Dr Mattias Larsson. Photo courtesy of Family Medical Practice

Dr Mattias Larsson*

Linh, a cheerful five-year-old girl, was playing near her home when a neighbourhood dog approached her with a wagging tail and innocent eyes. Not suspecting any danger, she extended her hand to pet the dog. In a moment of playfulness, the dog nipped her on the leg and then quickly ran off. Linh told her parents about what happened who considered it a harmless incident. They cleaned the small wound and applied a bandage. As days went by, the wound seemed to be healing well.

However, some days later a few houses away, the same dog had attacked another person, inflicting a severe bite on their neck. After a week that person developed fever, headache, fatigue, muscle aches and general malaise. Some days later he became anxious, agitated and confused, displaying hyperactive and erratic behaviour, and was taken to hospital. As he also had excessive salivation, hydrophobia (fear of water), and aerophobia (fear of drafts of air) the clinical diagnosis was rabies, confirmed by tests. Even if treatment was promptly administered it was too late.  When symptoms start showing, mortality is almost 100 per cent.

After Linh’s parents heard about this incident, they panicked and desperate to protect their daughter, rushing to Family Medical Practice (FMP). Linh promptly received a post-exposure prophylactic vaccine and immunoglobulins preventing the virus from taking hold in her young body.

Local health authorities acted. They located and terminated the dog to prevent further spread of the virus. They also assessed other dogs of whom some were already infected and had to be terminated.

Are there any real zombie viruses? Well, one can draw striking parallels between rabies-infected animals and the archetypal depiction of zombies which has most likely inspired the zombie movies. The rabies infected animals, notably dogs, become aggressive and bite, thereby facilitating the virus's spread.

Rabies is a lethal viral disease that affects the central nervous system, causing severe neurological symptoms and, ultimately, death if left untreated. The virus predominantly resides in mammals and spreads primarily through the saliva of an infected animal, typically transmitted via bites.

Rabies is a lethal viral disease that affects the central nervous system, causing severe neurological symptoms and, ultimately, death if left untreated. Photo shutterstock.com

The duration between exposure, infection, and onset of symptom depends on the site of the bite. Bites to the neck can lead to symptoms in a matter of days, whereas bites on extremities can allow for a longer incubation period. The incubation period is depending on the distance the virus travels along nerve pathways to reach the central nervous system. In adults, the incubation period tends to be longer, and the immune response may slow down the progression of the virus, ranging from a few weeks to several months. Children have a shorter incubation period due to developing immune systems and smaller body size that allows the virus to reach the central nervous system faster. Rabies is a highly unpredictable disease, and the incubation period can be influenced by various factors, including the amount of virus introduced during the exposure, the strain of the virus, the person's overall health, and their immune response.

In Việt Nam, 61 deaths were recorded due to rabies in the first eight months of 2023, an increase from the previous year. Over the past five years 410 deaths have been attributed to rabies. The World Health Organization (WHO) states that the country typically records 70 to 100 rabies-related deaths annually. As this is recorded rabies deaths the actual number is likely to be higher as rabies is not always correctly diagnosed or if diagnosed, not always reported. Health authorities state that one significant reason for the high rabies mortality in Việt Nam is inadequate vaccination as well as lack of awareness regarding the importance of post-exposure vaccinations following animal bites.

Both pre and post exposure vaccines are available at FMP. — Photo shutterstock.com

So how can you protect yourself and your child from rabies? At FMP we provide both pre-exposure vaccination to strengthen long-term immunity and as well as post exposure vaccination and immunoglobulins, antibodies to neutralize the rabies virus. If you have a dog, cat, or other pet, it is important to ensure that they are rabies vaccinated. Do not let pets  roam freely and not play with unknown animals. When bitten by a dog, cat or other animal, you should seek care as soon as possible for assessment regarding the need for post exposure prophylaxis. Family Medical Practice

*Dr Mattias Larsson is a paediatric doctor at Family Medical Practice and associate professor at Karolinska Institutet and has a long experience in research on infectious diseases. He has worked with the Oxford University Clinical Research Unit and the Ministry of Health of Vietnam. He is fluent in English, Swedish, Vietnamese, German and some Spanish.

Visit Family Medical Practice Hanoi 24/7 at 298I P. Kim Mã St, Ba Đình District. 

To book an appointment, please call us at (024).3843.0784 or via Whatsapp, Viber or Zalo on +84.944.43.1919 or email hanoi@vietnammedicalpractice.com.

FMP’s downtown location in Hồ Chí Minh City is in Diamond Plaza, 34Đ. Lê Duẩn St, Bến Nghé Ward, District 1, and 95Đ. Thảo Điền Street, District 2.  Tel. (028) 3822 7848 or email hcmc@vietnammedicalpractice.com