Frances

My daughter has been bitten by a dog this evening in Agra. She describes it as "small and excitable".
Her rabies jab was up to date before she left home. She understands that she needs a booster within 24 hours of the bite and intends to contact the Embassy in the morning to find out where she can go for this.
In the event that the Embassy is closed/doesn't know/ doesn't answer the phone, does anyone know where she can go in Agra? Is there any alternative which can be taken orally which she can buy over the counter without a prescription? Tomorrow is Friday and so moving into the weekend.
With thanks

ekscrunchy

If it were me, I would get myself to the best private hospital asap.

Kathie

There is no alternative to the rabies booster she needs. I agree with eks, have her get to the nearest private hospital as soon as possible.

Good for her that she had the rabies jabs. Otherwise, she's need to be evacuated to Bangkok, probably the closest place with the human immuneglobulin she would need along with the rabies series if she didn't have the pre-exposure vaccine.

Cicerone

First of all, your daughter should try contacting the US embassy right now:

U.S. citizen who wishes to request emergency assistance can call the American Citizen Services Unit during normal business hours (8:30 a.m. to 5:30 p.m.) at 2419-8000, ext. 4249 or 8562 or 4040. Outside of normal business hours, the person should call the Embassy switchboard at 2419-8000, and request to speak with the "Duty Officer."

You can also call the U.S. Department of State's Office of Overseas Citizen Services toll free at 1-888-407-4747.

Also, her hotel should help get her to the closest hospital. There are a number of them alone the Agra-Delhi road, just outside town. I am sure the hotel can recommend one.

For a list of hospitals in Delhi, se http://newdelhi.usembassy.gov/medical_information2.html. She could drive or train up to Delhi from Agra if she did not feel comfortable going to an Agra hospital.

lcuy

Marksfour's daughter got bitten by a dog in China just a few months ago, and went through the exact same thing. You might try adding a post with her name in it here.

One thing I know is that they didn't want to use the local rabies stuff, they got the one from Germany or whereever comes in a prepacked needle.

Tell her to call/go to the Oberoi Amaravilas hotel In Agra and ask them to recco a hospital if the embassy doesn't respond. I would trust them to know the best.

Kathie

Lcuy, do you know - did his daughter already have the pre-exposure vaccine or did she need the immune globulin as well? For future reference, I'm wondering if they were able to get the human immune globulin in a timely manner. Typically, the human immune globulin is not available in India, and they use a horse-derived product which can cause severe side effects. Getting the post-exposure vaccine is relatively easy even in India, but the immune globulin can be a real problem.

lcuy

I'm not sure of the details, kathie. I'm trying to reach her so she can comment more accurately than me!

vp_singh

Ask your daughter to immediately report to the nearest hospital & get the anti-rabies vaccine injected. I have asked a friend to provide me with a list of such hospitals & shall be back on the forum at the very earliest.
My wife joins me in wishing your dear daughter a speedy recovery!

marksfour

I am sorry ot hear about your daughter's dog bite.

Yes, DD did get bitten by a dog in China...we found out that she was NOT able to get the human immune globulin as we had initially thought. (too expensive and short shelf life for Chinese med facilities to keep it stocked) After contacting the CDC in Atlanta (via our State Health Dept. Head Veterinarian) I was reassured that the 5 shot series was fine. She could not receive her first vaccine until 5 days after her bite bcs. she was in a remote part of China.

Kathie (above) was very reassuring when we were going through this and thank you again Kathie for your knowledge.

I agree with all of the above posters...have her get to a hospital as soon as possible to start her series and ideally to get the immune globulin.

DD did have a bad reaction to each vaccine she received but what is the alternative? (sick to stomach, extreme irritability, fever, cycle thrown off, body aches, etc..) Just so you know in case your DD has a reaction.

Yes, make sure the needles are sealed and yes DD insisted on the vaccine made in Germany...(vaccination is called Rabipur outside of USA)

Also, DD would have rather taken an oral med than via syringe, but not an option. Must be given in arm muscle.

Please keep us posted!

PS. CDC stressed the importance of washing the bite area very thoroughly and as soon as possible.

Frances

Just received a message to say that my daughter has been to the Apollo clinic and had a rabies jab and tetanus . She has to have another in 5 days and another in 7 days- by which time she will be back in the U.K.
She says her arm is hurting (which is what she used to say as a child but it used to get her out of orchestra!) but if that's the worst that happens then that's O.K.
I'm so grateful to you all .

lcuy

Glad she was able to get to Apollo. Supposed to be an excellent hospital(s).

What a relief, Frances!

When I heard about marksfour's daughter's bite last spring, I tried to get the rabies vaccine for myself, but there wasn't time for the series before I left.

I stayed very far from all the dogs in India, and was really worried about our bike rides in Vietnam, but none of us attracted any dogs at all. Next time, I'll do the series in advance!

Kathie

Great, Frances! I'm glad to hear your daughter received the medical care she needed.

Marsfour, I'd forgotten your daughter was in China when she was bitten. I think it was really a good call not to get the Chinese vaccines and opt for the German vaccine.

Frances' daughter was fortunate to have had the pre-exposure vaccines, as it means she didn't need the immune globulin, just the (less perishable and more readily available) vaccine.

Elainee

The excitement never ends when you have children no matter how old they are. So glad your dd got the medical care she needed. Of course you will have her checked out as soon as she arrives home. I did not know about the propholatic (terrible spelling!) rabies injection. Good to know.

Frances

A post-script 24 hours further on. I managed to speak to my daughter this morning.
She told me that when she had initially been bitten she had rung the British Embassy in Delhi to ask for a list of hospitals in Delhi as she had intended to put off going to seek advice until she got back there. The Embassy was helpful and emailed her a list of clinics in Delhi. When she emailed me what had happened I spoke to my eldest daughter who is a doctor who immediately sent her a text to say she HAD to seek advice within 24 hours. She then rang the Embassy again- this was either overnight or first thing this morning. This time she said they were "crap" and said they couldn't recommend anywhere(which I took to mean they weren't allowed to as opposed to that there was nowhere sufficiently good.)She told me that she remembered that when we were in Shimla some years ago and staying in the Cecil, three out of the four of us had gone down with gastro-enteritis (which co-incidentally we had contracted in a hotel in Agra-but that's another story).She remembered that the hotel had been very efficient in getting a doctor for us- twice, and so thought that a similar 4 or 5 star hotel in Agra might also be helpful. She went to the Oberoi(she must have read your post Icuy!) and asked if they could help. She made the point that they were back-packers, not staying there and not visibly ill but the staff couldn't have been more helpful. I don't think she knew that the Cecil was an Oberoi- it was just hoping that they may help. It was they who recommended the Apollo clinic.
What also happened was that first thing this morning I checked the informal list of vaccinations which I kept for my daughters. If there is one word of advice I could give to parents it is this-keep your own list of the immunisations your children have had!
My daughter had left our surgery in September 2006 when she went to university and her records had gone Edinburgh to her new G.P. Every summer when she is planning her trip she rings and asks "Do I need jabs or am I up to date."
In the autumn of 2005 she went to Vietnam followed by Cambodia for her gap-year. I remember that at the time she was advised to have rabies and japanese encephalitis which were costing about £150. She just refused to have them even though I would pay. Just before she left she relented but because we live in a small village the surgery didn't carry the vaccine and couldn't get it in time. I remember having to try and find a chemist who had this and then going a fair distance to get it. By now time was too short for her to have the three shots of rabies and I thought she had only had two. The notes I turned up this morning confirmed this. So even though I had reported that she was up-to-date,when I checked it seemed she had never finished the course.
When I spoke to her she said she was definitely up to date because she hadn't needed any jabs this year. That was correct but this year she was going to India and I have never in 8 trips to India been advised to have a rabies jab so I take it the necessity in India is perhaps not thought to be so great as in Cambodia/Vietnam.
Anyway I spoke to our surgery where luckily they still have a computer record even though her records have gone, and they told me that they had given her doses 2 and 3 on the same day in November 2005.
It has taught me a lesson and for my next trip to India at Christmas I will be having the rabies jab.
This was the latest in a catalogue of things that have gone wrong for her this trip. She and her boyfriend were booked to go to Tibet which then closed to foreigners. Luckily they were able to rebook their tickets and flew into Nepal instead. When they wanted to leave Katmandu they had difficulty as there were strikes becuse of the increasing price of fuel. They got to the border with West Bengal and could not cross because of riots in Darjeeling which was where they were headed. They had to stay at the border during which time my daughter was bitten by an insect. She had a reaction to the bite and her leg swelled up until she had difficulty walking.They had to stay in an unsavoury hotel(when I told her to keep the bite clean she laughed and said that was not the best country to try and do that in).
The next day they were only allowed to cross the border in a bus which would not stop at all until it cleared the dangerous area. They got to Guwahati-many hours away to find that the national park they wanted to see was cloed because of the monsoon. They travelled on to Calcutta many many hours away to find floods and rioting there. When they tried to leave Calcutta for Puri a beach town the train was turned back because of floods. Now this! She has 5 more days(5 more disasters?) before she flies home!

Kathie

Frances, just for your future information, India has the highest incidence of human rabies in the world. For a traveler to India who isn't staying in luxe accommodations, I would recommend the rabies pre-exposure vaccine.

jules39

Out of couriosity Kathie why do you specify those not stayin in lux accom should get the vac? I would think there was a chance of any one gettinf bitten no matter where they are staying. The dogs are everywhere & there is always the chance you could be bitten whilst exploring a market or the likes?
J

Kathie

Jules, you are quite right, there are stay dogs everywhere. But depending on one's style of travel, one may be at greater or lesser risk. The more walking one plans to do in cities as well as villages, the more one is at more risk. Bicycling, in particular places one at more risk (you know how dogs like to chase moving things...)

I'd also note that most business travelers are at little risk, as they are whisked from place to place by car. Some leisure travelers do the same. This makes them lower risk, but obviously, not no risk.

jules39

Yes Kathie you are right there are different risks according to how you are travelling. The more potential interaction you have the greater the risk. I would be scared riding through a street full of dogs in India!!! It bothers me here at home if I am riding by a dog off leash, where there is no risk of rabies but there is always the risk of a bite and that would hurt!!
Safe & happy travels J

Kathie

Jules, like you, I can't imagine riding a bike in India, but people do!

Frances

Most recent information.
My daughter had the second jab three days later by which time she was in Delhi. The third was due yesterday- Friday. She returned to the U.K. on Wednesday and already had an appointent made for the third ja in case British doctors didn't carry the vaccine.) When she went to the surgery the person she saw consulted on the telephone with someone else who advised that she was low risk and as cases in Britain are dealt with on an individual basis - which I take to mean that there is no blanket policy, they thought she should not have it. However they agreed to seek further advice but it was now moving towards 5 p.m. on Friday. They rang our surgery here(she is until today staying in England) and agreed to notify them as soon as they heard and in the event that the advice was to administer the vaccine they would then send it on to our surgery where she would have it.
This though is going to be at least Tuesday and my daughter mentioned that in India where presumably they have a deal of experience about this, she was told that she MUST have three.
I was on a train when she told me all this and at that point we went into a tunnel, so I've never got any further but she returns home this afternoon.
By the way she feels absolutely fine!