Two months after rescuing a girl with rabies, the dog was confirmed to be virus-free

In December 2020, a 13-year-old girl named Jiang in Xiaoshan District, Hangzhou, suspected of suffering from rabies and suspected brain death, attracted worldwide attention.

A few days ago, Jinyun reporter learned from the father of the little girl, Mr. Jiang: Jiang has passed away in the hospital in early January 2021;
Family members still doubt whether he has rabies;
The CDC briefs that those responsible for the leaks have been investigated;
Family members complained that the local CDC briefing leaked a number of their personal privacy.

In the early morning of February 20, Mr. Jiang told reporters in Jinyun that the health commission staff said they would come to the door to discuss relevant matters two days later.

The suspected source dog was confirmed to be free of rabies virus

The incident was first known to the outside world as a bulletin issued by Xiaoshan District of Hangzhou in mid-December 2020 and a bulletin issued by Xiaoshan District Center for Disease Control and Prevention on November 26, 2020.

Among them, the CDC briefing said: “After investigation, the patient’s family picked up a stray dog from the outside in March this year, because in April, the dog appeared random bite cage and other abnormal conditions, lasted about 2 days, the dog was abandoned, missing.
The family denied that the patient had been injured by the dog.
In May this year the patient’s home from a friend back to a puppy feeding, in September the dog had bitten the patient’s younger brother (timely injection of rabies vaccine), the patient had to talk to parents about their own in July also had been injured by the dog, but did not give attention, so did not deal with the wound, did not see a doctor, did not inject rabies vaccine.
The family complained that the dog had not been vaccinated against rabies and showed no abnormal manifestations. The dog was discarded after the patient became ill and is now missing.”

In the interview, Mr. Jiang said that the second dog, the one brought back in May 2020, was named Duo Duo. His daughter claimed that in July 2020, she had a barb on her fingernail and was licked a lot. There was no bleeding or wound.

A rabies girl in Hangzhou passed away after two months of rescue, and the dog was confirmed to be virulent

Mr. Jiang adopted the second dog, Duo Duo

Jiang suddenly became ill on November 6, 2020, and was admitted to hospital with symptoms such as vomiting, headache and dizziness on November 8, and gradually began to fall into a coma on November 13.
At that time, because the whole family was overwhelmed by the rescue of their daughter in hospital, they had no time to feed Duo Duo, so they put it in a vacant lot on the side of a relative’s house, and someone went to feed it every day.
Duo Duo disappeared around November 18 when she went to feed him.

Jiang said a dog lover once told him that if a dog has a rabies attack, it will surely die within 10 days according to the “10-day observation method”.
After he waited for his daughter to get sick, he found that the dog was normal for ten days, so Jiang didn’t think her daughter had rabies.

At midnight of December 29, 2020, Mr. Jiang’s WeChat circle of friends suddenly posted a message: “Dear Duoduo, the whole family thank you for proving to your sister that you are free of rabies virus.”

A rabies girl in Hangzhou passed away after two months of rescue, and the dog was confirmed to be virulent

Mr. Jiang sent a circle of friends to Duo Duo redress grievances

Mr. Jiang told Jinyun reporter: “This test result is the Xiaoshan District Animal Husbandry Bureau staff told me, (about Duo Duo no rabies material) Animal Husbandry Bureau should have.”

As a family member, Mr. Jiang wondered whether his daughter had rabies, and he continued to doubt it until her death.

In fact, Mr. Jiang himself found three domestic gene companies at his own expense to carry out genetic tests on his daughter’s genetic samples for the rabies virus project.
Early days, the gene company of Shanghai, Hangzhou did not check what apparent virus.
Later, the University of Nanjing took three samples of the patient’s cerebrospinal fluid, blood and saliva, and finally gave Mr. Jiang four reports. The first three reports did not mention rabies virus, and the fourth report said that a trace amount of rabies virus was detected in the saliva.
The relevant disease control departments and the hospital accordingly confirmed Jiang as “rabies”.

The diagnosis issued by the Zhejiang Provincial Children’s Hospital, which treated Jiang, listed 18 illnesses, including viral meningitis, hypovolemic shock and respiratory failure.

Jiang believes that his daughter’s severe coma and eventual death may also have been caused by viral meningitis, hypovolemic shock and respiratory failure.

Tianjin cloud reporters query relevant information found that a number of domestic authoritative experts have also paid attention to the “rabies” cases of Jiang Mou, and suspected that rabies may have nothing to do with.

On December 15, 2020, Dr. Yan Jiaxin, one of the main authors of the National Health Industry Standards: Rabies Diagnostic Criteria (2008), published on his personal WeChat official account and blog a discussion on the suspected case of brain death of rabies in a girl in Hangzhou. He suspected that this case was not rabies on the most important basis, which was mainly based on three points: 1.
Source of rabies virus: This case violates the principle of 10-day observation method of rabies;

  1. Diagnosis of rabies. The confirmed evidence of this case is not sufficient;
  2. Prognosis of rabies: the death of rabies is usually within half a month after the onset of rabies, and there is no precedent of brain death and long-term survival.

Accused of “son preference” to health commission

The announcement inadvertently compared Jiang’s illness and treatment with that of his brother, and many Internet users labeled the couple as “more son than daughter.”

Mr. Jiang told reporters in Jin Yun, “Some people say I prefer boys to girls. I was very angry when I saw it in the early stage, but later I became numb and didn’t care. We think we have a clear conscience for our daughter.
Our children have been sensible since childhood. Her mother or I have always treated her as a darling, just like a princess.
Daughter wants what thing we all can satisfy her as far as possible, buy a telephone watch likewise, buy for daughter is the newest, more than 1000 yuan.
Son’s words will not say very rich raise him, watch also bought, bought is 299 yuan.
We spend tens of thousands a year on our daughter’s tuition fees.”

In fact, Jin Yun reporter in tracking interview also found that the little girl Jiang Mou rescue treatment, Mr. Jiang is almost at all costs to try.
During the hospitalization, the cost was five to six thousand yuan per day.
On December 17, 2020, the hospital officially informed him that his daughter was brain dead.

A rabies girl in Hangzhou passed away after two months of rescue, and the dog was confirmed to be virulent

The little girl Jiang was hospitalized in Zhejiang Children’s Hospital

On February 9, 2021, the reporter learned from Mr. Jiang that his daughter had passed away in early January 2021, “her daughter has been gone for more than a month”.
It took about 2 months for Jiang to arrive at the hospital for treatment and finally pass away.

Because xiaoshan district CDC briefing on the patients with clearly marked kang a name, id number, home address, school classes, the father’s name and phone number is very detail and specific personal information, such as the publication after rounds on the Internet and many net friend to call Mr. Jiang, send messages, and criticism, abuse.

Mr. Jiang said that many of the private information concerning him and his daughter in the briefing had not yet been coded, which caused them a lot of trouble, but he was busy trying to save his daughter and had no time or energy to think about it.

The Xiaoshan District Health Commission and the CDC responded to the media at the time, saying the leak of the documents was still under investigation.

A rabies girl in Hangzhou passed away after two months of rescue, and the dog was confirmed to be virulent

A newsletter circulating on the Internet

On February 9, Mr. Jiang told reporters in Jinyun: “Today, the National Health Commission called me to inform me that the leaked personnel had been found, and that they had already made criticism and education and deducted the bonus.
I demand that the commission report the incident through the local Xiaoshan Daily and make a public apology. I also demand that they make legal compensation for the incident.”

On the early morning of 20th, Mr. Jiang told the reporter of Jin Yun that the staff of the Health Commission of Xiaoshan District planned to come to his home in two days.

Previous reports:

Hangzhou girl brain dead from rabies, father: unwilling to give up treatment, hope someone can save my child

“I didn’t want to give up treatment and try again to see if I could bring the baby back.”
His voice trembled as he walked on the brink of losing his daughter.

Recently, the “rabies brain death of a girl from Xiaoshan, Hangzhou” has once again triggered a heated discussion on rabies in society.
According to the bulletin, the girl was in September brother was bitten by the dog after just tell parents he was also scratched by the dog in July, but the family saw the girl and no different, did not inject rabies vaccine to the girl, until two months later, the girl came on, life is dying.

This “do not take seriously”, may be able to cause the regret of a family life, also let numerous raise dog person and the person that had been hurt by the dog frighten a cold sweat: rabies vaccine, would rather hit, also cannot hold fluke psychology.

Girl’s father: I wish an expert could save my baby

“The child is still in the care unit and the family doesn’t want to give up treatment.”
“A staff member at the Children’s Hospital affiliated to Zhejiang University Medical College told Health Times on Sunday evening.

The girl’s father, Mr. Jiang, was contacted by the Health Times. He said his daughter’s condition is not optimistic, and the family is under pressure from both her condition and online criticism, but they don’t want to give up treatment.

“Kids love puppies.”
Mr. Jiang told the reporter that the community where they live is a demolition zone, the dog management is not very strict, can see a lot of stray dogs around, in March this year, he and his wife picked up a stray dog outside, the dog had been thrown into the river for many times, his wife saw its poor, took the dog back home.
However, the dog did not adapt to the life in the cage when it returned home. It always barked and bit the cage. Jiang was afraid that the dog would hurt the two children, so he sent it out again.

In May, Mr. Jiang brought back a puppy from a friend who was nearly a month old. “When the puppy got home, it was in normal condition. There was nothing unusual.”
Mr. Jiang said.

In September, the 9-year-old son was accidentally scratched when playing with the dog, broke some skin, he quickly took the child to vaccinate rabies vaccine, however, on the road, the 14-year-old daughter suddenly very puzzled to ask: “so little injury will go to have an injection?
I got scratched by a dog last time, and I didn’t get a shot.”

Hearing his daughter’s words, Mr. Jiang felt very nervous and asked his daughter what was the matter. Her daughter said that she had been injured by accident while playing with the dog in July, but whether she had been scratched or licked the barb on her hand. After all, it had been two months, and her daughter could not recall the details, so she gave a very vague answer.

“I was a little confused at that time, I know be bitten by a dog to want to hit rabies vaccine within 24 hours, but the daughter already passed two months, did not know to hit still have no use, and the daughter said did not bleed, I have a fluke, should not hit also have nothing to do.”
Mr. Jiang told the Health Times reporter, for the understanding of rabies, he still stay on some very shallow understanding.

Until November 8, the daughter appeared dizziness, nausea, binjiang campus to zhejiang children’s hospital medical clinic, November 9, has been admitted to the ICU at noon, the doctor also suspected rabies, then extract the cerebrospinal fluid, blood and saliva for screening of rabies, the report said, from the saliva detected traces of the rabies virus.

“In fact, now there is no clear diagnosis, said my daughter is rabies, but the doctor said her daughter recently appeared afraid of wind, afraid of light.”
Jiang said that on December 3, doctors declared their daughter brain dead and asked the family to give up treatment based on their clinical experience and test results, but they did not want to give up before a definite diagnosis came down. They gave their daughter a comprehensive examination again and are still waiting for the results.

“Hopefully some hospital or specialist who specializes in this kind of research can help us and save my baby.”
Mr. Jiang said.

Why is the girl so far difficult to be diagnosed with rabies?

A declined to be named infection physician tells a reporter, although the girl detected the rabies virus in the body, and the clinical symptoms of a girl is similar to rabies height, with rabies, most likely, but there is also a possibility is that the girl the viral encephalitis or other disease, but she is infected with the rabies virus, infection only low viral load, the incubation period is long, has not officially attack “.

“There is no absolute rule in medicine. Such a coincidence could happen, so to confirm whether it is rabies or not, we need an autopsy.”
The doctor said, he speculated that there are two reasons, one is the girl was diagnosed as brain death after survival to now, rabies patients have not heard of a similar situation, are the death after the disease;
Second, according to the notice, the patient’s dog has not been sick, it is not clear whether the dog has rabies.

According to the rabies prevention guidelines, human rabies incubation period from 5 days to a few years (usually 2-3 months, rarely more than 1 year), the length of incubation period and virus virulence, the nerve distribution of the invasion site and other factors related.
Muscle-specific small RNAs may affect the incubation period by inhibiting viral transcription and replication in muscle.
The maximum incubation period of rabies laboratory infected animals (e.g., dogs) is half a year.

This failed to inject the rabies vaccine in time, may become a family forever pain.
After questioning the “son preference” of girls’ families, more people still talked about the necessity of rabies vaccination.

A rabies girl in Hangzhou passed away after two months of rescue, and the dog was confirmed to be virulent

This is the first case of rabies in Xiaoshan this year and the second in Hangzhou in the past five years, according to the Xiaoshan Center for Disease Control and Prevention.
The last case dates back to June 2018. Also in Guali Town, Xiaoshan District, a patient was bitten by a stray dog one month before the onset of the disease, and no treatment was done after the injury, and the patient died 3 days after the onset of the disease.

A reporter from the Health Times found that from January 2018 to October this year, a total of 21 cases of rabies and 20 deaths have been reported in Zhejiang Province, with only three cases and one death this year.

In 2019, the country reported 290 cases of rabies and 276 deaths, ranking last among all statutory infectious diseases.

One of the reasons why rabies, which has such a low incidence, is so well known is because of its high mortality rate.
According to official statistics, the mortality rate of rabies is more than 95 percent, but in the eyes of doctors, its mortality rate is “basically 100 percent”, because there is no specific drug or rescue measures for the rabies virus.

Therefore, “be bitten by a dog, scratch must get rabies vaccine”, has almost become the public consciousness engraved in the DNA.
Reporter retrievals report discovery before, great majority dies because of rabies patient, it is to be caught by cat dog/bite hind did not inject rabies vaccine and come on die, very few case is to come on before did not inject complete ministry needle time die.

Ye Sheng, deputy director of the pediatric intensive care unit at the Children’s Hospital affiliated to Zhejiang University School of Medicine, where the girl was treated, also issued a warning on Weibo, stressing that “minor scratches without bleeding should also be vaccinated against rabies.”

And numerous journalists random call ask rabies vaccination clinics is found, much to the attitude of the rabies vaccine may be “would rather the letter have not trusted their nothing”, and contact with cats and dogs and surface of wound, if not being hurt by dogs and cats, staff also said safe recommended vaccination, even if is also best to cat and dog vaccinated against rabies vaccine immunization.
“The earlier the rabies vaccine hit the better, but there is no time limit, bite three or four days later also have to hit.”
“Said a staff member.

“Paraphobia is a unique phenomenon in China.
“There is no other country in the world where rabies is taken so seriously.”
Wuhan Institute of biological products genetic engineering researcher Yan Jiaxin has said.

China is still a rabies epidemic country

Health times had earlier reported, according to data unearthed by the world health organization (who), our country is the first to use the rabies vaccine powers, issued each year about 60 million the number of people with wild dog vaccine, but is still a rabies endemic countries in our country, this is our country the residents’ awareness of rabies epidemic growth performance, but also reflect a situation from another aspects: pay rabies epidemic prevention work in our country is big, but it’s not good.

“Shifting the global strategy to eliminate rabies towards dog immunization and scientific management is not only more cost-effective, it will also be more effective.”
Promulgated by the world animal protection association focused on dogs – elimination of rabies in 2030 solution “report point out directly, in order to achieve by 2030 descendants canine rabies cases for the global goal of zero, strategy must be turned to the dog, you first need to 70% of dogs in the group for mass immunization of dogs, to prevent the spread of rabies.

A number of Hangzhou residents randomly asked by the reporter said that there are strict regulations on keeping dogs in Hangzhou, but not many people actually follow them.

“We see stray dogs running around in our neighborhood all the time. I’ve also seen people walking around with large dogs that are banned in the city.”
Liu Hang (pseudonym), who lives in Yuhang District, told the Health Times that among the people who keep dogs around, not many people take the initiative to apply for dog licenses for dogs, but they regularly take their dogs to get rabies vaccines.

Reporters found that most cities have issued the dog management regulations, many dog behavior made norms, large dogs, fierce dogs can not be kept in the city, outdoor activities should be led by adults, for the dog to carry a license plate, the chain, also clear pet injury responsibility.

But in fact, the rules mainly rely on propaganda and raises the dog person consciously perform, lack of mandatory provisions on the administration of the existence of law enforcement difficult situation, to the uncivilized behavior of the dog defecate indiscriminately, noise and so on, for example, there is no way to as soon as possible back to those responsible for punishment, residents often troubled because of noise and pet health problems, but the law enforcement departments to do, only to persuade and verbal warnings.

In recent years, raise dog person to encourage to be vaccinated for dog rabies vaccine actively actively, each district health prevent epidemic station is passed free inject or the form such as financial subsidy for raise dog person derate dog to use rabies vaccine vaccinate charge.
And feel out according to the reporter before this row, the price that the animal uses rabies vaccine is still less than the person uses 1/3 of the price of vaccine.

“To the health and epidemic prevention station to the dog domestic vaccine is free, only the cost of labor, but this good policy has not seen the relevant departments of propaganda, a lot of residents do not know.”
Hangzhou Xiaoshan District, a resident told reporters that he is also to take the dog to the epidemic prevention station to do an inspection only to find that there are such concessions, but rarely see the popular science and propaganda about rabies vaccine.

“By getting the dog certified, vaccinated, leashed and cleaned up, we don’t hate dogs so much.”
A on weibo calls for strengthening the management of the kennel netizen, told reporters that many people no harm, for dogs, just life witnessed many people lack of strict management of the dogs, dogs are likely to threaten the safety of the people around you, people who do not follow the rules, strictly abide by the norms dog owners will be scold, along with all the dogs would have been rejected by surrounding people, for who are uncomfortable.

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