Part XX — Rabies, zoonoses, and household public health

This is the most consequential chapter in the encyclopedia, and the one whose absence was hardest to defend. India carries a large share of the world's human rabies deaths, and the overwhelming majority of them follow a dog bite. The encyclopedia has always described rabies as a canine disease; here it is treated as what it actually is — a household and public-health problem in which the dog, the owner, the neighbour, and the child on the street are all involved.

[MEDICAL REVIEW PENDING] The human-facing guidance below follows the standard public-health line (wash the wound, then seek medical care immediately). It names no drug, dose, or schedule, and it is not a substitute for a doctor. It must be reviewed by a medical professional — not only by a veterinarian — before it is published or surfaced in the Dally app.

20.1 Why rabies is different from every other disease in this book

• It is effectively always fatal once symptoms appear — in a human or in a dog. There is no treatment at that stage, anywhere in the world, at any price.
• It is entirely preventable before symptoms appear. Prompt wound washing and post-exposure medical care are close to completely effective.
• The gap between those two facts is measured in hours and days, and is the reason this chapter exists.
• Vaccinating dogs is what removes the disease at source. A vaccinated, well-kept dog population is the single most effective rabies-control measure — which makes vaccination a civic act as much as a veterinary one.

20.2 If a person is bitten, scratched, or licked on broken skin

Act immediately. Do not wait to see whether the dog looks ill, and do not wait for symptoms in the person — by the time there are symptoms it is too late.

1. Wash the wound at once with soap under running water, and keep washing — the recommended duration is around fifteen minutes. This mechanical washing is the single most effective thing anyone will do for the victim, and most people stop far too soon.
2. Apply an antiseptic if one is available. Do not close, stitch, or bandage the wound tightly, and do not apply traditional remedies — chilli, oil, herbs, or turmeric — which do nothing for rabies and worsen the wound.
3. Go to a doctor or hospital immediately for assessment. Post-exposure prophylaxis is a medical decision and a medical treatment; it is not something to arrange at home or to defer to the next convenient day.
4. Tell the clinician everything: the animal, whether it was provoked, whether it is owned or free-roaming, whether it is vaccinated, and where on the body the exposure was. Bites to the face, neck, and hands are treated with particular urgency.
5. If the biting dog is owned and can be safely observed, note it. A dog that remains well for ten days after the bite was not shedding rabies virus at the time — but this observation NEVER delays the human's medical care. It informs it.
6. Report the incident where a local mechanism exists, so that the animal and any other victims can be traced.

20.3 Recognising rabies in a dog

Rabies does not always look like the snarling, foaming animal of the popular imagination. The 'dumb' or paralytic form is easily mistaken for choking, a throat obstruction, or an injury — and people are commonly exposed while putting their hands in the mouth of such a dog to help it. Treat any of the following as rabies until proven otherwise, and do not handle the animal:

• A sudden, marked change in temperament — a friendly dog turning withdrawn or aggressive, or a wary dog becoming inexplicably affectionate.
• Drooling, an inability to swallow, or a dropped jaw — often misread as a bone stuck in the throat. Do not reach into the mouth.
• A change in the voice or bark.
• Hind-limb weakness progressing to paralysis.
• Snapping at nothing, restlessness, disorientation, sensitivity to light or sound.
• Any unprovoked bite from a dog that then behaves abnormally.

If a dog is suspected of rabies: do not attempt to catch or treat it yourself, confine or isolate it if that can be done without contact, keep children and other animals away, and contact a veterinarian and the municipal authority. Anyone who has been exposed follows section 20.2 immediately.

20.4 Vaccination is the whole game

• Keep every dog in the household vaccinated against rabies on the schedule the vet sets, and keep the certificate — you will need it for travel, for boarding, for housing disputes, and if your dog is ever accused of biting.
• Vaccinate community dogs you feed or care for. Animal Birth Control programmes vaccinate as they sterilise; supporting them is the highest-leverage thing an individual can do about rabies in their neighbourhood.
• A vaccinated dog that bites is still a medical event for the person bitten. Vaccination reduces risk; it does not license anyone to skip medical assessment.
• Never assume a free-roaming dog is vaccinated, and never assume a puppy is.

20.5 The other zoonoses — what a dog can actually pass to a household

Rabies dominates the conversation, but the everyday zoonoses are the ones that quietly affect families, and they are all preventable with routine care. Each is covered as a canine condition elsewhere in this encyclopedia; here is what they mean for the humans.

• Roundworm (Toxocara) — eggs passed in faeces contaminate soil and parks. Children who play in contaminated ground and put hands in mouths can, rarely, suffer serious consequences to the eyes or organs. Routine deworming and picking up faeces is a public-health act.
• Hookworm — larvae penetrate human skin, typically bare feet, causing an intensely itchy migrating track. A reason not to let children play barefoot where dogs defecate.
• Echinococcus (hydatid tapeworm) — the most serious of the worm zoonoses. Humans who ingest eggs can develop cysts in the liver or lungs. This is why dogs must not be fed raw offal or allowed to scavenge slaughter waste, particularly in livestock-keeping areas.
• Leptospirosis — spread in the urine of infected animals and rodents, concentrated in monsoon floodwater. It infects both dogs and people and can be severe in both. Vaccinate the dog; avoid letting anyone wade through standing water.
• Sarcoptic mange (scabies) — transmissible to humans, causing an intensely itchy rash. Self-limiting in people, but a strong hint that the dog needs treating.
• Ringworm — a fungal skin infection, not a worm, and readily passed between dogs, cats, and children.
• Ticks — carry disease to dogs, and some tick-borne organisms can affect humans. Check both the dog and yourself after walks in grass.

20.6 The household routine that prevents nearly all of it

• Rabies vaccination, kept current, for every dog — no exceptions.
• Routine deworming on the schedule the vet sets, for the life of the dog, and particularly for puppies and for dogs with outdoor access.
• Year-round tick and flea control appropriate to your climate.
• Pick up and dispose of faeces — the single most effective barrier between a dog's parasites and a child's hands.
• Handwashing after handling dogs, and before eating. Unglamorous; decisive.
• No raw offal, no scavenging, no access to slaughter waste.
• Keep children's sandpits and play areas covered and dog-free.
• Teach children how to approach dogs — and how not to. Most bites to children are to the face, from a familiar dog, in the child's own home, and are preceded by warning signals the child did not know how to read. Part IV covers those signals; teaching them to a child is rabies prevention, bite prevention, and dog welfare at once.