Whose standard?

Medical care should be clear and easy, right? Person gets bitten by an animal that could potentially have rabies, follow the protocol.

Now the problem becomes – whose protocol? Centers for Disease Control? ACIP? WHO?

Getting the idea? There are difference between countries on medicines, vaccines and treatment. Most of the time, between Europe, UK, US and OZ, these differences are trivial; mostly a difference of packaging or cultural dosing. The principles are the same, the care is the same.

And then we come to Rabies prophylaxis. WHO (World Health Organization) has a five shot protocol which is based on several factors: approved and tested vaccines, rising in viral titers, and actual prevalence of rabies. The latest US protocol is a four shot series. Based on US vaccines and risks, this is more than reasonable.

Now think about Afghanistan. Some of the assumptions we make in the US are simply not true – none of the feral animals have ever been immunized. Nor have their dams. The incremental difference in anti-body titers between 4 and 5 doses is not much. In the US it is unlikely to make a difference, but what about in a location where the assumption is likely that the feral is infected. In a location where we have seen rabies in 10 week old puppies.

All militaries adhere to their national standard; the challenges come when treating someone from another country. ISAF uses the WHO standard, except, of course, where national interests over ride for own country patients.

The debate is raging fast and furious.

Meanwhile, I spent some time thinking. If I was stupid enough to get bit by a feral animal here, I would not turn down any added protection that might be offered by a more conservative protocol that offered an additional vaccine dose.

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5 Responses to Whose standard?

  1. Angeluna says:

    Interesting. And ditto.

    There are subtle differences between Europe and the US on what constitutes desirable health markers. I have very low blood pressure. In the US, the doctors think it’s just wonderful. Living in Europe, they prescribed medication to bring up my pressure.

  2. Mark says:

    What about human bites? SF(GB) bites snake

  3. Brad says:

    I think the issue is limiting the operational availability of someone who is bit while they have to be around for shots.

    In Viet Nam soldiers would give themselves “rat bites” with their P-38 so as to stay in the rear while they got the shots, finding hanging out in the rear getting shots much preferable to walking through rice paddies that were often booby-trapped.

    If a bite can be seen as a way to avoid danger, it may become quite popular.

    Just a thought.

  4. Holly says:

    actually, the solders are not reporting for fear that someone is going to put down the animal which bit them. At the same time, we have a couple of people how are more interested in which law and what letter than they are to the on the ground implications.

  5. Janet says:

    You mean some id—s actually turn down treatment??

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