TRAVELERS’ GUIDE TO ANIMAL BITES
Hazel Gallardo Paez, MD
Vietnam, as with many other countries in Asia, has low dog vaccination coverage, poor animal control programs, and high post-exposure prophylaxis (PEP) usage. In the last decade, Vietnam reported a total of 914 human deaths from animal bites—averaging about 91 deaths each year. Studies show that vaccinating 7 out of 10 dogs in the dog population is sufficient to effectively protect people in the community. In partnership with several countries in the region, the Vietnamese government has been committed to achieving the ambitious goal of eliminating canine rabies by 2020.
Significant numbers of travellers come to the clinic each year due to animal bites. It is important to be aware that attacks by domestic animals are far more common than those by wildlife, and that secondary infections in bite wounds can result in serious illness or death.
Bites from certain mammals frequently encountered during travel abroad (such as dogs, cats, monkeys and bats) can present a serious risk of infection. These animals’ saliva can be so heavily contaminated with pathogens that a bite may not even be necessary to cause infection if saliva enters a preexisting cut, scratch or mucosal membrane.
Dog and Cat Bites?
Most cases of rabies in humans occur because of bites from stray dogs and cats. Keep in mind that rabies infections in dogs and cats may be difficult to detect, particularly during the early onset of symptoms. Rabies also cannot be definitively diagnosed in a live animal. To further decrease the risk of exposure to rabies, unfamiliar dogs should be avoided, and travelers should avoid the temptation to adopt a stray dog from abroad.
People who are bitten or scratched by dogs or cats should promptly clean the wound and seek medical care.
After dog and cat bites, there are also numerous cases of people being bitten by a monkey during a visit to the famous “Monkey Mountain”. These bites or scratches can transmit rabies as well as the herpes B virus.
After a monkey bite or scratch, travelers are advised to thoroughly clean the wound and seek medical care immediately to be evaluated for possible rabies and herpes B PEP. Macaque bites especially can transmit herpes B virus, a virus related to the herpes simplex viruses.
For the more adventurous travellers, bats may be encountered in caves or wilderness parks/forests. Bats, whether sick or healthy, may bite if they are handled. Any suspected or documented bite or scratch from a bat anywhere in the world should be considered a rabies risk. Any bat that is active by day, is found where bats are not usually seen, or is unable to fly is far more likely to be rabid. People may not notice that they have been bitten by a bat, as most bats have tiny teeth, and not all wounds are apparent. Furthermore, because bat bites rarely cause much trauma, people may ignore the bite and not seek care.
Travellers should seek medical advice even in the absence of an obvious bite wound if they wake up to find a bat in the room or see a bat in the room of an unattended child or other person who could not reliably report a bite, and they should be evaluated for rabies PEP.
Rat bites are unlikely to transmit rabies; however, rodent bites and scratches can transmit rat-bite fever and salmonella. Each rodent bite or scratch needs to be evaluated on a case-by-case basis to determine the need for treatment.
Bites and stings from bees, spiders and scorpions can vary in severity. Symptoms of venomous injuries can range from mild swelling and redness at the site to more severe symptoms (such as difficulty breathing or swallowing, chest pain, or intense pain at the site of the sting) for which immediate medical treatment should be sought.
As most travellers enjoy water sports and activities (snorkelling, scuba diving and even surfing), they should also bear in mind the marine animals they might encounter. Most marine animals are generally harmless unless threatened. Most injuries are the result of chance encounters or defensive maneuvers. Resulting wounds have many common characteristics: bacterial contamination, foreign bodies, and occasionally venom. Most species responsible for human injuries include stingrays, jellyfish, stonefish, sea urchins, and scorpion-fish. Do your research about which marine animals may be encountered at the specific destination you are diving into.
Before departure from your home country, make sure that:
You have a current tetanus vaccine or documentation of a booster dose in the previous 5-10 year period.
You have taken pre-exposure rabies vaccines if deemed necessary by your travel health providers.
Never try to pet, handle or feed unfamiliar animals (whether domesticated or wild!). Young children should be watched closely, as they are more “prone” to be bitten—and when they do, they tend to incur more serious injuries.
Travellers should be advised to maintain vigilance while engaging in recreational water activities, and wear protective clothing such as footwear and goggles.
It’s worth reiterating that the most important thing to do after being scratched or bitten by an animal is to promptly clean it with soap and water. Apply direct pressure if bleeding is present.
Seek medical advice as soon as possible! Health care professionals can then provide extensive wound care (debridement if necessary); vaccines (rabies immunoglobulin, rabies vaccine, tetanus vaccines); antibiotics; antivirals; and pain medications after a thorough assessment. Management varies from one individual to another depending on the severity of the condition.
Dr. Hazel Gallardo-Paez MD
Family and Community Medicine
Family Medical Practice
Having worked in Pediatrics for nine-years Doctor Hazel moved on to specialise in family and community medicine. She joined the Family Medical Practice, Danang in 2014.
Dr. Hazel’s medical expertise addresses a diversity of challenges and treatments, based on her extensive Pediatrics training in a tertiary hospital and her subsequent experiences handling pediatric patients under a variety of healthcare frameworks (including emergency departments, outpatient departments, pediatric wards and acute neonatal care). This background allows her to provide comprehensive medical care while building long-term relationships with patients, their families, and the community.
Having studied at the Far Eastern University-Nicanor Reyes Medical Foundation (FEU-NRMF) in the Philippines, Dr. Hazel speaks English and Filipino, as well as the Ilocano dialect. The widely-accoladed doctor has been chosen as a finalist for both her case presentation and research paper (poster presentation) in family medicine by the Philippine Academy of Family Physicians (PAFP).
Outside of the clinic, Dr. Hazel enjoys cooking, reading and craftwork, as well as spending precious time with her family.
You can find Dr Hazel at the FAMILY MEDICAL PRACTICE DANANG, 96-98 Nguyen Van Linh Street, Hai Chau District.
For general appointments call:- +84 236 3582 699
OR:- +84 913 917 303 (24 hour emergency line)
For further information about the Medical Practice, (and Family Medical Practice clinics nationawide) visit their website
Tropical climates, sunny beaches and all day happy hours bring out the day drinker in all of us when we're on our holidays.
But with the start of the south/central monsoon season, we need to prepare to fight off the attentions of a different kind of pesky day drunk. The mosquito.
Fortunately, Hoi An isn't considered a Dengue hot spot, though with symptoms taking up to a week to show themselves - arming yourselves with a bit of knowledge and preventative know-how is wise.