# Consequence of delaying rabies injection after dog bite



## andrewball1000 (Oct 16, 2009)

We are in El Jadida and my passenger has just been bitten by a dog which has dissappeared. We are at a clinic. But they can't get a Rabies shot as its Friday nor over the weekend

She flys home from Agadir on early Tuesday morning. Could someone with medical knowledge please advise on the risks of delaying the first shot till Tuesday?

It seems the earliest we can get in this country is Monday anyway. 

I have looked up the treatment required. It is just about the extra day delay. 

Thanks. 
Andrew


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## aldra (Jul 2, 2009)

Andrew, don't know

Could you check with the British Embassy/consulate??

Is there a local Christian aid they may have knowledge

I think I would try the consulate

aldra


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## prof20 (Jan 11, 2007)

Hi Andrew,

No knowledge of rabies, but Wikipedia link below says should be administered within 10 days.

Still, must be worrying.

Quote 'Treatment after exposure is highly successful in preventing the disease if administered promptly, in general within 10 days of infection.[1] Thoroughly washing the wound as soon as possible with soap and water for approximately five minutes is very effective in reducing the number of viral particles. "If available, a virucidal antiseptic such as povidone-iodine, iodine tincture, aqueous iodine solution, or alcohol (ethanol) should be applied after washing. Exposed mucous membranes such as eyes, nose or mouth should be flushed well with water."

http://www.google.co.uk/url?sa=t&rc...zYGwAw&usg=AFQjCNHOZ9B0BQ9adk_HYHE3V0FpUVpNpQ

Roger


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## peejay (May 10, 2005)

I'm sorry I don't know ether Andrew, but if it were me and the clinic couldn't help I would be heading for Casablanca which isn't too far away, they must have a big hospital there that can help ?

Pete


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## peejay (May 10, 2005)

Andrew,

If it helps, the main hospitals in Casablanca seem to be....

Clinique Aftal
50 Bd Abderrahim Bouabid
Oasis
Casablanca
Morocco
Tel: + 212 2 223 1818
+ 212 2 223 5064
Fax: + 212 2 223 5028 

Clinique Chirurgicale Anoual 
14 rue Zaki Eddine Attaoussi
Casablanca
Morocco
Tel: + 212 2 286 0207
Fax: + 212 2 286 0211 


Do let us know how you get on. Judy is fond of dogs and fed them a few times while we were there but I was always uneasy about it, so its hit a nerve with us, hope you get the treatment soon....

Pete


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## andrewball1000 (Oct 16, 2009)

Thank you all for your help. Roger your extract is very useful especially the duration. The treatment of cleaning is what they have done at the clinic. They did phone Casablanca but although the hospital is open over the weekend, the peson who administers the treatment is not there till Monday. 

We will get it done Monday in Agadir or hopefully en route in Safi or Essaouira.


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## simandme (Jan 11, 2011)

I won't add anything more on the rabies front (has been covered well), but if she notices any type of cellulitis or if the wound looks infected and leaks pus then antibiotics might be needed.

Dogs carry a few different bacteria that (occasionally) cause infections...which can get nasty if not treated properly. Also, she may need a tetanus booster.

Please ask your friend to make sure she sees her doctor when she gets back to the UK. (another source of help is hosp of tropical diseases)


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## Penquin (Oct 15, 2007)

I have found this info.;

http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-rabies.pdf

it describes the schedule of doses and says 4 doses if not had vaccine before and have been exposed;

_Vaccination After an Exposure
Anyone who has been bitten by an animal, or who otherwise may have been exposed to rabies, should clean the wound and see a doctor immediately. The doctor will determine if they need to be vaccinated.
A person who is exposed and has never been vaccinated against rabies should get 4 doses of rabies vaccine - one dose right away, and additional doses on the 3rd, 7th, and 14th days. They should also get another shot called Rabies Immune Globulin at the same time as the fi rst dose._

The same schedule is confirmed in this link;

http://www.immunizationinfo.org/vaccines/rabies

Another reference has this about delay;

_RIG should not be given >7 days after the start of the postexposure vaccine series. This 7-day period does not relate to the time of the bite exposure itself. Postexposure prophylaxis, including RIG, should be initiated after a possible bite exposure even if there has been a considerable delay between the exposure and the traveler presenting for evaluation._

RIG is the rabies immunoglobulin NOT the vaccine, it provides a method of destroying the virus immediately if present, the article talks about the incubation period;

*CLINICAL PRESENTATION*

_Most patients will present after a documented, highly suspected, or likely exposure from a rabid animal. Clinical illness is compatible with acute, progressive encephalitis. *After infection, the incubation period is highly variable, but it lasts approximately 1-3 months.*_

Reference;

http://wwwnc.cdc.gov/travel/yellowb...ectious-diseases-related-to-travel/rabies.htm

I hope that gives you some advice, my students at school were told that pre-exposure vaccination simply gives you an extra 24 - 48 hours before the normal routine schedule takes place.......

It is NOT something I ever came into contact with for the ambulance service!

Dave

Dave


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## andrewball1000 (Oct 16, 2009)

My sincere thanks to all of you for your help with this situation. The doctor phoned the hospitals for us and our first chance is Agadir on Monday so that isshst we will do. 

If anyone can supply GPS Corcfunates it would be very much appreciated as I have a very poor connection at the moment. 

Thanks so much.


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## Penquin (Oct 15, 2007)

Polyclinique de Souss
Avenue Abderrahim Bouadid
Agadir
Morocco

BUT I cannot locate that on Google maps - it could be that the spelling should be Bouahid.

This hospital is listed by several different sites including Allianz Worlwide Medical

There is also a Clinique Argana listed as having English staff, it is at

30.416592,-9.594188

I have only found one review which describes it as Excellent and was dated 7 months ago.

So if you have more information I will happily have another look,

Dave


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## andrewball1000 (Oct 16, 2009)

Thanks Dave, much appreciated. I can play on Tomtom with that.


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## olley (May 1, 2005)

Is this it? http://goo.gl/maps/yn4Bn
GPS: 30.409854,-9.583377

Ian


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## Penquin (Oct 15, 2007)

That is certainly the one that is mentioned on various sites, the GPS is as you said;

or this seems to be a different part of the same site........

30.409921,-9.583367

BUT of course it all depends on what hospital the Doctor actually arranged it for........

we could all be barking up the wrong palm tree...... :lol: 

Dave


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## pippin (Nov 15, 2007)

My first action (after cleaning the wound) would have been to telephone the emergency medical line of my travel insurer.

From that moment on they would do all the arranging using multilingual staff.

Hope it all turns out well for you and your passenger.


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## aldra (Jul 2, 2009)

I think it needs to be remembered that dogs bite

It does not need to be a rabid dog

it may well just be a nervous dog

Certainly without the dog all precautions should be taken

I think Andrew you are doing that

Aldra


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## andrewball1000 (Oct 16, 2009)

pippin said:


> My first action (after cleaning the wound) would have been to telephone the emergency medical line of my travel insurer.
> 
> From that moment on they would do all the arranging using multilingual staff.
> 
> Hope it all turns out well for you and your passenger.


Very good point indeed. We didn't think of that one till today but will next time. The clinic did telephone locally and to both Safi and casblanca but no one was available till tomorrow. We have used the time to get south in reach of their return flights from agadir and now are at Essouria. We have been to the hospital and they have referred us to a clinic which we will visit first thing tomorrow.

Will let you know how it goes.

Thanks all


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## andrewball1000 (Oct 16, 2009)

Final update. This is all sorted now. We were outside the clinic in Essouria just after 8 this morning. They had the two vaccines but we had to wait till 9 30 for the next door pharmacie to open to buy two hyperdermics! Then it was done in a moment

Not to myself is to carry a hyperdermics in my first aid kit. 

Thanks all


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## cypsygal (Dec 19, 2009)

various sizes of 'sharps' and barrels available FREE from your local pharmacy/drug services that offer 'cleanworks'


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