WHO Needs to Re-look at Animal Bite Wound Classification for Rabies Post Exposure Prophylaxis to Save People from Deadly Rabies!

Abstract

Rabies is a deadly zoonotic disease that is largely caused by bites or scratches of an infected dog. WHO has defined wound classifications for taking decisions on Rabies Post Exposure Prophylaxis (PEP) after bites. Some experts have suggested a change in WHO classification to include another category IV in severe wounds. As we work in the rabies endemic country contributing the highest number of rabies deaths annually, we discuss what changes in Rabies PEP classification are actually required based on our clinical practice. We discuss here how the lives of victims of rabid animals were saved and what factors led to the failures of PEP. We also discuss why there is no need to expand existing wound classification to category IV and no need to use higher concentrations of RIG for severe wounds like those on the head and neck. We recommend omitting category II and keeping only categories I and III for wound classification for rabies PEP based on our clinical experience with rabid dog bites and scratches i.e. either there is exposure or no exposure using spirit test in doubtful abrasions without bleeding. Moreover, because the rabies virus attaches to the nerve at the site of the bite and there is no viraemia in rabies infection, therefore, to classify a scratch or abrasion with or without bleeding is not rational.