Sunday, 9 March 2008

Butt Shots

Since the Secretary already mentioned that the Assistant was bitten by our patient and that we had to spend around P20,000 for his post exposure prophylaxis, I might as well post about that incident.

I plead guilty. Had I listened to the Secretary to have the Assistant vaccinated early on, we need not have spent that much and the experience would not have been traumatic for the Assistant ( Either I've acquired the skill of letting constant nagging escape through my other ear, or I was just too preoccupied with work at that particular time, sorry guys! )

We brought the Assistant to the Research Institute for Tropical Medicine (RITM) on the same night he was bitten. It was getting close to midnight, but the queue at the emergency room kept on building up. Every every now and then, children and adult alike are ushered in, each nursing wounds in different parts of their bodies from the bite of either a dog or a cat. Every now and then, we would hear children ( and sometimes adult too) crying their lungs out from the pain of the injections and see their families or the owners of the animals wincing at the cost of the shots.

One patient, a girl, was bitten at the back of her head by a neighbor's dog. Due to the proximity of the bite to her brain, she had to be given a shot costing P20,000 for the first shot alone. Anyone who's been there would probably think twice before getting a warm blooded animal for a pet. An animal bite would cost you an arm and leg, literally and figuratively.

Once Rabies enters the brain of a bite victim, the results are always fatal. The only thing that can save a patient from a certain death is timely treatment consisting of a dose of immunoglobulin injected at the site of the bite, and intramuscularly at another part of the body far from the wound( usually at the upper part of the buttocks). The immunoglobulin is an antibody that will immediately neutralize and kill the virus before it can cause any damage. The patient will then be given five doses of active rabies vaccine at day 0, 3, 7, 14, and 30, which will stimulate his body to produce antibodies against Rabies and afford protection for a year, subject to succeeding annual booster shots.

The World Health Organization has classified exposures to an animal in three categories, with each category having a specific treatment regimen. The above regimen prescribed to the Assistant is for Category 3 exposure which include the presence of bite wounds in different parts of the body.

Persons frequently handling animals are at a high risk of being bitten, hence it is recommended that they be given pre exposure prophylaxis which consist of an intradermal shot ( just under the skin) of active rabies vaccine at day 0, 7 and 21.

There are animal bite centers all over the country, but it can be very expensive to have your rabies vaccine there ( each shot costs about P1700) owing to the fact that once opened, a 1 ml vial has to be discarded after eight hours. A patient ends up paying for the entire vial even if he only needs .01 ml of it. At the RITM, rabies vaccines are a lot cheaper ( P240 per shot) because of the volume of patients who can actually share in the cost of every vial.

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