Dog bite in Thailand - a word of Warning

Post by **kris** » March 21, 2016, 8:33 am

hi.. I have been meaning to write this post for a while because I feel it may come of use to folk somewhere down the line

Back in early 2015 I was training for a half marathon running in a local village. I am experienced cyclist but, at the time, was not an experienced runner. While I was running through the village there were a group of dogs barking up ahead. I kept an eye on them but I didn`t hear or see one of the dogs that crept up behind and bit me on the back of my left leg just above my ankle. Obviously my immediate thought was... 'bugga'...

I waved the snarling dog off and had a closer look. 2 puncture wounds that were bleeding but the cuts didn`t seem that deep. My honest thoughts at the time were, 'iy, thats not too bad'.. walked back to a local shop and cleaned the wounds up with tissue and water and carried on with my run.

when I got home I told the wife what had happened and she said straight away that I had to go to the local hospital to get injections for rabies & tetanus!... I thought.. 'eee thats a bit over the top. they are only small cuts, no need for all that'... but the wife kept on saying YOU HAVE TO GO, you have to go!....so I started to think... 'hmm.. better off save than sorry'

so off we went to the hospital and sure enough the doctor said i would have to have these injections. its almost a year ago so I forget exactly how many their were but it was alot. some small injections around the wound areas, a few in the bum, and another few in both arms. big needles they were as well so not a pleasant experience. I then had to go back the following week and again after a month had passed for the same same. it did seem at the time alot of bother over nothing much but I`m very glad now that I did follow the wifes advise.

a couple of months ago a farang husband of a friend of my wifes was bitten by a dog on Koh Samui where he used to run a couple of bars with his wife. i had only met him on a few occasions. he seemed like a good bloke. one of the few decent folk you meet in this place. he was only in his early 60`s, not a big drinker and in pretty good health.

unfortunately he, like myself, didn`t think it was a big deal, but unlike myself he decided not to follow the advise of his wife and would not go to hospital for the injections. 3 weeks later the wounds had turned green and his leg was swollen and finally he decided to go to hospital. but it was too late. 1 week later he was dead. I`m still not sure exactly what killed him. whether it was rabies or tetanus or just plain ganggreen so have all the injections the doctor advises.

so i`m writing the post as a warning to anyone who gets bitten by a dog in Thailand (or for that matter anywhere in the world)

do not hesitate no matter how small the bite. the size of the wound is irrelevant. once that bacteria from that dogs mouth is in
your system GO STRAIGHT TO HOSPITAL AND GET THE INJECTIONS FOR EVERYTHING ASAP

also if you are running in villages or anywhere outside of your house, always take some kind of stick with you. of course there are no garrantees u won`t get bit but as you run the stick swishing around will put dogs off (unless they are particularly vicious). Cycling wise, I have clocked up many miles and have realised that so long as you keep going and keep pedaling, the dogs can get close but they are never able to time a bite while you are moving. again, there are no garrantees but my advise is don`t panic, keep moving and keep pedaling.

Post by **Techland** » March 21, 2016, 9:14 am

Sorry, but the correct recommendation seems to be to get all the necessary vaccinations already BEFORE you get bitten! Especially as stuff like tetanus is not about dog bites but small skin scratches from daily life.

I am pretty sure that many expats here had all vaccinations when they came here. Many just forget to refresh them regularly.

Post by **kris** » March 21, 2016, 9:51 am

all I know is I went to hospital and survived. my colleague didn`t. one month later he was dead

Post by **rct** » March 21, 2016, 9:57 am

A few years ago I was walking on the sidewalk near my home in Phuket after just landing from Udon, a dog lying there suddenly lept up and bit my leg, broke the skin. A policeman was nearby so I told him what happened, he nonchalantly told me to go to the hospital a....nd he could care less about the dog.

At Bangkok Phuket Hospital I was informed by a doc I knew from before, yes rabies is a big problem, I needed the shots, could do it there for about 35,000 baht or go down the road to the public hospital to save money and do it for about 15,000 baht which he highly recommended! I had the movers coming early the next day and a lot to do, moving to Udon, so did not have time to waste, paid 35,000 baht.

Getting the vaccination in advance makes a lot more sense.

Post by **kris** » March 21, 2016, 10:05 am

i was told at the hospital that the vaccine only lasts 6 months

what % of folk that live here full time do you think go for a rabies vaccination twice a year at the cost of 30,000baht per year?

Post by **kris** » March 21, 2016, 10:11 am

Techland wrote:Sorry, but the correct recommendation seems to be to get all the necessary vaccinations already BEFORE you get bitten! Especially as stuff like tetanus is not about dog bites but small skin scratches from daily life.

I am pretty sure that many expats here had all vaccinations when they came here. Many just forget to refresh them regularly.

at the end of the day its your call what you do if it happened to you. I know what I will be doing if I ever have the misfortune to get bitten again...

Post by **kris** » March 21, 2016, 10:23 am

Techland wrote:Sorry, but the correct recommendation seems to be to get all the necessary vaccinations already BEFORE you get bitten! Especially as stuff like tetanus is not about dog bites but small skin scratches from daily life.

I am pretty sure that many expats here had all vaccinations when they came here. Many just forget to refresh them regularly.

if you don`t know what you are talking about you are better off staying quiet as it could cost somebody their life... tetanus can be transmitted thru dog bites
http://www.uptodate.com/contents/animal ... the-basics

i would also say that you are in the minority if you stay on top of all your jabs all the time... or any of the time for that matter... do not hesitate, go to the nearest hospital ASAP and have whatever they tell you to have. if you have a vaccine book, take it with you

Post by **Brian Davis** » March 21, 2016, 10:59 am

35,000 baht! Bloody hell.
I agree that even if one has the vaccinations before coming out here, there's a tendency to forget or not bother with 'top-ups'.
But, in trying to save a cat from my two dogs, I suffered a bite - from the ungrateful cat! It was at a time when those hospital cards issued if you had a yellow book were being issued. So injections at Phen Hospital - 30 baht.
Even without the card now, I cannot imagine the cost more than a few hundred baht, in line with what I pay for dental work.
(Rct - I too had cause to visit Bangkok Phuket Hospital when living there. Nothing to do with bites - this was a camera down the throat etc. Fairly expensive, perhaps reasonable for a private hospital, but oh boy, did they try and add thousands for 'necessary' medicines.)

Post by **kris** » March 21, 2016, 11:09 am

I can`t recall how much it was but I do recall thinking it was alot. to the point where I considered not having the injections, but in the end I decided to bite the bullet and pay up.

I don`t know the full story but the cost may have been partly why my colleague decided not go to the hospital. a decision which cost him his life. he lived on Samui, I live in Udon. so i got the story 3rd hand. apparently his last message to his wife was to say how sorry he was that he didn`t listen to her.

i know its a morbid story but if someone gets bitten and reads this post it might make a difference. up to hearing my colleagues sad story I didn`t think that much about the time when i was bitten. i thought it was probably all a big fuss about nothing much. after hearing his story my opinion changed which is why i decided to write the this post

Post by **Barney** » March 21, 2016, 11:14 am

Good warning Kris,
It has had me check my vaccine books. I am up to date because it is a requirement of employment overseas for me.

Why do we always shoot the messenger.

Tetanus and rabies are different and should be treated differently.
Tetanus/Diptheria 10 years or if you are not sure of the date after a puncture wound then a 5 year booster is good. This is an easy shot to keep up to date with.
Rabies can be vaccined against with 1-2 year pre exposure but can also be treated post animal bite with 5 HDVC shots plus HRIG shot, 50% in wound.
Just do as suggested in the original post and go to the doctor immediately for advice.

Post by **Jello** » March 21, 2016, 11:46 am

I appreciated the post. Reminded me that I need to go in for a tetanus booster. Like you and your friend, I tend to put off seeing a doctor after a injury or illness if I don't think its too bad. Not a wise decision after a dog bite.
Thanks for the post Kris.

Post by **GT93** » March 21, 2016, 2:19 pm

I was once bitten on the calf by a dog while I was riding a bicycle through an Udon temple. I was wearing light trousers but my skin was pierced. I decided I wasn't going to risk dying from this so I went for the injections. I couldn't friggin' recall when I'd last had my injections. This was about 10 years ago. It cost a bit but not like what I felt was a total rip off.

Post by **FLICKFLACKER404** » March 21, 2016, 3:17 pm

GT93 wrote:I was once bitten on the calf by a dog while I was riding a bicycle through an Udon temple. I was wearing light trousers but my skin was pierced. I decided I wasn't going to risk dying from this so I went for the injections. I couldn't friggin' recall when I'd last had my injections. This was about 10 years ago. It cost a bit but not like what I felt was a total rip off.

Was the dog ok????

Post by **Barney** » March 21, 2016, 3:43 pm

FLICKFLACKER404 wrote:
GT93 wrote:I was once bitten on the calf by a dog while I was riding a bicycle through an Udon temple. I was wearing light trousers but my skin was pierced. I decided I wasn't going to risk dying from this so I went for the injections. I couldn't friggin' recall when I'd last had my injections. This was about 10 years ago. It cost a bit but not like what I felt was a total rip off.
Was the dog ok????

Rover is still undergoing counseling, and living a quiet life at the temple.

Post by **wazza** » March 25, 2016, 9:35 am

This is from a research paper in Thailand

" Treatment
Human
Rabies is a fatal and incurable disease and therefore prevention of establishment of
infection before or after exposure is the main treatment approach.
Post exposure treatment (PET)
The first step of post exposure treatment is immediate and thorough wound cleansing
and flushing with soap and water.
Human rabies immunoglobulin and vaccine are needed after exposure to rabid or
rabies suspected animals. The criteria are as follows:
A person exposed or attacked from wildlife or bats should receive post exposure
treatment. The animal involved in the attack should be killed, and tested as soon as
possible, regardless of whether it is considered to be a suspect rabies case.
A person exposed or attacked by any non-wild animal (privately owned, unvaccinated
pet or stray dog for example) should have PET initiated immediately. The animal
should be confined and observed for at least 7-10 days. This may require caging if
repeat observation will be difficult. If the animal shows no evidence of rabies during
the seven to ten day period of observation or is proved rabies negative, human PET is
then discontinued.
If a person is attacked by an animal of unknown status and the animal then disappears,
a full course of PET should be applied.
The World Health Organization (WHO) and Centres for Disease Control (CDC) have
guidelines for post exposure treatment and assessment of each category of exposure
and level of risk.
Two kinds of rabies immunoglobulins, human rabies immunoglobulin (HRIG) and
equine rabies immunoglobulin (ERIG), are currently effective forms of passive
immunization used in serious or high risk exposure cases except for the exposed 22
person who has been vaccinated previously. HRIG is given at 20 IU/kg and ERIG at 40
IU/kg by infiltrating one half around the wound and one half intramuscularly followed
by five doses of cell culture vaccine one each on day 0, 3 7, 14 and 28 (Greene and
Dreesen, 1990). "

Bali has a huge issue with rabies , but Thailand, whilst having some disease, dogs, monkeys and bats etc doesn't seem to have significant deaths ( 1000s )

There is a general push to vaccinate , post bite, without testing the animal if possible.

Private Hospitals and travel clinics will always push proactive vaccinations as its a revenue raiser

Kris

If your friend had rabies, his clinical symptoms would have been very obvious the same if it was tetanus.

The wound itself , could have contained a few nasty bugs and septicaemia certainly an issue.

Was a Post Mortem conducted with blood tests to confirm any underlying clinical microbiology ??

Wounds in Thailand need attention asap, lovely 37 C Celsius is the ideal temperature for bacteria etc to breed.

Post by **redwolf** » March 25, 2016, 2:49 pm

Barney wrote:Good warning Kris,

Why do we always shoot the messenger?

Tis true indeed.

Good on ya Kris for the post, very informative, and also shows the mindset some of us have when injured similar. Good on the wife too for keeping you safe with solid advice.

RW

Post by **marcusb** » March 25, 2016, 7:27 pm

My rabies knowledge is limited to "Old Yellar" , so not up to date,

I understand the shots when a random dog bites you. If it's the neighbors dog can't you test the dog, instead of taking all the shots yourself?

Post by **samster** » May 17, 2016, 1:16 pm

I got bitten by a monkey last week (!!) although, having lived in Kumphawapi for nearly 10 years, where there is the monkey park, I should have known to be been more careful. It wasn't a serious wound but it broke the skin.

I attended Kumphawapi hospital and within 30 minutes had seen the doctor. I was up to date with tetanus so, he gave me a rabies shot in each arm, they cleaned the wound and gave me a course of penicillin based drugs.

Since then, I have returned twice more for 2 more sets of injections in each arm which I am told will protect me for 6/7 years. The injections were relatively pain free, as was the cost at just over 800 baht for everything

Reading online apparently there is also a risk of HIV and herpes but the monkey seems fine!!!