It was an accident. My four-year-old daughter, Jrue, and four-month-old Shiba Inu, Kiseki were playing. Kiseki was about to lunge at the toy Jrue was holding when she bent down to reach for her homework that was lying on the floor. It was an unfortunate timing that resulted in my daughter getting canine teeth marks on her face.
But things happen for a reason. Because of this incident I learned the risks, as well as the right practice to keep our children safe around dogs. This post will explain the dangers of rabies and the steps to follow after a dog bite.
1. A bite on the face is an emergency case.
I didn’t witness what really happened. All I got was a reenactment from the kids after they had settled down. I came in five minutes late after the incident and only saw a weeping Jrue with blood dripping from her left cheek. “Should we take her to the doctor?” Lalaine (my wife) asked. I checked the bite, and based on my own assessment, it was minor. She has two punctures the size of a sesame seed. One on her cheek and one under her lower lip. She also got a very light, wolverine-like slash under her eye.
“Nope, I don’t think we need to. The extent of the damage is minimal.” I replied. “Let’s just wash it with water and soap, then apply some antibiotic ointment.” I continued. “Besides,” trying to reassure her, “Kiseki is already fully vaccinated. What’s to worry about?”
But Lalaine wasn’t at peace with my response because of a similar incident that happened two decades ago. Her nephew was bitten by their chow-chow on the face, and was advised to be admitted to the hospital immediately. “That injury was significant,” I countered. “His upper lip needed to get stitched.” Still unconvinced, Lalaine asked me to seek advice from Kiseki’s veterinarian.
I grabbed my phone and sent this message to Dr. Nor:
“Good day Doc! My daughter was playing with Kiseki, and was bitten accidentally. She has two VERY SMALL punctures on her face. Question: does she need to get shots? Or we can simply wash it then apply antibiotic ointments? Thank you in advance!”
Then she responded:
“Good afternoon. Please wash the affected area with clean water and soap. For your daughter’s protection, I advise you to bring her to the nearest animal bite center to get anti-rabies shots since this is a bite on the face.”
I like Dr. Nor, but I’ve only known her for two months. I guess that’s my way of saying that I’m not fully convinced with her response. It’s possible that she leans more towards the conservative side. I needed a second opinion. I messaged another veterinarian, Dr. Franz, who we’ve known for decades. I trust him completely, but his clinic is now too far from where we live. I sent the same message to him, and this is his response:
“Since the bite is on the face, you need to bring her to the doctor for the necessary shots against rabies.”
I quickly changed my shirt and drove Jrue to the nearest ABC (Animal Bite Center). Later I found out that a bite on the face is considered an emergency case.
2. You should visit the Animal Bite Clinic (ABC) no matter how small the punctures are.
The nearest ABC is 15-minutes away from our house. On the way there, I still questioned whether we’re overreacting to a small wound. Perhaps I should have sent the photo of Jrue’s face, so they could see how insignificant the punctures are. But since we have already left the house, my best bet is for the person in charge to say, “That’s too small to worry about. You can go home now.”
I slowly peeled the band-aid off my daughter’s face as we arrived. The nurse (Rachel) examined them and asked, “Did those bleed?” “Yes, the one on the cheek” I replied. “Your daughter needs to go through Post-Exposure Vaccination.” Rachel advised. I don’t like to pretend that I am familiar with this procedure, so I asked, “What is boast-enclosure vaccination?”
What is post-exposure vaccination?
Post-exposure vaccination is a medical treatment for people who have been bitten or scratched by an animal, particularly a dog, that may have rabies. The vaccination aims to prevent rabies, a deadly viral disease that affects the nervous system.
The patient will receive a series of rabies vaccinations, usually given over a period of three to four weeks. The usual schedule is two shots on both shoulders on the day of exposure (Day 0), and then more shots on Days 3, 7, and 28. It’s essential to complete the entire vaccination series to ensure full protection against the virus.
If the bite comes from a confirmed rabid animal, the patient will receive a dose of rabies immunoglobulin (RIG). This provides immediate, short-term protection by blocking the virus at the site of the bite.
Post-exposure vaccination is highly effective if administered promptly after exposure. Rabies is almost always fatal once symptoms appear, so this treatment is crucial for preventing the disease.
“She has to go through all of this even with this teeny tiny wound?” I asked with a pleading look. “Any wound from a potentially rabid animal should be treated right away.” Rachel replied with a straight face.
3. Fully vaccinated animals can still spread rabies.
I don’t know why I feel like I have to “save” my daughter from the vaccine. In truth, getting the rabies shot will make her safer. I’m not sure why I need to overthink this. Why not get the shot and go home? Maybe because one, it’s going to be messy. Try telling a four-year-old girl that she’s getting multiple injections this week. I’m sure she’ll go berserk.
Two, it’s going to be time-consuming. We already have lots of matters to attend to this week – and now we have to add more to our plate.
Three, maybe the biggest one, is guilt. I was the one who brought Kiseki to our home. Therefore, it would be because of me that Jrue has to go through the pain. I guess that’s the ultimate reason I was forced to give Rachel my final plea:
“Does she still need to go through the procedure even if our dog lives indoors and is fully vaccinated?”
Rachel explained, “Anti-rabies vaccine protects dogs from rabies, but it doesn’t prevent them from carrying and spreading the virus. In addition, the Department of Health (DOH) says that vaccinated animals still have a 1% chance of catching rabies.”
In short, “Yes.”
4. Rabies is not the only concern after a bite.
I’m terrible at math, but I know 1% is virtually 0%. Yet, that percentage is something you do not want to mess with. The World Health Organization (WHO) said rabies causes about 59,000 human deaths every year in more than 150 countries. That’s about 6 deaths per hour.
“But rabies is not the only concern,” Rachel added. “Dog bites can also cause nerve and tissue damage as well as bacterial infections like tetanus.”
What is Tetanus?
Tetanus is a serious infection caused by bacteria that enters the body through cuts in the skin. It causes muscle stiffness and spasms, typically starting in the jaw (“lockjaw”) and spreading to other parts of the body. It can be life-threatening if untreated.
The most effective way to prevent tetanus is through vaccination. The tetanus vaccine is usually given as part of the DTaP (diphtheria, tetanus, and pertussis) or Tdap booster vaccine. Adults are recommended to get a tetanus booster every 10 years.
“So, you’re saying Jrue needs a tetanus shot too?” I asked. Rachel flipped through Jrue’s vaccine records and said, “Yup, she’s already due for a booster.”
5. Rabies vaccines do not work right away.
“Okay, let’s do it.” I told Rachel. “But let me talk to my daughter first.”
I told Jrue what she had to go through: two anti-rabies shots on both of her shoulders plus a shot of tetanus toxoid. After learning that, she folded her hands, looked down, and started to sob. “This is going to be messy,” I told myself. But it’s a process I’m now willing to do for Jrue’s protection and my own safety from my wife. I’m certain Lalaine’s going to kill me if something happens to our daughter.
Rachel asked me to fill out some forms while she siphoned the vaccines into a syringe. She asks if Jrue is allergic to anything, since the shot could cause allergic reactions. “None that we know of.” I said.
I placed Jrue on my lap as Rachel approached us with a tray of three syringes, ready to be served. I hugged Jrue and told her that she could do this. But as soon as she saw the needles she began to struggle and jumped off my lap. The next thing I know we were playing cat and mouse around the clinic. She ran and hid from me, while I did my best to catch her. We did this for like eternity.
I have no idea what happened next. All I could remember was Jrue and I were back on our monoblock chair hugging one another. She already had those colorful band-aids on her shoulders, and I was all sweaty. Thank God we braved through the first day. I launched my e-wallet and scanned the QR code to pay the bill.
How much does dog bite vaccines cost?
According to Rachel, the cost of vaccines vary across different Animal Bite Clinics. But in our case, the total bill for day 0 of post-exposure vaccination was Php 1,600. Here’s the breakdown:
| 2 shots of anti-rabies | Php 650 |
| 1 shot of tetanus toxoid | Php 950 |
| Total cost | Php 1,600 |
As we get ready to head out, Rachel said that I should watch out for Jrue and Kiseki. “Come again?” I said. “Rabies vaccines don’t do anything until the 6th shot.” Rachel advised to carefully monitor any symptoms that may develop. “What are the symptoms we have to watch out for?” I asked. This is what she said:
Initial symptoms of rabies
- Fever or hot flushes.
- General weakness or discomfort.
- Headache.
- Diarrhea.
- Prickling or itching at the bite location.
She also added that it’s critical to observe the dog that bit Jrue. If Kiseki suddenly falls ill, or looks weak and doesn’t eat much, I have to bring her back to get the (RIG) shot since the risk for rabies is high.
“Great.” I said. “Thanks for the info, Rachel.”
I guess it’s going to be a long week for us.
6. Rabies symptoms can take days, months, or even years to show up.
We’re already done here, but my curiosity about the subject suddenly kicked in. I pulled the white monoblock chair back and sat on it. Jrue was sitting on the bench behind me, while Rachel was behind the desk in front of me. I said, “Rachel, you know I have been a dog owner for the most part of my life and I never had any shots despite the countless bites and scratches I got.”
She responded, “That’s good to hear. But I also have to caution you that rabies could take days, months, or even years to show up.” “Years?!” I asked. “You heard that right. Years.” She replied. “We have reported cases that rabies showed up 6 to 10 years after the bite,” she continued. “They thought it was an ordinary fever or diarrhea, but they’re actually symptoms of rabies.”
“What causes the variance in the incubation period?” I asked. “There are several factors. But mostly it depends on the person’s immunity, and the location of the bite.” Rachel answered. “Bites on the face, which is the case for Jrue, is an emergency situation because it’s near the brain. Likewise, any bite on any major veins is also critical because it hastens the travel of the virus.” She paused, then asked, “When was the last time you got exposed to a dog bite?” I showed her my scar on my left thumb, and said, “Maybe three weeks ago.” Then it hit me. I looked Rachel in the eyes and asked, “should I get vaccinated?!”
“Did it bleed?” She asked back.
Conclusion: Every dog (and cat) owner should get vaccinated.
For the first time in my life I got vaccinated for anti-rabies. I am not sure whether Rachel was an amazing resource person, or an extraordinary sales woman. Either way she got all of us, (Joab and Lalaine included), to get the anti-rabies shot.
The truth is, we do not have to wait to get bitten or scratched before we get vaccinated. It’s a good protocol for all aspiring dog (and cat) owners to get vaccinated before they get their new pet. This is called a Pre-Exposure Rabies Vaccination.
Rachel told me that pre-exposure vaccination is similar to post-exposure vaccination but has less number of shots. Post-exposure has a total of 8 anti-rabies shots, while pre-exposure only has 6. But the main advantage for pre-vaccinated people is they do not need rabies immunoglobulin (RIG) when they get bitten. RIG is often expensive and in short supply in certain areas. All they need is a booster shot of anti-rabies.
Before we went home, Rachel also oriented us about the efficacy of the vaccines in our body. She said that after we complete the series, we will be safe from any exposure for 3 months. If we get bitten after the window time, all it takes to keep us safe is to get a booster shot. For maintenance, we can either get a yearly booster or do a vaccination series every two to three years.
P.S. What if your dog bites a person?
I was having lunch with a friend recently and found out that he was bitten by his neighbor’s mini pinscher. I’m not sure how the dog owner handled it, but according to Republic Act No. 9482 “Anti-Rabies Act of 2007”:
Dog owners should assist the bite victim immediately and shoulder the medical expenses incurred and other incidental expenses relative to the victim’s injuries. Pet owners who refuse to have their dog put under observation and do not shoulder the medical expenses of the person bitten by their dog shall be meted a fine of Twenty-five thousand pesos (P25,000.00).
If you are the victim, the first aid to a dog bite is to clean the wound immediately. Wash the wound with soap and water for 5 to 10 minutes to reduce the risk of infection. Seek medical attention immediately if the bite is on the face or major body part – especially if the bite is from an unknown dog.
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