always rely on its availability.

 

It’s wiser—not to mention more cost-effective—to do the pre-exposure prophylaxis (PEP) vaccines in China, where high demand means lower costs. The human vaccine is locally produced, safe, and effective, says Dr. Richard Saint Cyr.

 

“Parents often dismiss the rabies vaccines as ‘extra’ for Beijing, but I consider them important,” Dr. Saint Cyr says. “It’s so much easier to get the three preventive vaccines over one month, and if you are ever bitten in the future then you would only need two shots over three days, and no immunoglobulin injection.” Otherwise, he notes, you need to do four-to-five shots and the HRIG injection. “This is always much more complicated, not to mention very stressful, and the immunoglobulin injection can be expensive, painful, and sometimes difficult to keep in supply.”

If exposed, immediately wash the wound with soap, water, and iodine if you have it, says Dr. Saint Cyr. “You have about a week to come in to a clinic for the first rabies injection, but earlier is always better,” he says.

“This is why anyone traveling in remote areas in China, India, or anywhere at high risk, should get the three-shot pre-exposure vaccines before their trip; it will make potential exposures on your holidays much less stressful.” 


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