Rabies is deadly!

Rabies is an infectious viral disease that is almost always fatal following the onset of clinical symptoms. In up to 99% of cases, domestic dogs are responsible for rabies virus transmission to humans. Yet, rabies can affect both domestic and wild animals. It is spread to people through bites or scratches, usually via saliva.

Rabies is present on all continents, except Antarctica, with over 95% of human deaths occurring in the Asia and Africa regions.

Rabies is one of the neglected tropical diseases that predominantly affects poor and vulnerable populations who live in remote rural locations. Although effective human vaccines and immunoglobulins exist for rabies, they are not readily available or accessible to those in need. Globally, rabies deaths are rarely reported and children between the ages of 5–14 years are frequent victims. Treating a rabies exposure, where the average cost of rabies post-exposure prophylaxis (PEP) is US$ 40 in Africa, and US$ 49 in Asia, can be a catastrophic financial burden on affected families

Every year, more than 29 million people worldwide receive a post-bite vaccination. This is estimated to prevent hundreds of thousands of rabies deaths annually.

 

Rabies Disease

Rabies is a disease caused by a lyssavirus. This disease is usually transmitted through animal bites, but scratches or saliva contact of an infected animal can also be the cause of transmission. According to past cases, dog bites contributed to most of the rabies transmission. Furthermore, in the early stages after exposure, an infected person will enter the incubation period for around 20-60 days and not experience any severe symptoms.

Early symptoms may also hard to notice because they’re quite similar to flu. However, it should be noted that getting treatment before any symptoms appear is a must. If it’s left unchecked, the condition could get fatal and even cause death. Moreover, people who have a high risk of rabies exposure are suggested to get vaccinated as a prevention against the virus. These people include animal farmers, veterinarians, laboratory workers, any people who work closely with animals, and tourists traveling in high-risk areas, for example, Bali.

 

 

Rabies Vaccine

Finding medical treatment such as by getting rabies vaccine is important and must be done quickly after a person is exposed to rabies. The rabies vaccine is a deterrent against the rabies virus. After getting bitten by an infected animal and before getting vaccinated, the patient must ensure to wash the wound with soap under running water for 10-15 minutes, After that, put an antiseptic like povidone-iodine or 70% alcohol to disinfect the wound. Then, immediately find medical care to have vaccination treatment.

Your doctor will either give Anti-Rabies Vaccine or Anti-Rabies Serum depending on the infected person’s condition. The patient will also be informed regarding the vaccination schedule during a consultation with your doctor. Anti-Rabies Vaccine has a function to stimulate and form antibodies in the body and neutralize the rabies virus.

On the other hand, Anti-Rabies Serum is composed of Rabies Immunoglobulin. Rabies Immunoglobulin will also activate the antibodies and neutralize the rabies virus. Anti-Rabies Serum is given to patients with deep or large wounds, multiple wounds, and wounds on the dermatome or facial area because the virus can enter and infect the brain faster. Anti-Rabies Virus can also give protection for 7-10 days before the antibodies appear.

 

Why Patient Must Not Skip 3rd Rabies Vaccine?

Skip 3rd rabies vaccine during a series of vaccinations isn’t recommended, it is better to always stick to the schedule and follow your doctor’s instructions.

Rabies is a serious and acute infectious disease that can spread to the brain and central nervous system. Animals that can potentially cause rabies are dogs, cats, foxes, skunks, monkeys, bats, and raccoons. In general, animal bites are the main cause of rabies outbreaks.

Rabies transmission can also happen through scratches and licking/saliva contact of a rabid animal on injured human skin. The virus will become dangerous if it has spread to the brain and nervous system because if this happens, it will always lead to death. Therefore, if someone is exposed to rabies, the condition can’t be ignored. Getting a rabies vaccine is vital and delaying treatment can be risky. In addition, do not skip 3rd rabies vaccine and always complete all the required vaccinations.

 

Skip 3rd Rabies Vaccine During a Course of Vaccinations

Usually, someone infected with rabies but has never been vaccinated will get 4 doses of rabies vaccine, with the following conditions:

• Immediate dose: Given immediately after a person is exposed to rabies. In addition, a shot of Anti-Rabies Serum (Rabies Immunoglobulin) will be given if the person has deep/large or multiple wounds;
• Additional dose: Given on the 3rd, 7th, and 14th day after the first dose is given.

On the other hand, someone infected with rabies but has previously undergone rabies vaccination will get two doses of rabies vaccine, with the following details:

• Immediate dose: Will be given immediately after someone is positive of rabies;
• Additional dose: Will be given on the 3rd day after the first dose is given;
• Shot of Anti-Rabies Serum (Rabies Immunoglobulin) is not required.

People might wonder if they can skip 3rd rabies vaccine, or if not completing all the doses is fine. However, the patient is advised to follow the schedule and stick to the doctor’s instructions. You must not skip 3rd rabies vaccine. The patient must complete all the required doses so they can have maximum protection. If someone exposed to rabies skip 3rd rabies vaccine, the condition may be fatal. If you really have to skip 3rd rabies vaccine, immediately reschedule the vaccination with your doctor as soon as possible. Rabies is dangerous and can cause death, it is better not to delay and wait too long to get treatment.

 

Prevention

Eliminating rabies in dogs

Rabies is a vaccine-preventable disease. Vaccinating dogs is the most cost-effective strategy for preventing rabies in people. Dog vaccination reduces deaths attributable to rabies and the need for PEP as a part of dog bite patient care.

Awareness on rabies and preventing dog bites

Education on dog behaviour and bite prevention for both children and adults is an essential extension of a rabies vaccination programme and can decrease both the incidence of human rabies and the financial burden of treating dog bites. Increasing awareness of rabies prevention and control in communities includes education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Engagement and ownership of the programme at the community level increases reach and uptake of key messages.

Preventive immunization in people

Human rabies vaccines exist for pre-exposure immunization. These are recommended for people in certain high-risk occupations such as laboratory workers handling live rabies and rabies-related (lyssavirus) viruses; and people (such as animal disease control staff and wildlife rangers) whose professional or personal activities might bring them into direct contact with bats, carnivores, or other mammals that may be infected.

Pre-exposure immunization is also recommended for travellers to rabies-affected, remote areas who plan to spend a lot of time outdoors involved in activities such as caving or mountain-climbing. Expatriates and long term travellers to areas with a high rabies exposure risk should be immunized if local access to rabies biologics is limited. Finally, immunization should also be considered for children living in, or visiting, remote, highrisk areas. As they play with animals, they may receive more severe bites, or may not report bites.

Symptoms

The incubation period for rabies is typically 2–3 months but may vary from 1 week to 1 year, dependent upon factors such as the location of virus entry and viral load. Initial symptoms of rabies include a fever with pain and unusual or unexplained tingling, pricking, or burning sensation (paraesthesia) at the wound site. As the virus spreads to the central nervous system, progressive and fatal inflammation of the brain and spinal cord develops.

There are two forms of the disease:

People with furious rabies exhibit signs of hyperactivity, excitable behaviour, hydrophobia (fear of water) and sometimes aerophobia (fear of drafts or of fresh air). Death occurs after a few days due to cardio-respiratory arrest.

Paralytic rabies accounts for about 20% of the total number of human cases. This form of rabies runs a less dramatic and usually longer course than the furious form. Muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the under-reporting of the disease.

Diagnosis

Current diagnostic tools are not suitable for detecting rabies infection before the onset of clinical disease, and unless the rabies-specific signs of hydrophobia or aerophobia are present, clinical diagnosis may be difficult. Human rabies can be confirmed intra-vitam and post mortem by various diagnostic techniques that detect whole viruses, viral antigens, or nucleic acids in infected tissues (brain, skin, urine, or saliva).

Transmission

People are usually infected following a deep bite or scratch from an animal with rabies, and transmission to humans by rabid dogs accounts for 99% of cases. Africa and Asia have the highest rabies burden in humans and account for 95% of rabies deaths, worldwide.

In the Americas, bats are now the major source of human rabies deaths as dog-mediated transmission has mostly been broken in this region. Bat rabies is also an emerging public health threat in Australia and Western Europe. Human deaths following exposure to foxes, raccoons, skunks, jackals, mongooses and other wild carnivore host species are very rare, and bites from rodents are not known to transmit rabies.

Transmission can also occur when infectious material – usually saliva – comes into direct contact with human mucosa or fresh skin wounds. Human-to-human transmission through bites is theoretically possible but has never been confirmed.

Contraction of rabies through inhalation of virus-containing aerosols or through transplantation of infected organs is rare. Contracting rabies through consumption of raw meat or animal-derived tissue has never been confirmed in humans.

Post-exposure prophylaxis (PEP)

Post-exposure prophylaxis (PEP) is the immediate treatment of a bite victim after rabies exposure. This prevents virus entry into the central nervous system, which results in imminent death. PEP consists of:

• extensive washing and local treatment of the wound as soon as possible after exposure;
• a course of potent and effective rabies vaccine that meets WHO standards; and
• the administration of rabies immunoglobulin (RIG), if indicated.

Effective treatment soon after exposure to rabies can prevent the onset of symptoms and death.

Extensive wound washing

This involves first-aid of the wound that includes immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.