Percutaneous Infections (Bites)
In Asia, the principle animal vectors of rabies are dogs, cats, and monkeys. Rats can also carry the disease. If you get bitten, immediately cleanse the wound with flowing water for at least 15 minutes and then rinse with alcohol or iodine. Seek medical advice. A tetanus toxoid vaccination may be necessary, and if blood was drawn rabies vaccination is a must. If 5% of the dogs in Bangkok have rabies then expect a similar percentage in Phnom Penh; around 800 people die from rabies every year in Cambodia.
Unlike the situation in Burma, snake-bites in Cambodia are uncommon. One clinic recorded 500 cases of dog bites and only 4 cases of snake-bites in the same period of time. Nevertheless avoid the possibility by: (a) walking on clear paths, wearing boots, and using a torch at night, (b) not putting your hand and feet in places you can not see, (c) not sitting on logs (snake bites on the bottom are not uncommon), (d) being wary when exploring dark cool places such as inner temples and ruined houses where cobras sometimes reside and (e) checking shoes and clothing in the morning. The commonest snakes in Cambodia are pit vipers and cobras. 30-50% of venomous bites result in no significant injection of venom. A viper bite will usually cause local swelling, possibly bleeding and has a 5% fatality rate. A cobra bite often produces little local reaction but can affect the nerves to the heart and lungs, with a fatality rate of 10%.
First aid: relax / remember what snake it was / handle a dead snake cautiously as a decapitated head may retain a bite reflex for up to an hour / wash bite with clean water / do not cut or suck wound / apply compression bandage above the bite / immobilize the limb / seek medical advice. If after 6 hours there is no local swelling and no signs of poisoning the patient may go home. Antivenin is only given if there is massive swelling, tissue destruction or signs of poisoning; it was found (2010) that all the Indian made antivenom supplied by the MOH was ineffective. Thai made TRC Haemato & Neuro Polyvalent Snake Antivenoms should now be used; 1 vial costs $40 and 2 vials are normally used for each patient. Treatment should only be given by experienced doctors in large hospitals.
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