One morning in September, Sloane Kaplan, an American volunteer with an NGO, was on her way to work near the Russian market when two dogs ran out from a gate across the street and started barking ferociously at her.

Seconds later one of them ran up behind her and sunk its teeth into the back of her leg.

Two months later, as she recovers, the scars are still visible on her left shin. She is one of an increasing number of people who have visited the Pasteur Institute, the country’s biggest rabies vaccination clinic, to be given vaccinations for  rabies: a disease that experts estimate kills around 800 Cambodians per year.

“There were people around that saw it and didn’t really do anything,” Kaplan recalls. “I just kept walking to work. When I got to the office I was crying.”

It was the second time that Kaplan, 28, had been bitten by a dog since arriving in Southeast Asia: just a week earlier she was bitten in Thailand. Rabies immunoglobulin had to be injected directly into her wound in the hospital there for $800. “The doctor poked a needle into my open puncture wound four or five times. It was incredibly painful,” she said.

She completed the course of shots at the Pasteur Institute, which is expanding its rabies vaccination centre after experiencing a surge in demand for the vaccine.

A series of four or five vaccinations, if administered before the symptoms appear, are usually 100 per cent effective in preventing the disease – a  viral infection usually spread through an animal bite. A vaccine can also be given as a preventive measure before a person is bitten, but additional injections are still required after a bite.

The increase has prompted the institute to double the capacity of their centre, according to Dr Arnaud Tarantola, who heads up the epidemiology and public health unit at the Phnom Penh-based centre.

According to the institute, the number of people getting vaccinated after being bitten has more than doubled from 8,400 in 1998 to more than 20,000 per year today.

There is no way to be certain whether if more people are being bitten or if they are more likely to get vaccination after a bite.

Many factors might explain the increase in the number of visits to the rabies vaccination clinic, including better roads and an improvement in the standard of living that might be making it easier for people from the provinces to come to Phnom Penh, according to Tarantola.

To meet the increase in demand for vaccines, the institute’s on-site rabies vaccination centre will be expanded this year – doubling its capacity. An additional vaccination room will supplement the existing one, and should be open to the public in February.

The last confirmed human rabies case in Cambodia was in a boy who died in Phnom Penh in April 2011. However, the Pasteur Institute estimates that the real number of recent rabies victims in Cambodia is much higher – because people who are bitten outside of Phnom Penh often cannot travel to the city to get the vaccines.

Many rabies victims – most of whom are children – die at home, without being diagnosed, Tarantola said.

According to a Pasteur Institute study entitled Rabies Situation in Cambodia, published in the journal of Neglected Tropical Diseases in 2010, rabies might be killing as many as 800 Cambodians every year. This is more deaths than from dengue or malaria, the authors say. Tarantola equates this number as “more than five Airbus A320s crashing with no survivors each year”.

While the Pasteur Institute does not collect data on how many foreigners are bitten by dogs, a receptionist at Naga clinic said she sees about two dog bite victims weekly, who are usually foreigners. British doctor Gavin Scott, who runs a private clinic in Phnom Penh, reports treating about one foreigner per week with a dog bite.  

“The most common vaccine I give is the rabies vaccine because dog bites are very common,” he said. “If you get bitten, you must assume that you are at risk and it doesn’t matter what the dog owner says about the dog being vaccinated.”

Even if dogs are not strays, they are just as likely to have rabies. Most of those who attack have owners according to Scott.

That’s because most of the dogs in Cambodia are not vaccinated, and there is no way to know that a dog doesn’t have rabies unless its head is cut off and brain analysed, he added.

French veterinarian Arnaud Demarti’s agrees. At his Phnom Penh animal hospital AGROVET, which does not treat dogs which do not have owners, a rabid dog is brought in every six months on average.

“I get bitten regularly, but I’m vaccinated,” Demarti said. “I was bitten by a dog that had rabies and died, but I didn’t die. The vaccine works well.”

To contact the reporter on this story: Julie Masis at [email protected]