When a rabid dog turns: How an attack can unfold and what to do next

A friendly dog can become aggressive. [BBC]

According to Dr Pauline Gitonga, a veterinary surgeon, one of the first clues that something is wrong is a change in the animal’s normal behaviour. A dog that was previously friendly can suddenly become aggressive, while one that was normally aggressive may become unusually quiet and withdrawn.

“It is a change in behaviour,” Dr Gitonga says, explaining how rabies can alter an animal. “A friendly dog can become aggressive, and a dog that was aggressive can become very quiet.”

The change may be followed by other signs. The dog can become restless, attack people or other animals without an obvious provocation, bite repeatedly and develop excessive salivation or frothing around the mouth. Its behaviour may become unpredictable, making it difficult for a person to know when an encounter is about to turn into an attack.

WHO identifies abnormal behaviour, unprovoked biting and excessive salivation among signs that may occur in rabid dogs. The organisation also notes that dogs account for up to 99 per cent of human rabies cases globally.

But Dr Gitonga cautions that people should not rely on the appearance of a dog before deciding whether a bite is dangerous.

A dog may bite when a person approaches it, attempts to touch or feed it, or comes into contact with it unexpectedly. WHO says provoked bites are often linked to attempts to feed or handle animals, while unprovoked bites can be associated with the infectious stages of rabies.

Children are particularly vulnerable. WHO says children make up a large proportion of dog-bite victims, with those in middle and late childhood frequently affected. Injuries to the head and neck are also more common in children, increasing the risk of severe injury.

And the danger is not confined to dogs.

Nusrat Mohammed, founder and executive director of Pwani Animal Welfare Organisation, says her organisation has had to correct the perception that rabies is simply a disease of aggressive dogs. Since beginning annual rabies vaccination work in 2019, the organisation has focused on low-income communities and street animals, where people and animals frequently share the same spaces.

Mohammed says cats can also become infected and may show a less obvious, paralytic form of rabies. Instead of attacking people, an infected cat may become quiet, weak or avoid light, making it appear harmless.

“That cat is a poor cat, it's a very sweet cat,” Mohammed says, describing the kind of animal people may attempt to rescue and take home.

That is why, she says, her organisation's education work has included people who randomly rescue animals from the streets.

But when a bite happens, the priority shifts immediately from identifying the animal to protecting the victim. The first response is simple but critical: wash the wound immediately.

WHO recommends washing and flushing a bite or scratch thoroughly with soap and running water for at least 15 minutes. If available, an iodine-containing or other appropriate virucidal preparation can be applied after washing. Irritants such as chilli, plant juices, acids or alkalis should not be put on the wound.

The victim should then seek medical care immediately for assessment and post-exposure prophylaxis (PEP).

The reason for the urgency is the way the virus moves through the body. Rabies virus is transmitted mainly through the saliva of an infected animal, usually through a bite or scratch. It enters tissue at the site of exposure and travels through the nervous system towards the spinal cord and brain.

PEP is intended to stop that process before the virus reaches the central nervous system. WHO says it consists of wound treatment and rabies vaccination, with rabies immunoglobulin or monoclonal antibodies used when indicated for severe exposures.

A bite that breaks through the skin is classified as a severe Category III exposure. Immediate wound washing and vaccination are required, with rabies immunoglobulin or monoclonal antibodies indicated for such severe exposures. Minor scratches or abrasions without bleeding can also require vaccination.

A person infected with rabies can remain apparently well for weeks or months because the virus takes time to reach the nervous system. But once clinical symptoms appear, the disease is fatal in 100 per cent of cases.

Dr Gitonga says another important step is dealing with the animal through the appropriate veterinary and public-health authorities.

If it can be done safely, the biting dog should be confined and placed under veterinary or public-health observation. WHO recommends observation of a biting dog for 10 days where appropriate. People should not attempt to capture or handle an aggressive or suspected rabid animal themselves.

Mohammed says communities often struggle with what happens after the bite, including where to report the incident and how to access treatment. She argues that veterinary and human health departments need to work more closely.

“There needs to be a more integrated system between public health and animal health,” she says. “That integration is lacking a lot.”

The stakes are high. WHO estimates that rabies causes about 59,000 deaths globally each year, with children under 15 accounting for about 40 per cent of deaths. Most human infections are linked to dogs.

For Mohammed, however, preventing those deaths begins before an animal attacks through responsible pet ownership, vaccination, community education and better management of street animals.

For someone who has already been bitten, the message is even more immediate: do not wait to find out whether the dog was rabid. Wash the wound for 15 minutes, seek medical attention immediately, follow the recommended PEP and report the animal through the appropriate authorities.