A Severe Dog Bite in a Small Child. (How Can It Become an Ethical Dilemma?)
HENRY WILDE, M.D.*, SUKHIT PHAOSA V ASDI, M.D.**, SURASAK TANEEPANICHSKUL, M.D.**, YUEN TANNIRANDORN, M.D.**, CHUMSAK PRUKSAPONG, M.D.***
Affiliation : * Queen Saovabha Memorial Institute, Thai Red Cross Society, Bangkok 10330, ** Obstetrics and Gynecology Department, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, *** Surgery Department, Police Hospital, Bangkok 10330, Thailand.
It only just now happened to us at the Queen hold with a small child. Children can be maimed and
Saovabha Memorial Institute. Father and mother, even killed by such a dog(3). The child suffered
an upper middle class couple, brought their 2 year severe injuries which, should the dog be rabid, anti
old girl to the animal-bite clinic. The child had severe cipate a very short incubation period and would
(at least 10 ) lacerating bites of the face and scalp. mandate immediate treatment including injection of
They had been inflicted by the family dog, 5 years all the bite wounds with rabies immune globuJin(4).
old and vaccinated against rabies only once some The clinic staff therefore suggested two options :
4 years ago. The wounds had been sutured the pre 1) Kill the dog and bring it to the institute
vious day at a local hospital. The child was terrified for immediate necropsy and testing of the brain by
and screaming at a high pitch without repreave. fluorescent antibody staining which has a sensiti
What to do? vity of near 100 per cent(5). If the test is negative,
Thailand is a canine rabies endemic country no rabies postexposure treatment would be indi
and one time vaccination of a dog does not confer cated(6) and the child would be spared from further
long lasting immunity against rabiesO). The dog, trauma. The family would also be rid of this dange
which was known as irritable and ready to bite, rous animal.
could nevertheless be shedding rabies virus(2). It 2) Start immediate postexposure treatment
also is a dangerous animal, particularly in a house- with injections of all wounds using immune glo-
Keywords : Ethics, Canine Rabies
