Rabies

Most people associate the word ‘rabies’ with two things – dogs and injections. They do not know other important facts that they ought to. The APCRI (The Association for the Prevention and Control of Rabies in India) estimates that, 20,565 people die of rabies every year in India alone. We spoke to our expert Dr A.K Gupta, renowned physician practising in New Delhi, to find the answers to some of the most common questions regarding rabies.

Causes

In India, the animals commonly responsible for transmission of rabies are dogs and cats followed by wild animals like mongoose, foxes and jackals. Occasionally animals like horses, donkeys, monkeys, cows, goats, sheep and pigs can also spread the virus.

The virus is transmitted mainly through the saliva, the bite or scratch of an infected animal can lead to infection. Other animals like rats also can be infected by the virus, but usually die quickly and do not have the capability of spreading the disease. In the case of mammals, the virus has a long incubation period that allows them to spread the disease.

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Types

Rabies could manifest as different types namely -

Furious rabies: In this type, the person is hyperactive, aggressive, suffers from hydrophobia (a fear of water) and in some cases aerophobia (a fear of flying). A few days after these symptoms present, the patient usually dies of cardio-respiratory failure.

Paralytic rabies: The progression of this type of rabies is far slower than its furious form. Amongst the people who contract the disease, about 30 percent of them suffer from this type of rabies. Here the patient’s muscles gradually get paralyzed starting from the site of the bite. This then slowly progresses leading to a coma and then death.

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Symptoms

The initial signs and symptoms of rabies are -

Fever
Lethargy
Headaches
Pain and a pin prick like feeling around the site of the wound

Within a few days as the condition progresses, it results in a

fatal inflammation of the brain and the spinal cord resulting in symptoms like anxiety, confusion and agitation. This then progresses to a state of delirium, hallucinations and insomnia.

Diagnosis

As the virus is usually found only in brain tissue, there is no method to diagnose the presence of rabies infection in human beings before the onset of the symptoms.

Treatment

According to

Dr Gupta, '

Any person who gets exposed to animal bite or scratch or lick on

broken

skin must visit a doctor for post exposure prophylaxis (PEP) without waiting for the symptoms of rabies to develop

.' Observing the dog for 10 days without initiating treatment is risky. It is mandatory to start treatment soon after exposure. The vaccination must be started immediately irrespective of the status of the biting animal. According to law an animal bite should be considered as ‘medical urgency’ and treated with due care.

Prevention

Animal vaccination:

It remains the method of choice to control and eradicate rabies. People with pets need to understand that a proper and careful vaccination schedule is necessary for the safety of the dog itself and their family. The cost of a post-bite treatment in humans is about one hundred times more costly than getting your dog vaccinated.

The primary vaccination schedule for the dogs and cats, consists of initial two doses of vaccine, that is, one dose given at 3 months of age and the second given

a month later. This is followed by a booster dose of vaccine every year. Giving a vaccine before the animal is exposed to the virus is imperative in dogs because the Post Exposure Prophylaxis (PEP) vaccination is not very successful in them.

Another important factor is that any pets that come in contact with wild animals are at risk. If your cat or dog has been bitten by a wild animal or has bites or scratches of unknown origin, consult the veterinarian immediately.

Immunization or vaccination:

There is a pre-exposure vaccination (

) which is a form of

vaccination or immunization

before the bite. It should ideally be given to veterinarians and staff, rabies laboratory personnel, personnel working

rabies vaccine manufacturing plants, wildlife rehabilitation and animal control workers, military personnel and armed forces, adventure travelers to canine rabies endemic countries, children in canine rabies endemic high risk areas. The regimen consists of three injections on the first, seventh and 28

^th

day

Pre-exposure vaccination also reduces the number of injections of the post-exposure vaccination one has to take. After a bite, those who have received the full course of the pre-exposure vaccination, require only two doses of post exposure vaccine on days 0 & 3. The only precaution one should take is to avoid administering the rabies vaccine to pregnant women.

One can choose to incorporate the pre-exposure vaccination into a child’s vaccination

programme

. The recommended dose is one at birth and second at two months of age or one at two months and second at four months of age. Both intramuscular (in the muscle of the arm) and intra-dermal (within the skin) routes are equally effective in protecting a person from infection for up to 5 years.

Identify a rabid animal:

The signs of rabies in dogs or cats are not that easy to notice, but for an owner there are few subtle changes that they should keep an eye out for - any change in normal behavior suggesting either undue aggression or depression, running aimlessly and attacking others without provocation, becoming too drowsy and withdrawing to a corner, change in voice/bark, excessive salivation and refusal to feed or eating objects like stone, paper, wood, metal pieces etc.

Apart from this, here are few things you need to keep in mind -

While many people think that it is only when they get bitten that they at risk of contracting the disease, but they need to remember that there are some other things that can be done to keep themselves and their family safe.

They should remember that if their dog or cat is sick, they should seek the advice from their veterinarian

immediately. T

hey should protect their pets from stray or wild animals.

If a person has any stray animals in their

surrounding

s, they should

immediately

report it to their local health authority.

People should remember that they should not feed or handle wild animals especially those that appear particularly aggressive or sick. And finally people should not keep wild animals as pets.

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