Rabies Risks After a Dog Scratch: What You Need to Know

Q: Rabies Risks After a Dog Scratch: What You Need to Know

Dear Mr. <br>Luka：<br>1. <br>Generally speaking, if the dog or cat that bit or scratched you has been regularly vaccinated against rabies, then the patient should be fine. <br>However, if the dog or cat has not been vaccinated regularly, it is recommended to isolate and observe t

Questions related to rabies!

Dear Doctor: About 20 days ago, I was lightly scratched by a dog that was being kept by someone.
The scratch broke the skin but did not bleed, and there was a small red mark.
I did not take any special measures, only applying some Mentholatum.
I am unsure if the dog had received a rabies vaccination, but it is a small dog that is mostly kept in a garage and does not go out much.
After more than 20 days, the dog shows no signs of illness.
Can I feel reassured? Have there been cases in Taiwan where dogs did not cause any fatalities but still developed rabies? Recently, I have started experiencing itching on my skin, and sometimes the muscles near the affected area feel painful or tense, but scratching or touching it provides relief.
I have not experienced any fever, nausea, vomiting, or loss of appetite.
I consulted with the 1922 hotline, and they advised me to observe the dog for 10 days, and if there are no abnormalities, there should be no danger.
Recently, I visited a local clinic due to some upper respiratory infection, and the doctor there suggested observing for two weeks, which I have already exceeded.
I hope to get your opinion!

Luka, 30~39 year old female. Ask Date: 2020/04/11

Dr. Xiao Yongxun reply Family Medicine

Dear Mr.
Luka:
1.
Generally speaking, if the dog or cat that bit or scratched you has been regularly vaccinated against rabies, then the patient should be fine.
However, if the dog or cat has not been vaccinated regularly, it is recommended to isolate and observe the animal for ten days to see if it shows any signs of illness or dies.
If the animal remains healthy after ten days, according to decades of medical research, the person who was bitten or scratched should not have any concerns about developing the disease.
In fact, in clinical practice, since 1959, there have been no reported human cases in our country; nor have there been reports of humans becoming ill after being bitten by a dog that did not die.
Instead, dog and cat bites often lead to conditions such as cellulitis or cat scratch fever.
Regarding animals, since 2013, our country has increased rabies surveillance in wildlife, discovering concerns primarily in wild animals located in central, southern, and eastern mountainous areas, with the main infected species being the ferret badger and a few others like the lesser panda.
This is why the government currently does not recommend immediate vaccination for patients bitten or scratched by stray or domestic dogs and cats; instead, they advise observing the animal for ten days for any signs of rabies symptoms before deciding on vaccination.
Of course, if vaccine supply is sufficient, individuals can choose to receive the four doses of rabies vaccine at their own expense according to the schedule.
2.
As for the itching of the skin or muscle pain or tightness near the affected area that you mentioned, it is advisable to discuss this with your family physician for further evaluation, or to visit an infectious disease clinic at a regional hospital for more information.

Reply Date: 2020/04/11

More Info

When it comes to rabies, understanding the risks associated with animal bites or scratches is crucial. Rabies is a viral disease that primarily spreads through the saliva of infected animals, most commonly through bites. The rabies virus can also be transmitted if saliva comes into contact with open wounds or mucous membranes, such as the mouth or eyes.
In your case, you mentioned being scratched by a dog that you are unsure whether it has been vaccinated against rabies. The fact that the scratch was superficial and did not draw blood is a positive sign, as the risk of rabies transmission is significantly lower in such cases. However, it is essential to consider a few factors to assess your risk accurately.

1. Vaccination Status of the Dog: If the dog has not been vaccinated against rabies, there is a potential risk, especially if the dog is known to roam outside or has had contact with wild animals. However, since you mentioned that the dog is mostly kept in a garage and has shown no signs of illness over the past 20 days, the risk of rabies transmission is likely low.

2. Observation Period: The standard recommendation is to observe the animal for 10 days. If the dog remains healthy during this period, it is highly unlikely that it was shedding the rabies virus at the time of the scratch. Since you have already surpassed this observation period without any signs of illness in the dog, this further reduces your risk.

3. Symptoms: You reported experiencing itching and muscle tightness near the scratch site, but you have not exhibited any classic rabies symptoms such as fever, nausea, vomiting, or loss of appetite. Rabies symptoms typically manifest within one to three months after exposure, and the absence of these symptoms is reassuring.

4. Local Rabies Incidence: In Taiwan, rabies is not commonly reported in domesticated dogs, especially in urban areas. The risk of rabies is higher in rural areas or regions where rabies is endemic among wildlife. Since you are in an area where rabies cases are rare, this also lowers your concern.

5. Consultation with Healthcare Providers: It is always wise to consult with healthcare professionals regarding any potential exposure to rabies. If you have lingering concerns about your symptoms or the scratch, it would be prudent to seek medical advice. A healthcare provider can assess your situation more thoroughly and may recommend a rabies vaccination if deemed necessary.

In summary, based on the information provided, the likelihood of contracting rabies from the scratch you described seems low, especially given the dog's observed health over the past 20 days and the nature of the injury. However, if you continue to experience unusual symptoms or if your anxiety about the situation persists, it would be beneficial to consult with a healthcare professional for further evaluation and peace of mind. Remember, it is always better to err on the side of caution when it comes to potential rabies exposure.

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