Rabies Exposure Concerns: What Parents Need to Know

Rabies infection issues

Hello, doctor.
I would like to ask, if my hand came into contact with the saliva of a stray dog and I only washed my hands normally afterward, touching water 2-3 times during that period, and then handled fruit for my child to eat (with my hands touching the fruit), and my child has a wound in their mouth, is there a concern for rabies infection due to not washing my hands properly? We live in Chiayi County, in a general flat area, and that stray dog is often seen nearby every day.
I consulted a hospital, but they said this situation does not meet the criteria for vaccination and advised to monitor the situation.
If the dog shows no unusual symptoms (no death) within 10 days, can I feel reassured? The potential infection site for my child is in the mouth; does the incubation period tend to be shorter in this case? I am unsure how long I should be worried and when I can feel at ease.

Niming, 40~49 year old female. Ask Date: 2017/02/04

Dr. Liao Zhongxin reply Internal Medicine

Dear readers,
Regarding the question of whether contact with the saliva of a stray dog could lead to rabies infection after only washing hands normally, touching water 2-3 times, and then cutting fruit for a child (with the hands touching the fruit), especially since the child has a wound in the mouth, is there a concern for rabies infection due to insufficient hand washing? The residence is in Chiayi County, in a generally flat area, where the stray dog is frequently seen.
The hospital was consulted, but they stated that this situation does not meet the criteria for vaccination and advised to observe the situation.
If the dog shows no specific symptoms (no death) within 10 days, can we be assured? The potential infection site for the child is in the mouth; does the incubation period tend to be shorter in this case? I am uncertain how long to be anxious and when I can feel reassured.
A: According to the CDC information (www.cdc.gov.tw):
1.
Transmission: The rabies virus is present in the saliva of infected animals, and it can enter the human body through bites or scratches from these animals (occasionally through skin wounds or mucous membranes).
Therefore, being scratched by an infected animal is also dangerous, as animals may lick their paws.
Human saliva can also contain the virus, and theoretically, direct transmission between humans is possible, but there have been no reported cases to date.
There have been instances where rabies was transmitted to corneal transplant recipients from donors who died of central nervous system diseases.
Airborne transmission may occur in bat colonies or laboratories.
In Latin America, vampire bats commonly transmit the virus to livestock.
Almost all mammals are susceptible to this disease, but susceptibility varies with the strain of the virus.
Thus, the risk of infection should be considered when bitten or scratched by an infected animal or person; observing the animal for ten days (quarantine) can assist in determining whether rabies vaccination is necessary.
2.
Clinical Symptoms: Early symptoms of rabies are nonspecific and may include fever, sore throat, chills, malaise, anorexia, vomiting, difficulty breathing, cough, weakness, anxiety, headache, or specific symptoms at the site of a bite or scratch.
After several days, symptoms of excitement and fear may develop, followed by paralysis, difficulty swallowing, and spasms of the throat muscles, leading to hydrophobia (hence the term hydrophobia).
Subsequently, confusion and convulsions may occur.
Without medical intervention, patients typically die from respiratory paralysis within 2 to 6 days (sometimes longer).
Observing the animal for ten days (quarantine) is based on the fact that the disease progresses in animals over about ten days, while humans, being larger, typically show symptoms about a month later.
Therefore, there is ample time to administer the vaccine (five doses of rabies vaccine can be given within a month).
If there are still concerns, it is advisable to consult another hospital for further evaluation.
Thank you!

Reply Date: 2017/02/04

More Info

When it comes to concerns about rabies exposure, especially in the context of children, it is crucial to understand the nature of the virus, its transmission, and the appropriate steps to take following potential exposure. Rabies is a viral disease that is primarily transmitted through the saliva of infected animals, most commonly through bites. However, it can also be transmitted if saliva comes into contact with open wounds or mucous membranes, such as those found in the mouth.

In your situation, where your child's hand may have come into contact with the saliva of a stray dog and then subsequently touched fruit that your child ate, there are several factors to consider:
1. Exposure Risk: The risk of rabies transmission through saliva on hands is significantly lower than through a bite. However, if the saliva came into contact with an open wound or mucous membranes (like a cut in the mouth), there is a potential risk, albeit a low one, especially if the dog was rabid.

2. Observation of the Dog: The fact that you have observed the stray dog for 10 days without any signs of illness (such as aggression, excessive drooling, or paralysis) is a positive sign. Rabies symptoms typically appear within 1 to 3 months after exposure, but the incubation period can vary. If the dog remains healthy and shows no signs of rabies, the risk of transmission decreases significantly.

3. Symptoms and Monitoring: It is essential to monitor your child for any unusual symptoms, such as fever, headache, or changes in behavior. If any concerning symptoms develop, it is crucial to seek medical attention immediately.

4. Consulting Healthcare Professionals: While the hospital may have indicated that the situation does not warrant immediate vaccination, it is always a good idea to seek a second opinion if you are still concerned. Rabies post-exposure prophylaxis (PEP) is typically recommended if there is a clear risk of exposure, especially in cases involving bites or significant contact with saliva.

5. Preventive Measures: To prevent future incidents, it is advisable to avoid contact with stray animals. Educating your child about the dangers of interacting with unknown animals can also help reduce the risk of exposure.

6. Timeframe for Safety: Generally, if the dog has shown no signs of illness after 10 days, the risk of rabies transmission is low. However, the incubation period for rabies can vary, and it is essential to remain vigilant. If you have any lingering concerns, especially regarding your child's health or the potential for infection, do not hesitate to consult with a healthcare provider for further evaluation.

In summary, while the situation you described does carry some risk, the likelihood of rabies transmission appears low given the circumstances. Continued observation of the dog and your child, along with open communication with healthcare professionals, will help ensure that any potential issues are addressed promptly. If you have any doubts or your child's condition changes, seeking immediate medical advice is always the best course of action.

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