Beasts that bite by John Debbie and Takao Fujikura

areful travellers are advised mals are friendly towards a visitor. -should be thoroughly cleaned to enquire about the risks If animals are sick with rabies, or a with soap and water immediately, Cthat prevail in the area of the multitude of other diseases, they and either alcohol, tincture or world they intend visiting, and often act strangely, and this should aqueous solution of iodine or about the availability of anti-ven­ be a clue that something is wrong. quaternary ammonium compounds oms for insect- and snake-bite, and Thus a wild animal that is generally should be applied. Bandage the bit­ of rabies vaccines. elusive or nocturnal will appear in ten area and do not put sticking Rabies-infected animals may be broad daylight and appear timid plaster on the wound. Medical as­ encountered in most countries but and easily approached. Docile dogs sistance should then be sought. Try the following are reported to be which become rabid may show ag­ to identify the animal and its own­ rabies-free : Australia, Bermuda, gressive behaviour but the opposite er, if possible, so that official fol­ many of the Caribbean islands can also occur: a highly-strung, low-up is made easier. If the animal (but not Cuba, Grenada, Haiti, nasty animal can become friendly is owned, the owner should be told Puerto Rico, or Trinidad), Finland, and loving. to restrain the animal and keep it Gibraltar, Iceland, Ireland, Japan, restrained until official action is Malta, New Zealand, Norway taken. (except the island of Svalbard), the Should post-exposure rabies Pacific islands, Papua New Guinea, treatment be warranted, there are Portugal, Spain, Sweden, and the many different vaccines in use for United Kingdom. protecting humans. It might be Rabies is the first thing to think advisable to check with the local of when an animal bites, but teta­ authorities about the availability of nus and other bacterial wound in­ rabies vaccines and types before fections from animal bites or travelling. Antirabies serum and its scratches also require medical at­ globulin fractions are of proven ef­ tention. All travellers should know fectiveness as an adjunct to vaccine about the threat from animal bites treatment. and should take precautions to en­ Some 2500 different kinds of sure they have up-to-date tetanus snakes are known to exist in the immunization. Those who are trav­ world, but fewer than 200 snakes elling extensively in the tropical are dangerous to man. Poisonous areas of the world where dog rabies snakes are not generally found in is still prevalent might consider pre­ very cold climates, although a very exposure rabies immunization with The cardinal rule is-do not inter­ robust viper is known to exist in licensed tissue culture or suckling fere with animals. If they are eating Scandinavia and within the Arctic mouse brain rabies vaccines. If they or fighting, resting or working, Circle, extending into Siberia. In want to keep up their rabies vaccine leave them alone. It is rare to be North America, poisonous snakes protection, booster doses should be attacked by an unprovoked animal, are not known north of the south­ administered at intervals of one to but it is inevitable that a provoked ern borders of Canada. By con­ three years. animal will sooner or later respond trast, poisonous snakes are abun­ The best protection against ani­ in a defensive or aggressive way. dant throughout the continent of mal bites is to be aware of the risk, A rabies vaccination certificate Africa and are also found in most particularly of rabies transmission, should be filled out for all individ­ parts of Asia and South America, and to avoid being bitten. Most ani­ uals who receive rabies vaccine, with the exception of the high mals are wary of humans and will either post- or pre-exposure. The mountain tops. Sea snakes occur keep their distance unless encour­ certificate should indicate the type near the coasts of Southern Asia aged to approach. The best advice of vaccine used, the date, the man­ and Northern Australia. that can be given is to leave animals ufacturer, lot number, schedule Snake-bite, in some regions of alone. Do not try to catch, feed used, antibody titre if determined, the world, is a common cause of se­ or pet strange or wild animals, and allergic status of the individual. rious disability and death. Epidemi­ whether dogs , cats, bats, monkeys This certificate should be carried ological information obtained from or wildlife carnivores. A visit to with the traveller at all times. 23 provinces of one Asian country friends in their home does not nec­ If an animal does bite you, the showed a mortality rate from essarily mean that pets or farm ani- wound-no matter how superficial snake-bite of four to five per cent.

W oRLD HEALTH, December 1987 11 Beasts that bite

lack of visibility increases the risk of disturbing them. Do not enter bush and grassland without taking precautions (such as carrying a stick) and, if walking at night, use a torch. Examine shoes and clothing with caution, before dressing, par­ ticularly in the morning, as snakes can shelter in them. Don't put your hands into holes and crevices or un­ der rocks, and try to avoid defecat­ ing in the bush or grassland. If trav­ elling in fairly remote areas, obtain in advance the address of a health centre or hospital in the area to be visited. If your are bitten, clean the wound with soap and water and ap­ ply iodine ; find transport to get you to a health centre or hospital as soon as possible, where anti-snake venom can be given. Apply a tight bandage around the limb, above and below the bite marks. An expe­ rienced travelling companion will know how to suck out the liquid which is coming from the wound, for five to ten minutes, immediately spitting out the liquid; or use an as­ pirator, if available. Keep the limb still and, if possible, in a splint. Make a note of the time of the bite. If the snake has been killed, put it in a container and take it to the hospital or health centre for identification. Anti-snake venoms are produced against the effect of most poisonous snakes in about 30 countries, al­ though these may not be available in all areas. If bitten by a snake, try to stay calm. Not all snakes are poi­ sonous and snake-bite can be treat­ ed. Fear, excitement and drinking alcohol can only increase the spread of poison to the rest of the body. As for scorpions, about 30 spe­ cies exist, mainly in tropical and sub-tropical zones, and only a few are poisonous. They live under logs , stones and in buildings. Inside houses, scorpions may hide in shoes and clothing. So it is advisable to check boots, sleeping bags, bedding Travellers would be well advised to and clothes before using them. In . . . Docile dogs which become rabid seek information from a travel may show aggressive behaviour . .. the South-western United States agent, a doctor or the health auth­ and in Mexico, most fatal cases of ority on the species of poisonous Photo WHO/P. Almasy scorpion sting occur in children. snakes existing in the area to be Potentially lethal species also live in visited, and the extent of the risk. legs , and thighs, and also take a Brazil, Egypt and other countries. In snake-infested areas, go first-aid kit. If possible, avoid trav­ Similar first-aid measures to equipped with boots, since snakes elling in remote areas alone ; in par­ those for snake-bite can be applied tend to bite the lower extremities ticular, avo.id walking at night when to scorpion bites. Anti-scorpion such as toes, feet, lower part of the snakes are still active and where venom is produced in a number of

12 W oRLD HEALTH , December 1987 Beasts that bite

countries for some of the more dan­ gerous species (such as Algeria, Iran, Mexico, South Africa, United Kingdom, USA), and may be life­ saving if administered within a few hours of the sting occurring. All spiders have venom glands, but only a few species of two gen­ era are dangerous to man ; these ~ are commonly called the "Black § Widow" spider and the "Brown ~ Recluse" spider. These are wide- § spread in distribution and may be ~ numerous both locally and § seasonally. ti: These spiders usually bite people only in self-defence or when guard­ ing their egg sacks. Commonly, the Snakes that cause serious ~ disability or death spider bites occur when a person dons clothing in which the spider Some countries which has hidden. The bites are not im­ Area Name of snake produce anti-venoms mediately painful but progress through localised swelling to the North America Eastern diamond-back USA development of a depressed ulcer. rattlesnake/Agkistrodon piscivorus!Crotalus viridis Western diamond-back USA, Mexico rattlesnake

Mexico, Central Barba amarilla Brazil, Colombia, Ecuador, America, and Mexico, Peru, USA, South America Venezuela Central American rattlesn~ke Costa Rica Mexican rattlesnake Mexico Western diamond-back Mexico, USA rattlesnake Jararaca/Wied' s lance­ Argentina, Brazil head/painted jararaca South American Argentina, Brazil, Colombia, rattlesnake/cascabel Mexico, USA, Venezuela

North and middle Puff adder/Spitting cobra/ Naja South Africa Africa mossambica Saw-scaled viper . South Africa {France, India, Iran, USSR)

Southern Africa Puff adder/Spitting cobra South Africa

Eastern Indian cobra India, Thailand (France, USSR) Mediterranean Levantine viper Iran Palestine viper Israel Puff adder (South Africa) Rabies researchers can track the fox's movements when it has been fitted with Saw-scaled viper India, Iran a tiny radio transmitter. South-East Asia Indian cobra India, Thailand (France, USSR) Photo WHO Malayan pit viper Thailand Russell's viper India, Thailand Systemic reactions, affecting the Saw-scaled viper India, Iran (France, USSR) body as a whole, do occur and are Beaked sea snake especially dangerous in children. Travellers who are bitten by a spi­ Western Pacific Chinese habu China der should consult the closest dis­ Indian cobra Thailand, ln'dia (France, USSR) pensary or hospital for treatment Habu and advice. Anti-spider venom is Australia, Pacifjc Eastern brown snake/Death produced in Australia, South Afri­ Islands adder/Tiger snake · ca, and the USA, as well as a num­ ber of other countries. • Europe European viper (adder) Czechoslovakia, France, Federal Republic of Germany, Italy

WoRLD HEALTH, December 1987