What to do after a dog bite

Do you know what to do after a dog bite? Dogs are man’s best friend. They are very friendly animals that are loyal to their owners. They can be trained to protect, direct or run errands.

Dogs are lovely and playful but in the process of playing they could bite mistakenly. They could also bite if they are agitated or provoked.

A dog bite is something that should be taken seriously as there are some infections that could arise from a dog bite. These may be viral or bacterial infections. Rabies is the most common viral infection that could be transmitted through a dog bite. Bacterial infections are also common as the saliva of a dog has a lot of germs in it which can be transmitted to humans in a bite. These infections may also be transmitted by the licking of an open wound in humans.

Rabies virus infection affects the brain resulting in swelling of the brain and this is mostly fatal once symptoms appear. Bacterial infections at the site of a dog bite wound may spread through blood to cause sepsis. Bacterial infections may also cause a swelling of the brain and its coverings. Tetanus is an infection that results from poor wound care as presence of dead tissues at wound site is a conducive environment for the growth of bacteria such as Clostridium tetani– the organism that causes tetanus.

Dog bite law suit

The dog owner may be sued to court for leaving his/her dog to go rouge in a residential area or even in his house without warning unsuspecting visitors. In Nigeria, there are laws to regulate dog licenses and to avoid rabies transmission which varies from state to state. In a dog bite law suit ruling, the dog owner may be required to pay a fine or risk serving jail term ranging from 6 months to one year or in extreme cases, lifetime imprisonment. This is solely at the discretion of the judge. Out of court settlements are more common with the dog owner taking up the medical bills of the dog bite victim.

Dog bite force

The force of dog bite and the breed of dog determines the depth of injury. Adult dogs because of their strong jaws can exert up to 200 pounds of pressure per square inch when they bite to attack a victim either in defense or from provocation. Dog bite force is higher with provocation than with inadvertent biting during a sport. Pit bulls and Rottweilers are dog breeds are most likely to cause serious injuries because of their strong bite force.

Dog bite by either of these dog breeds may result in death if victim is not rescued early enough either because the dog owner was not available to instruct, restrain or spray the dog or the victim was too weak to resist or flee from the attack. Children and the elderly are particularly at risk as they have less strength to resist an attack.

Death following a dog bite may be due to excessive bleeding, blood or brain infections. Head injury in cases where the victim was bitten in the head or dragged on a hard surface particularly children may also be a cause of death after a dog bite.

 Dog bite infection and symptoms

Dog bite symptoms depend on the time interval after a bite. Early symptoms include:

  • Bruises at bite site
  • Pain at the site of bite
  • Redness and/or swelling around the wound
  • A puncture wound
  • Crushing injury
  • Bone fracture

Late symptoms include:

  • Skin and subcutaneous tissue infection (Cellulitis )
  • Bone and tendon infection
  • Blood infections
  • Reduced or lost sensation at the site of the bite

Dog bite infection

Infections can be transmitted to humans through a dog bite. Rabies virus infection from a dog bite may result in

  • Headache
  • Muscle pains
  • Fever
  • Nausea and vomiting
  • Abnormal behaviour such as aggression
  • Excessive salivation
  • Anxiety
  • Seizures
  • Confusion
  • Coma

The person may also have Symptoms of tetanus such as

  • Inability to open the mouth (Lock jaw)
  • Painful Muscle twitching or spasms
  • High blood pressure
  • Excessive sweating
  • Difficulty swallowing

Other dog bite infections are:

  • Cellulitis– swelling, pain, redness and hotness of the skin
  • Tendinitis- swelling, pain, redness in the tendons
  • Bone infection (osteomyelitis)
  • Abscess (accumulation of pus) at site of dog bite injury
  • Severe bacterial infections are more common in alcoholics, elderly and people who have had their spleen removed.

What to do after a dog bite

Dog bite treatment

Adequate wound care after a dog bite helps prevent infections like tetanus and dog bite abscess. To treat a dog bite, first aid is to wash the wound thoroughly with soap and water before getting to the hospital emergency department. At the hospital, the doctor would explore the wound to remove foreign bodies like dog tooth and dead tissues are removed to encourage faster wound healing and avoid an abscess. A germicide is applied on the wound to kill microorganisms before the wound is sutured if necessary. Wound dressing may be open in order not to encourage growth of bacteria that thrives in dead tissue. The doctor may give antibiotics if needed.

Dog bite abscess increases risk of tetanus which is higher with those who are not vaccinated. Tetanus from dog bite is not uncommon. Therefore, tetanus immunization is given to avoid this infection. Tetanus is more fatal if the bite is closer to the head.

Dog quarantine

 A dog that has bitten a human and/or fellow dogs should be on 10 days’ quarantine to observe if it has rabies (rabid dog) and avoid it infecting other dogs or biting more people. Aggressiveness, excessive salivation and drooling, swallowing difficulty, fever, excessive sensitivity to light (photophobia) convulsions and paralysis are all symptoms of rabies in a dog. Euthanasia may be offered the rabid dog as there is no cure for rabies in dogs and keeping it alive puts others in harm’s way.

Contagious dog bite

Dog bite is contagious if you have an open wound that may come in contact with the dog bite wound. Adequate barrier nursing is therefore imperative.

Dog breed that bites the most

Many dog breeds are friendly and domesticated. The dog breeds that bite most are the pit bulls, German Shepherd, bulldogs, Chihuahuas and Rottweilers.

Dog bite vaccine

Vaccines to be taken after a dog bite are rabies and tetanus vaccines. The rabies vaccine is given after a dog bite irrespective of the vaccination status of the victim. The rabies vaccine is injected into the deltoid muscle in the upper arm in adults or in the thighs for younger children.

The vaccine is given at contact (day zero), then at day 3,7 and 14. The vaccine schedule is completed in 14 days, although another dose can be given on day 28. The vaccine is injected into the deltoid muscle in the upper arm in adults or in the thighs for children less than 2 years of age. Rabies vaccine confers immunity against rabies virus infection for two years.

Rabies immunoglobulin is given immediately after a bite and up to 7 days after for passive immunity. However, rabies immunoglobulin may not be given to individuals who have completed their rabies vaccination schedule and have developed antibodies against the virus. A portion of the immunoglobulin is given into the wound site to neutralize the virus and intramuscularly into the upper arm or thigh.

Tetanus vaccine is given intramuscularly at contact and then after 4 weeks,6 months and 1 year. Td or TT (tetanus toxoid) may be given as prophylaxis for tetanus. Tdap or DTP which is a combination of diphtheria and tetanus vaccines is given to children less than 7.

Things to consider when you have been bitten by a dog:

  1. Who owns the dog?
  2. Is it a stray dog?  Stray dogs fend for themselves and unlikely to be vaccinated. In many African countries, these stray dogs are local dog breeds referred to as ekuke, bingo etc. The local dog breeds may be either Basenji, Azawakh or greyhounds. However, crossbreeds between these are is very common.
  3. Has it been vaccinated? You can get the answer to this from the dog owner or guardian. You may request to see the vaccination card of the dog because not all dog owners care enough to ensure their dog’s vaccinations are up to date.
  4. Was it a small abrasion or a deep bite? Deep bites require urgent medical attention. If it is a small abrasion and the dog is fully vaccinated, you may decide not to go to the hospital. However, to err on the side of caution, you may start rabies vaccination immediately.
  5. Has the dog bitten other people recently and has it been unusually aggressive? If the dog has bitten others recently or become more aggressive, then the suspicion of rabies infection is higher. That means you should get to the hospital immediately no matter how little the wound may be.
  6. Has the victim been previously vaccinated? If the victim has been previously vaccinated, he/she should still have post exposure prophylaxis vaccines but rabies immunoglobulin is not needed. Prophylaxis is precautionary measure taken before an event such as taking a medication to avoid a particular illness.
  7. Inform local health authorities so that the dog can be taken and detained while watching out for symptoms of rabies in the dog.
  8. Decide if you want to press charges on the dog owner.

Dog bite prevention

The risk of being bitten by a dog is highest in dog owners, dog walkers, vet nary workers and those who are strangers to a dog. Dog bite can be prevented by using a dog mouth guard or muzzles on the dog particularly when a painful or uncomfortable procedure is to be carried out on the dog.

Take the following precautionary measures to avoid dog bites:

  • Avoid overfamiliarity with a dog that does not know or recognize you.
  • If a dog is advancing towards you, do not scream. Allow the dog to smell you and try not to run away from it.
  • Train your dog to avoid rough sports
  • Talk gently to the dog and avoid touching its head or tail.
  • Also do not attempt to stone or attack the dog. A counter attack when it feels threatened may result in a bite.
  • Do not approach or disturb a dog when it is eating or sleeping. Literally, let the sleeping dogs lie.

About the author

Doctor

Grace is an internist currently practising in Nigeria. She has gained experience practising both in the private and public health sectors over the last ten years. She is passionate about giving patients adequate information about their health conditions. She believes that a large part of the management of chronic diseases lies with patients' understanding of their illnesses and the need for lifestyle modifications and medications.