Rabies: Virus, Symptoms, Vaccine(What you should know).World Rabies day is on 28th September and I wanted to write about it since then.But better late than never.

Rabies is a virus of the Lyssavirus genus spread by saliva of infected animals.It is known to cause a disease that has almost 100 percent known mortality. That’s the bad news. The good news is it’s almost 100 percent vaccine-preventable.Its an old disease with history dating back to 4000 years.

Rabies causes viral encephalitis which kills up to 70,000 people/year worldwide. Infected animal saliva transmits viral encephalitis to humans.

Primary prevention involves dog vaccination campaigns to reduce the virus reservoir.

If exposure occurs, timely post-exposure prophylaxis can prevent the progression to clinical disease .

Rabies eradication is possible but will need multifaceted approach where dog rabies control is crucial if the crux of the problem is to be addressed.

Tldr

The rabies vaccine and Anti Rabies serum are given for free in all Government hospitals all over India. In case of a dog, cat, or monkey bite, visit your nearest center immediately for the best result. Even for a pet or domestic animal vaccination is required as vaccine failure in pets can occur due to multiple reasons.

Rabies transmitted by the bite of which animals?

• 99% of human Rabies is caused by Dog bites
• Cat bites
• Other Bites: monkeys, horses, cows and other large mammals.
• Infected human bite
• In America: Hematophagous Bat bites (not reported in India). Bat-mediated rabies is also an emerging public health threat in Australia and Western Europe.(Source)

These animals don’t cause Rabies: Domestic rodent (rat) bites and bites by small mammals (e.g.rabbits, squirrels) .

The incubation period is usually 2 -3 months . May vary between 1 month to 1 year and has been reported even after 8 years.

Live and let live is a very good way of life. Kindness towards our animal friends is also great. But Rabies being endemic in India, being careful is crucial, and preventive healthcare is our strength and the reason I started Healthwealthbridge.

But I sincerely believe in the Bengali adage

Kids are happiest in the mother’s Lap and animals in the jungle. While urbanization made having domestic animals in the yard impossible, pets at home are usually well cared for and hopefully vaccinated.

This year’s World Rabies Day theme is: “All for 1, One Health for all”.
28 September this year will mark the 17th World Rabies Day.

In many countries having adequate vaccination is mandatory as otherwise, it amounts to cruelty to the animals. But what about the stray animals? Stray dogs in particular are a horror and anyone who has had to work at night in any part of West Bengal may have faced groups of angry barking dogs. The issue was so personal that I refrained from writing about it, as who needs trolling about a healthcare emergency that few understand or realize?

Incidents that made me decide to write.

No.1 A dear friend’s mom was scratched by a stray cat.

A close relative was scratched thrice by a monkey.

A colleague was badly mauled by a rabid dog (who went on to bite several others)in front of the medical college where we worked, while he was on his way to the operation theatre.

I was on a vacation and a family had brought a very large Dalmatian with them for a vacation. The young boy of the family decided to let the dog go loose and I was faced with a dog with both its forelegs on my shoulder(I am five feet tall) and my daughter in my lap. Luckily the dog only wanted to play!

Finally, a social media video on Twitter showing a child being attacked by several digs which I was unable to watch fully because of the triggering effect of the incident.

Everyone knows about Rabies and the “no cure” tag attached to it.

If any rabid dog/monkey bites anyone that person depending on the grade of bite must get the vaccine with or without the human antisera immediately. If the bite is anywhere in the face or neck the urgency is paramount. Visit your nearest Government health center or private clinic where vaccine and antisera can be given and emergency care is done.

One of the people who was mauled by the dog had his dominant hand totally devoid of muscles and tendons exposed. As with Antirabies protocol, it couldn’t be sutured and was left to heal by secondary intention. The trauma of it cannot be imagined. The dog was taken away by the municipality and no one knows whether he had bitten other dogs and humans.

The Rabies Problem in India

In India annually 21000 people have Rabies(Association of Prevention and Control of Rabies in India)and these people face death within 1 month of symptoms like hydrophobia becoming apparent. There is no treatment only post-exposure vaccine and vaccination of dogs and stray dog population control by humane methods.

The Rabies Problem in the World

Most cases reported in Africa and Asia .35% human rabies death occur in India. Less than 0.05% deaths due to human rabies occur in America.

In case of a suspected Rabid animal or any animal bite Woundcare

Clean the area thoroughly with soap and water. Remember to keep cleaning the wound for at least 10 minutes under running water. Then clean with Povidone Iodine(Betadine solution ) and/or 70% alcohol spirit. The wound should not be bandaged. In case of bleeding, suturing done after infiltration of HRIG.

Rabies Symptoms:

There are two forms of rabies:

Furious rabies: hyperactivity, excitable behavior, hallucinations, lack of coordination, hydrophobia (fear of water), and aerophobia (fear of drafts or of fresh air). Death occurs after a few days due to cardio-respiratory arrest.
Paralytic rabies is 20% of the total number of human cases. Less dramatic and gradual coma and death and often the diagnosis can be missed.

Laryngospasm manifests itself as:

Aerophobia: Fear of air

Hydrophobia: Fear of water

The virus infects the peripheral nervous system after skin breach and gradually as the central nervous system is involved the patient succumbs.

Anti Rabies Vaccine and Anti Rabies Serum

Vaccine Schedule in India is given after exposure

Category 1 (No exposure):

Lick on intact skin, exposure to saliva on intact skin, feeding of milk of infected animals: Wound washing.

No vaccine or antisera needed.

Category 2 Exposure

Nibbling of uncovered skin, minor scratches or abrasions without bleeding (exposure)Lick on breached skin/wound. Bite without bleeding.

Wound washing and immediate vaccination.

If wild animal bite :Treat as cat 3(vaccine and HRIG)

If immunosuppresed due to any cause treat as cat 3 vaccine and HRIG).

Category 3 exposure

Single or multiple transdermal bites or scratches, contamination of mucous membrane or broken skin with saliva from animal licks,

Exposures due to direct contact with bats in America(severe exposure).

Wound washing, immediate vaccination and administration of rabies immunoglobulin/monoclonal antibodies

Pre-exposure prophylaxis is given to those with a high risk of Rabies due to working with animals.This includes

• veterinary doctors,
• animal handlers,
• wildlife workers,
• postmen,
• taxidermists,
• municipal workers
• Children with pet dog at home/exposed to community dogs/neighbour’s dogs/stray dogs .
• Adults with pet dog at home/exposed to community dogs/neighbour’s dogs/stray dogs .

Anti Rabies Serum(Human Rabies Immunoglobulin or HRIG)

Human Rabies Immunoglobulin is now available widely and helps to give good protection if given immediately as post-exposure prophylaxis. The antisera is infiltrated around the area of bite

Should your child receive the vaccine if bitten by a vaccinated, pet dog?

Vaccinated animals may also transmit if adequate seroconversion didn’t occur.Haplens in 29% of pets.Whether provoked or unprovoked bite is a difficult to assess.

Pet animal vaccine failures may
occur due to varied reasons.Category of bite should be the deciding factor for treatment.

Who should not receive the anti-rabies vaccine?
Anti-rabies vaccine is for everyone on case of exposure.For details and personalized treatment please consult your doctor.

There is almost 100% mortality in proven cases of Rabies. The best treatment is prevention. It is a 100% vaccine preventable disease.Rabies is included in WHO’s 2021–2030 Roadmap for the Global Control of Neglected Tropical Diseases, which sets regional, progressive targets for the elimination of targeted diseases. Rabies is one of these.

Source

WHO https://www.who.int/news-room/fact-sheets/detail/rabies