I HAVE been trying to track down a quote from something written by the famous mountaineer Reinhold Messner. I haven’t found it but it goes something like this: “Only from the extremes of comfort will someone seek the extreme of adventure.” What he’s getting at, according to my interpretation, is that only when a person and the society he or she lives in has reached a safe, comfortable state, will they then start to look for the excitement and danger of adventure. Only when people individually feel secure and comfortable will they have the confidence, resources and possibly naivety to look for risk. People who have to live daily with risk and discomfort don’t go looking for more. As well as trying to find that quote, I have also lost several hours of my life recently to an online veterinary forum. I posted a fairly innocuous comment, which attracted some slightly negative comments, which I felt obliged to respond to. I then followed the conversation in which, amongst other things, human and animal vaccination was discussed: the pros and cons and whether we should vaccinate against a variety of diseases.
An adventure… It struck me that many of those in the discussion who are anti-vaccination in the UK (a small minority of vets on that forum and a larger minority of the public in general) would never have experienced life without it, and thus were arguing from Messner’s position of “extreme comfort” to embark on an adventure of extreme risk: the adventure in this case being living without vaccinating. Much of this debate and antivaccination sentiment has been sparked, of course, by the MMR/Wakefield scandal. I was reminded of some experiences with preventable diseases I had whilst working in India, a country less comfortable than ours and whose human and animal populations are less well vaccinated than our own. Rabies is a pretty nasty infectious disease and one which can be successfully vaccinated against. The project I worked for vaccinated all the dogs through its doors, and its staff too. Anyone who suggests that vaccination per se is not a good thing
has never seen this disease in action. One of my first experiences with it started with a highly unusual ’phone call: “Can someone come please, there’s a buffalo chasing mopeds round the village.” Luckily, by the time I arrived the villagers had caught it and asked me to euthanase it. This was the only time I remember being asked to euthanase an animal in India, especially a bovine, where the concept of humane killing is not really well known. The next encounter was when dealing with the queue of people and animals at the gate. A rickshaw arrived with some English tourists who had “adopted” a dog for the duration of their holiday. This was a common scenario we encountered. This dog was a beach dog and was having difficulty eating and drinking. The dog was salivating and was very weak. On a brief clinical inspection I was concerned about this being a dog in the “paralytic” stage of rabies. The chief Indian vet confirmed my suspicions and took the dog to be euthanased whilst I spoke to the tourists: had they had rabies vaccination: “No”. Had they considered it before coming here: “No”. They had been hand-feeding this dog for several days and so would have had copious contact with virus-laden saliva. I discussed treatment and vaccination with them, including the current best practice advice on postexposure immunoglobulin therapy. We advised them to come back to see us to check they were receiving the right treatment but we never saw them again. Let’s hope they didn’t go looking for a homoeopathic nosode…
A scare… A colleague spayed a dog, which a few days later turned out to be rabid. We couldn’t find any record of animal blood to human spread of the virus, which mainly travels in nerves, but it gave us a scare. Luckily, all the staff were vaccinated and booster vaccinations were given after any exposure. This dog sadly didn’t show any clinical signs for rabies until a few days post-op. One of the lay staff had noticed it was acting oddly one day. The next morning we arrived at work to a
chaotic scene. Early that morning it had escaped from its pen and had attacked several of the house-dogs. It had then run down to a squatter camp at the end of the road and had bitten a small child. The kennel staff had managed to get the dog confined back into its kennel without getting bitten. I ended up being the one who had to euthanase it. The dog was wild and looked like the classic image of the “rabid dog”: madly attacking anything that came near her and hypersalivating.
Contacts euthanased Alpha 2 sedation had no effect, neither did ACP. Eventually some intra-peritoneal thiopentone had enough effect to send her to sleep so we could euthanase it with more thio in the heart (euthanasia drugs don’t really exist in India, or not that we could get hold of – thiopentone had to do). Despite all the other dogs being vaccinated, any in-contact dog was euthanased as well. We arranged for the child to see a doctor and then administered the follow-up injections ourselves. I will never forget him receiving these injections from us without complaint. He was fine and received the full treatment prescribed by a hospital. The longest known incubation of rabies by a human is seven years! Stray dog rabies vaccination (along with the usual DHPPiL) is a routine and essential part of most neutering and welfare organisations. We all felt terrible that the dog had done this, but on reflection the dog had only been with us a few days, so if it was not here it would have been running rabid round the village it came from and almost certainly would have bitten many more people before being stoned or beaten to death by the villagers. At least our staff contained it quickly with only one human bite
victim who could then receive the proper treatment. Distemper is a disease we also became very familiar with and is one that many younger vets in the UK will never have seen (as I age, the definition of “younger” becomes looser!). This can lead to people thinking that vaccination for diseases of low prevalence is no longer needed, but until it goes the same way as smallpox (i.e. extinct due to worldwide vaccination) then I’ll keep recommending it to my clients. Any medical intervention carries a risk, but the risk of infectious disease is usually much higher than that from receiving the vaccine against it. However, as the recent MMR scandal shows, that shouldn’t get in the way of a good scare story. For a good discussion of the MMR story, a good place to start is the Bad Science book by Ben Goldacre, or his website, www.badscience.net . My parents visited in the January whilst I was in India. They brought with them the story of the foot-andmouth disease outbreak in the UK and all its horrors for the animals, farmers, public and the economy. The Indian vet listened intently, but looked slightly perplexed. After we had all grasped the enormity of the implications for the country, she shrugged almost apologetically and said: “We just vaccinate against it here.” Why
