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 whose average daily income is around US$ 1–2 per person. Every year, more than 15 million people worldwide receive a post-bite vaccination. This is estimated to prevent hundreds of thousands of rabies deaths annually.

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.

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).

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.

There are some steps you can follow to get protected from Rabies when you are in Bali. Here are as follows :

• Vaccinate dogs and cats against rabies as required by law.  All dogs and cats more than four months of age must be vaccinated against rabies.  Keep vaccinations current at all times.
• Keep dogs and cats under control.  Animal control laws prohibit allowing animals to roam unsupervised.  Roaming pets are more likely to have been exposed to rabies than those supervised by their owners.
• Leave stray or unknown dogs and cats alone.  Loose animals are more likely to have been exposed to rabies and to attack others.  Keep pets away from strays, too.
• Leave wild animals alone. Avoid wild animals even if they appear friendly, and do not coax a wild animal to eat from your hand.  Do not fear wild animals, just respect and stay away from them. Very young children can learn this rule.
• Do not keep wild animals as pets.  Even a raccoon or skunk born in captivity may be a rabies carrier. Local laws prohibit acquiring of keeping such animals as pets. There are no approved vaccines or known quarantine for wild animals.
• Make your property unattractive to wild animals. Cap chimneys and seal off any openings in attics, under porches and in basements.  Feed your pets indoors and keep trash cans tightly closed.

If YOU are Bitten, Scratched, or have Contact with an Animal:

• Obtain the owner’s address and telephone number if possible.
• Immediately wash the wound thoroughly, cleaning and flushing with plenty of soap and water for several minutes.
• Immediately report all animal bites to your animal control agency, police department of health department for follow-up.
• Identify and continue to observe the animal (if wild or stray) to aid its eventual capture, but do not risk exposure again.
• Get prompt medical attention.  Call your family doctor or go to the nearest emergency room.

If Pets are Bitten, Scratched, or have Contact with a Wild Animal:

• Call your pet away from the animal.
• Confine the wild animal, if possible.  (Do not touch it or risk exposing yourself.)
• To prevent exposure of saliva to an open wound, it is recommended that you do not handle pets, touch or examine your dog or cat for at least two hours following the fight.
• If you must handle your pet shortly after a fight, wear heavy gloves and afterwards be sure to thoroughly wash your hands with soap and water.  Then contact your doctor or local health department for advice to determine whether or not there may have been any direct exposure to the rabies.
• Contact your local animal control agency immediately for advice about testing the wild animal for rabies and follow-up for your pet.
• Vaccinate dogs and cats against rabies as required by law.  All dogs and cats more than four months of age must be vaccinated against rabies.  Keep vaccinations current at all times.
• Keep dogs and cats under control.  Animal control laws prohibit allowing animals to roam unsupervised.  Roaming pets are more likely to have been exposed to rabies than those supervised by their owners.
• Leave stray or unknown dogs and cats alone.  Loose animals are more likely to have been exposed to rabies and to attack others.  Keep pets away from strays, too.
• Leave wild animals alone. Avoid wild animals even if they appear friendly, and do not coax a wild animal to eat from your hand.  Do not fear wild animals, just respect and stay away from them. Very young children can learn this rule.
• Do not keep wild animals as pets.  Even a raccoon or skunk born in captivity may be a rabies carrier. Local laws prohibit acquiring of keeping such animals as pets. There are no approved vaccines or known quarantine for wild animals.
• Make your property unattractive to wild animals. Cap chimneys and seal off any openings in attics, under porches and in basements.  Feed your pets indoors and keep trash cans tightly closed.

Once signs of rabies appear, the disease is almost always fatal.  However, rabies can be prevented if early treatment is administered.  If in contact with an animal with possible rabies, you must contact the health department or a medical facility for advice on rabies prevention treatment.

Treatment includes a first dose of vaccine and another protective injection.  Then 4 more doses of vaccine are administered over 28 days. If you need further information about rabies or need to get vaccinated before or after got bitten by animal, you can visit Hydro Medical clinic Bali. They are ready to serve you with all of the things that you may needed for rabies.

Author : Bagas