In the United States (US) military services Innovative Readiness Training (IRT) exercises, such as Operations New Horizons, Belize 2014, are classified as Civil-Military Operations. If you would like to know more about these operations, which I consider to be some of the investments made by the US Department of Defense, you can read about them in Joint Publication 3-57: Civil-Military Operations, 9 July 2018. It is not classified as a secret document, so there is no need to place it in a storage box in your bathroom, but you can do so if it pleases you. Please, don’t ask one of your coworkers to hide the box if the FBI shows up.
As mentioned in Operation New Horizons, Belize 2014, Part 1, a big part of the veterinary mission during this exercise was immunizing Belizean dogs against rabies. If you live in the United States or Europe you might ask, why is this important? It is important for three reasons.
First, rabies is a zoonotic disease affecting the central nervous system of mammals. After a bite by a rabid animal or in the event that infective saliva enters an open scratch or wound the rabies virus travels very slowly up a person’s or mammal’s peripheral nervous system towards the brain. It can take almost two months for the virus to migrate through the nervous system to the brain and for the expression of neurological symptoms depending on how far the virus has to move! Once neurological symptoms appear, the disease is nearly always fatal. There is no effective treatment that can stop the progression of the virus or reverse the damage once symptoms appear. In other words, prevention is key. How big a problem is rabies for human health? Almost 60,000 people die from rabies each year worldwide. It is such an important disease that in 2007, September 28th of every subsequent year was designated as World Rabies Day.
Secondly, rabies is found in mammals on all continents except Antarctica. In some areas of the world such as Africa, Asia, Central and South America, rabies is a big problem. Wild animals serve as a reservoir for the virus. Domestic animal immunization and human treatment are not readily available in these areas. In the US many species of bats, foxes, coyotes, raccoons, my personal spirit animal, and skunks are potential vectors of human variant rabies; the rabies variant that is most likely to infect and kill humans. The significance of these various vectors varies regionally. For example, along the eastern seaboard of the United States raccoons are the most important vector whereas in California skunks are the most important vector. If you plan to travel outside the United States, you can find country-specific information on rabies on the Centers for Disease Control and Prevention’s website at https://www.cdc.gov/rabies/specific_groups/travelers/index.html. Their website contains important, accessible information concerning dangers to human health and vaccines to prevent those diseases.
Third, we can limit human exposure to rabies. The most important way we can do so is to immunize our companion animals. Why? Because they may interact with rabies-infected wild animals. For example, a rabid bat may lose its ability to fly and may tumble to the ground in your home or yard. Your cat or dog may approach the bat to investigate, be bitten and infected, later posing a danger to you or your family’s health. If you suspect this has occurred, box up the bat without touching it in a plastic container and take your pet and the bat to your veterinarian. Your veterinarian will consult with the appropriate department of health and will receive direction to immunize your pet, even if it has recently been immunized. The appropriate department of health will retrieve the bat to be tested for rabies and you will be directed to see your family physician or an infectious disease specialist.
An important point: if a bat has fallen to the ground or you provided help for it to fall to the ground using a broom, for example, don’t pick it up barehanded. It may bite, scratch, and infect you. Wearing protective gloves, scoop the bat up in a dustpan, place the bat in a closed container, and notify your local health authorities.
You might be thinking, how often should I have my pet immunized against rabies? Vaccine duration is between one and three years, dependent upon the vaccine. The vaccine is effective and reasonable in cost. It protects you and your pet.
Sometimes when you are travelling in a country where you might interact with potentially rabid animals you may be bitten by an aggressive dog, cat, or other animal. What should you do? First, you should avoid interacting with potentially infected animals. The animal may be a coyote or raccoon, but it might also be a puppy that is acting dopy and drooling. Stay away. However, if you are bitten or scratched immediately gently flush the wound with soap and water or betadine and water. Next, seek medical attention to receive Rabies Postexposure Prophylaxis (PEP).
As mentioned in Part 1, my soldiers and I were working with Dr. Joe Meyers, the Belizean Public Health veterinarian, and his colleagues to immunize as many dogs against rabies as possible within our area of operation. The majority of these dogs were not immunized against rabies and roamed free where they would interact with other non-immunized mammals, including wild carnivores that might be infected with rabies. During our exercise, Dr. Meyers and his colleagues were able to communicate with the owners in Spanish and explain what we were doing and why. This eliminated the need for me to attempt communication with the owners in my own Spanglish. The Belizean National Defense troops and Dr. Meyer's colleagues restrained the animals while my team administered the immunization.
Although the performance of surgery on Belizeans was not part of the mission, we were accompanied by a Forward Surgical Team (FST) which are small, mobile Army surgical team, the same team that worked on SPC Ladesh. They accompanied my veterinary team for an afternoon of immunizations in order to broaden their experience in the community. We approached a home that had four or five dogs roaming around, untethered, and not within a fenced area.
One of our Belizean colleagues was restraining a dog using a device known as a come along. A come along is a long handle with a loop at the end. The loop is slipped over a potentially aggressive or aggressive canine of any species and the loop is tightened, providing restraint. As I immunized the dog that was under restraint, a pointer-sized, black, and white dog flew at me from left field and bit me on the left arm, then ran away. We continued our immunizations until a member of the FST noticed that my sleeve was turning red with blood, a very embarrassing moment for me because I am agile and quick, and animals rarely succeed in biting me. The spotted dog succeeded because one of my hands was holding the left hindleg of the dog who was receiving his rabies immunization and my right hand was injecting the vaccine.
The FST and the Exercise Commander, an Air Force physician, were not pleased because even though I had been immunized with rabies vaccine multiple times for over 32 years they did not relish the infinitely small possibility that I might become infected on their watch. It would not look good on their Officer Evaluations. Since we were far from the United States, the Air Force airlifted yet another dose of rabies vaccine and doses of human rabies immune globulin (HRIG) for my treatment, all of which arrived the following day.
The vials arrived and one of the Army physicians injected the HRIG around my bite via half a dozen deep intramuscular injections. In addition, although previously immunized, I was immunized with the rabies vaccine on days 3, 7, and 14 post-exposure. I went through this same drill in 2019 following a bite by Jihadi Jane, a wild jackal in Afghanistan, but that is another story. Additional information concerning PEP can be found on the CDC website at https://www.cdc.gov/rabies/medical_care/index.html.
The point of this article is that rabies is no joke.
Make sure your companion animals are immunized. Avoid contact with bats and other wild animals that might be infected with rabies and if you suspect you are bitten or scratched by a potentially rabid animal immediately seek medical attention.
.