7 year old boy and 8 year old girl, Serengeti, 2006
On the morning of the 1st of February JG’s dog who was about 9 months old attempted to bite passers by and at 6am bit a dog from a neighbouring household, afterwards ran away. The dog that was bitten developed symptoms on the 1st of March and died on the 3rd without causing any more problems. However at 5pm on the evening of the 1st of February JG’s dog reappeared and bit AM (7 year old male) on his way home from school. PM (8 year old female) was bitten by the same dog also around 5pm as she returned home from school. AM had very severe wounds on his left hand, right cheek and on his spine, PM was bitten on both hands and on the head, also very severely. After the dog attack both children were rushed to the district hospital where the wounds were washed and dressed. They were unable to be given PET that same day, Sunday, because the clinic was closed. On the second of February they both got their first dose of PET (10,000Tsh/ dose). They got their second doses on the 9th of February. On the 15th of February AM started to shake his head, twitch and became nervous. He was vomiting and could not eat. On the 16th he was taken to a private dispensary in the village and later that day to the district hospital. He died in hospital the following day. On the 1st of March PM was taken to Tarime district hospital where she was treated for cerebral malaria because she showed signs of nervousness. However they came to realize it was rabies when she was unable to swallow, and because of the history of the dog bite. She was taken home on the 5th of March and she died on the 8th. JG refused to admit his dog had not been vaccinated and showed a fake vaccination card that didn’t belong to his dog although local people all confirmed that the dog belonged to him and that after biting AM, PM and various dogs in the neighbourhood it had returned to JG’s house where they believe he killed and buried it. It seems likely that these two children developed rabies because of the severity of their wounds and lack of RIG, even though they were treated with PET the day after the bite.
Source: Katie Hampson, Princeton University
8 year old girl, Tanzania, 2004
MM, an 8 year old girl was bitten on her hand by a dog on her way home from school around midday on the 21st July 2004. The owner of the dog showed the girl’s father and the doctor at the local dispensary the vaccination card of a dog which had been vaccinated against rabies. Therefore the doctor did not agree to vaccinate the girl because he believed the dog could not have had rabies. MM developed symptoms of rabies on the 20th of August and died on the 25th. Before dying, she bit her father causing deep wounds on his left shoulder and onto his back, and on his left forearm, wrist and hand. The dog owner later admitted that the vaccination card was from another dog, and the dog which bit MM had not been vaccinated. He said he had only acquired the 2 year old male dog which bit MM in June 04. After the injury, he didn’t kill the dog, it actually disappeared and we therefore presume it died of rabies. The dog owner had not wanted to pay for the post exposure treatment which at that time would have cost around 30,000 Tanzanian shillings (around $30). He later paid for the father’s post exposure treatment.
45 year old man, Tanzania, 2004
JS’s dog, a 3 year old female, developed signs of rabies in late August 2004 and bit one of his goats and its own 3 month old puppy. The family didn’t know where she had contracted rabies from and killed her on the second day of abnormal behaviour. Two weeks after the bite the goat developed symptoms which it showed for 3 days until it was killed and buried. Six days after the bite the puppy developed symptoms and bit JS (a 45 year old man), scratched his father and his ten year old daughter. The puppy was killed and buried. After the bite JS visited his local dispensary and was told he would have to pay to get vaccinated, but because he had no money he decided not to bother. He had been bitten on the left hand in the middle of his finger and he had two small but deep puncture wounds. On the 5th of October 29 days after the bite he started symptoms such as shouting, feeling feverish and not being able to eat, so he was taken to the regional hospital in Musoma. He was not admitted because the staff recognized the signs and said that there was nothing they could do for him at this point. His family took him to his district hospital in Mugumu, where he was also refused. He was brought home and died on the 9th of October. On the 4th of October 2004 an unknown dog appeared in the village of Nyamatoke and bit another girl from JS’s extended family , aged 14 years on her right calf as she was coming from school. After hearing about JS’s death she told her own father about being bitten, was rushed to hospital and received her first dose of Post exposure treatment on the 22nd of October.
Source: Katie Hampson, Princeton University
10 year old girl, Tanzania, 2003
EM, a 10year old female primary school student from Kijima village in the Mwanza region, lives in a mud and grass thatched house. The household has a total of 8 people and spends US$ 18.5 per month on expenses. EM was bitten by an unknown suspected rabid dog on the head and ribs on the morning of 03/02/03, while on her way to school. The bite wound was not washed at the time, and the girl reported to the district hospital 5 days later. The delay was because she had to wait until her father had sold one of his three cows to get money for post exposure treatment, accommodation and the bus fare. The money raised from selling the cow was not enough to meet all the costs, so she received only 2 injections of anti-rabies vaccine. She could not attend school for a week, but at the time of the interview she was doing well and attending school as usual.
Source: Magai Kaare, Ministry of Livestock Development, Tanzania
5 year old girl, Tanzania, 2003
L’s 5 year old granddaughter was herding cattle near the mountain top in late November 2003 when she was bitten on the ear and scratched on the head by an unknown dog. She went to the dispensary in Sale and then to the dispensary in Malambo where she was referred to the district hospital in Wasso, some distance away. However, the wound had healed by then, so she didn’t go. Two and a half to three weeks after the bite she started to show symptoms and so was taken directly to Wasso. This was more than 6 hours by car, and it is unusual for more than one car to pass through the village in a day. Unfortunately, by this time it was too late. She died in late December 2003.
11 year old boy, Tanzania, 2002
JG’s mother tearfully relayed the following story. At 9pm one evening in May 2002, JG, an 11 year old boy was playing outside his house, when she heard him cry out and went to see what had happened. He said he had been bitten on the right thigh by a dog and so she took him to the local dispensary. The nurse there said that he didn’t need any treatment because he had no obvious wounds, and that he should go to school. Two weeks later he started to get headaches but the tablets that they bought from the dispensary didn’t help. After 3 weeks he developed skin rashes and would ache while he was sleeping. He wasn’t able to sleep properly and developed nervous symptoms, screaming out whenever somebody touched him. On the fourth day of these symptoms she took him to hospital where he was admitted but he died later that evening. The same dog had bitten two other children, who both received treatment, as well as other dogs.
12 year old schoolgirl, Tanzania, 2002
A 12 year-old female primary school student from Kigangama village in North Tanzania is the daughter of a primary school head teacher. She was bitten on the thigh by an unknown suspected rabid dog on 19th December while going to fetch water at a village borehole. The bite wound was washed with water, kerosine and salt on the same day when she arrived home. The next day she was taken by her farther to the district hospital for rabies post-exposure treatment (PET). She received all the 3 injections of anti-rabies vaccine, with her father using savings from his salary to pay for treatment and travel costs. The full cost was $78.70, almost as much as the $85.20 that her family of 6 usually spends in a month. The daughter continued to attend school as usual after the bite.
Source: Magai Kaare, Ministry of Livestock Development, Tanzania
54-year old man, New York, 2000
On September 22, a 54-year-old man who had resided in Ghana arrived in the United States, and on September 26, reported discomfort in his right lower back. During the next few days, the pain intensified and alternated with abdominal discomfort. He developed restlessness and anxiety. On September 30, he was admitted to a local hospital for suspected bowel obstruction. On examination, the patient appeared anxious and had swelling and tenderness on the right side of his body, excessive sweating, vomiting, and a temperature of 99.3 F (37.4 C). Other symptoms appeared within hours, including difficulty swallowing, dizziness, shortness of breath, and paranoia. The patient became delirious, with frothing and agitation. On October 1, the patient had a cardiac arrest, was resuscitated, and placed on mechanical ventilation. Rabies tests were positive on October 3. After a gradual decrease in respiration, heart rate, and blood pressure, the patient died on October 9. History from the patient's employer in Ghana revealed that the patient had been bitten in Ghana on his thumb and leg by his unvaccinated puppy in May.
Source: CDC, MMWR December 15, 2000 / 49(49);1111-5
11 year old girl, Tanzania, 1999
An 11 year old girl carrying water with her aunt in rural Tanzania was pounced upon by a rabid hyena. The aunt tried to pull the hyena away, and suffered a wound at the shoulder. A Maasai warrior killed the hyena with a spear and took the girl to the Wasso hospital. The 3 very experienced doctors who received her were horriifed at the extent of her injuries, one even prayed that she would die quickly to be out of pain. The hyena had ripped open her face and throat, she could see nothing and felt only pain. With her head totally wrapped up, breathing through a tube and her pulse racing, she was transferred by air ambulance across the border to Nairobi in Kenya. Surgeons worked from 5pm to 2am to reconstruct her face and neck. Astonishingly, she survived this ordeal, and further operations to reconstruct her jaw and skull with titanium plates. Post-exposure rabies treatment was administered in time, she can now talk, see and has recently married.
Source: Flying medical service, Arusha, Tanzania
23 year old english traveller, India, 1981
A 23 year old was bitten on the leg by a dog while walking in the Himalayan foothills. A local doctor cleaned the wound with iodine and applied antiseptic powder, tetanus injection was not available. He asked if the dog was mad, but rabies was not suspected, so no treatment sought. On her return to England, a month after the bite, the wound was still not healed, but a hospital casualty department treated it and it was improving quickly.
Two months after the bite, the woman started to feel very tired, and developed shooting pains in her waist and lower back. She became anxious and depressed and seemed to catch her breath when trying to drink. Soon it was impossible to take more than sips of water, and on her husband’s motorbike, the wind made her catch her breath. She started to be very sensitive, the cat sitting on her lap, or the feeling of hair on her face became unbearable. Frequently she sat up in bed, apparently terrified, and became confused, hallucinating and screaming in terror. A diagnosis of hysteria was made and tranquilisers administered, but the symptoms worsened. She awoke terrified and collapsed on the way to the lavatory, but medical advise was that this was a mental condition and nothing could be done. The following morning her pulse appeared to stop and she was taken by ambulance, suffering a cardiac arrest from which she was resuscitated, to hospital. Admitted to intensive care, she died less than 48 hours later without regaining consciousness. From the onset of symptoms to death was just over a week. Rabies infection was confirmed.
Source: BMA guide to rabies.
30 year old farmer, Tanzania
MM is a 30 year-old married man from Kemange village in the Mara region of Tanzania. He is a farmer with a family of 5 and a monthly household expenditure of $32.40. He was bitten on his leg by an unknown, suspected rabid dog at his homestead. He reported to the district hospital the next day for post exposure treatment, but didn’t receive it because he did not have the $23 the hospital staff demanded he pay for the first injection. He went back home to try and borrow money. After 3 days, he had enough money and went back to the district hospital for treatment. He could not get the treatment again, this time the vaccine was out of stock. Friends advised him to travel to Kenya, a neighbouring country, for treatment. He went back home and borrowed more money to pay for the travel costs. He managed to get enough money and travelled to Kenya where he got his first injection (10 days after the bite) at a cost of $13.8 per dose. To avoid going back to Kenya he also bought a thermos flask at a cost of $ 3.7 and 2 more doses of the vaccine; and stored the vaccine in the thermos flask with some ice he got from a pharmacy where he bought the vaccine. He was doing well at the time of this interview.
Source: Magai Kaare, Ministry of Livestock Development, Tanzania
