Most people associate the word 'rabies' with two things - dogs and injections. They do not know other important facts that they ought to. It is a highly neglected and severely under-reported disease killing almost 55,000 people each year worldwide*. 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.
Why is rabies so dangerous?
Dr Gupta: Rabies is a disease that is 100% fatal. It is important for people to understand that unless they have had the pre exposure vaccine or proper post exposure prophylaxis after the bite or scratch, there is no cure for the disease. Once the symptoms appear in a human there is nothing anybody can do to save the patient.
Which animals spread rabies in India?
Dr Gupta: 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.
How can people control rabies in dogs?
Dr Gupta: Animal vaccination 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 timesmore 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.
Is the vaccine required even if a pet (vaccinated animal) bites or licks a person?
Dr Gupta: Yes. If a potent veterinary vaccine is given correctly as per pre-exposure schedule, it will most likely prevent rabies in the vaccinated dog, unless the exposure is severe. It was found that about 40% of the dogs that were vaccinated early on in life had lost most of their immunity after a few years. Ideally, a dog that bites or scratches a human should be tested for the presence of antibodies against the virus, but this is rarely practical due to scarce facilities in our country. Therefore, PEP vaccination is recommended following bites even by vaccinated dogs.
What precautions can people take to keep rabies at bay?
Dr Gupta: There is a pre-exposure vaccination (PrEV)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 in 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 28thday.
Pre-exposure vaccination also reduces the number of injections of thepost-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 topregnant women.
Why can a person not get the vaccine at birth (like other vaccines) and be protected for life?
Dr Gupta: 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 orone 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.
When should a person get treated for a bite?
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.
How can a person identify a rabid animal?
Dr Gupta: 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.
8. What precautions should people take when it comes to rabies?
Dr Gupta: 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. They should protect their pets from stray or wild animals. If a person has any stray animals in their surroundings, they should immidiately 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.
*Source: WHO (2007 statistics)
** Source: APCRI 2004 statistics
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