Model Answer
0 min readIntroduction
Rabies is a fatal zoonotic viral disease transmitted through the saliva of infected animals, most commonly dogs. It affects the central nervous system, leading to encephalitis and ultimately, death. Prompt and appropriate post-exposure prophylaxis (PEP) is crucial for preventing the development of rabies after a potential exposure. The severity of a dog bite and the risk of rabies transmission are categorized to guide the appropriate PEP strategy. Early and thorough wound care is the first step in minimizing the risk of infection.
(i) Category of Bite
Based on the provided information, this injury would fall under **Category I** bite according to the WHO guidelines. Category I bites are defined as:
- Transdermal scratches
- Breaks in the skin without bleeding
- Animal licks on broken skin
The description explicitly states abrasions on the hand *without* bleeding, fitting perfectly into this category. This categorization is crucial as it dictates the level of PEP required.
(ii) First-Aid Measures
Immediate first-aid measures are critical, even for Category I bites:
- Wound Wash: The wound should be thoroughly washed with soap and water for at least 15 minutes. Vigorous washing mechanically removes virus particles. Povidone-iodine solution (1%) or other virucidal agents can be used after washing, if available.
- Avoid Irritation: Avoid any harsh scrubbing or irritating the wound, as this can increase capillary permeability and potentially enhance viral entry.
- Dressing: Apply a sterile dressing to the wound.
- Observation: Monitor the child for any signs of local infection or systemic symptoms.
- Documentation: Document the incident, including the date, time, location, and details of the animal involved (if known).
(iii) Prophylactic Steps to Prevent Rabies
For a Category I bite, the WHO recommends the following PEP:
- Local Wound Treatment (as described above): This is the most important step.
- Vaccination: A three-dose post-exposure vaccination schedule is recommended. The vaccine should be administered intramuscularly, typically on days 0, 3, 7, and 14. Cell-culture vaccines are preferred due to their safety profile.
- Rabies Immunoglobulin (RIG): RIG is *not* routinely recommended for Category I bites. Its use is reserved for Category II and III bites, especially when PEP is delayed.
The choice of vaccine and RIG should be based on local availability and national guidelines. It is crucial to complete the entire vaccination schedule for optimal protection. Parents should be educated about the importance of adhering to the schedule and potential side effects of the vaccine.
Important Considerations:
- If the dog is available, it should be observed for 10 days. If the dog remains healthy during this period, the risk of rabies transmission is considered negligible.
- If the dog is unavailable or shows signs of illness, the PEP should be completed as scheduled.
- The child should be educated about avoiding contact with animals, especially stray or unfamiliar ones.
Conclusion
In conclusion, this 7-year-old girl with a Category I dog bite requires thorough wound washing and a three-dose rabies vaccination schedule. While RIG is not indicated in this case, diligent wound care and completion of the vaccination series are paramount to prevent the potentially fatal consequences of rabies. Public health education regarding rabies prevention and prompt medical attention following animal bites are essential components of a comprehensive rabies control program.
Answer Length
This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.