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Indian Journal of Community Medicine

Rabies: What We Know and What We Need to Know

Author(s): T.S. Sandhu

Vol. 29, No. 4 (2004-10 - 2004-12)

Introduction

What is Rabies?

Rabies is a deadly viral disease affecting the central nervous system. It is caused by a bullet shaped Rhabdoviridae virus found in the saliva of infected animals. Who gets rabies? All warm blooded mammal including humans, dogs, cats, cows, and horses etc. act rabies and can act as carriers2. How is rabies spread? Rabies is almost always contracted by exposure to a rabid animal. There are several ways3 in which rabies can be transmitted:

  1. By the bite of an infected animal,
  2. By a scratch, abrasion, or open wound coming in contact with infectious material (i.e. blood or saliva of an infected animal),
  3. By mucous membrances coming in contact with infectious material,
  4. By the airborne route: There are a few documented cases of rabies being contracted in caves where bats reside and in laboratories that work with the virus.
  5. By human-to-human contact (e.g., a corneal transplant from an unknown infected individual).

Incubation Period

It is normally of two of eight weeks but incubation periods of over one year have been reported. Symptoms of rabies Early symptoms include irritability, headache, fever and sometimes itching or pain at the site of exposure. The disease eventually progressses to paralysis, spasms of the throat muscles, convulsions, delirium, hydrophobia and death.

Treatment for Rabies

Treatment requires prompt scrubbing of the site with lot of water and soap, application of alcohol on the wound, followed by local administration of RIGs i.e. rabies immunoglobulin around the site of bite and five doses of tissue culture vaccine including human diploid cell rabies vaccine, administered in the arm on days 0,3,7,14 and 28 after exposure. Do not apply prickle concentrate, kerosene oil, petrol, mobile oil, etc. on the wound. Do not go for spiritual/magical/tantrik way of curing. These are of no use and lack scientific credibility.

Prognosis of rabid bite

Exposure of man to a rabid animal does not always result in rabies. If preventive treatment is obtained promptly following a rabies exposure, most cases of rabies will be prevented5. Untreated cases will invariably result in death.

Control rabies

  1. Exposure to rabies may be minimized by removing all stray dogs and cats as well as having all pets vaccinated.
  2. Wild animals should not be kept as pets.
  3. Do not allow bats to live in your house attic or chimney. Remember: bats may carry rabies.
  4. If you hunt, use gloves while skinning animals in particular while handling nervous tissue or organs (spine and brain for example).
  5. Avoid picking up dead or abandoned animals, and do not capture or eat animals that do not look or act normal.

Rabies vaccine

The vaccine that is currently being used is Rabies Human Diploid Cell Vaccine (HDCV) and tissue culture vaccine. It is a sterile, stable, inactivated cell capture rabies vaccine for human use by injection. The vaccine is derived from material that is grown in rabbit brain. It is refined and cultured with the Human Diploid Cell Strain to create the vaccine6.

Pre-exposure vaccine should be given to high-risk groups like animal handlers, certain lab workers, persons living in countries where rabies is a threat, persons who work with potentially rabid animals - zoo keepers, trappers, other willing persons, etc. There are three doses of pre-exposure vaccine given IM or ID on Day 0, 7, 21 or 28. Booster doses of vaccine are recommended every two years for those individuals who continue to be at increased risk of contracting rabies and whose rabies antibody titer is less than 1:5.

Post-exposure vaccine

The number of doses required is determined by the previous immunization status of an individual. An unimmunized person will be given a series of five total injections of IM HDCV on Day 0,3,7,14, and 28 of the exposure. In addition, rabies immune globulin (RIG) will be given according to your weight on Day 0. This injection will provide some protection from the virus, while the antibodies to the vaccine are being produced.

Oral Rabies Vaccination Programs (ORVP)

The Zoonosis Control Division's Oral Rabies Vaccination Programs (ORVP) were created to eliminate rabies in coyotes (Canis latrans) in South Texas and rabies in gray foxes (Urocyon cinereoargenteus) in West Central Texas. Oral rabies vaccine encased into a bait matrix of fish/chocolate/chicken flavor has been developed by U.S. scientists7. These vaccine/bait units are distributed aerially by Twin Otter aircraft over the forests to vaccinate the wildlife.

Who should not take the vaccine without checking with their physician?

You should avoid the vaccine if you have either of the following conditions: Febrile illness (fever of over 100°F), Pregnancy. If there is a substantial risk of exposure to rabies, administration of the pre-exposure vaccine series may also be indicated during pregnancy.

A Final Word of Warning

Wash pet dishes separately from your own and rinse with boiling water. Children really should never kiss animals and certainly shouldn't share eating dishes with them. Any turtle tanks, fish bowls, or bird cages should be placed out of reach. Make sure pets are vaccinated against this disease. Always wash hands thoroughly with hot water and soap after handling pets (their dishes, cages, or litter boxes).

Need of Government by-laws

In the interest of public health, laws should be formulated and strictly followed to eliminate this disease. Some of the suggestions are:

  • Euthanise all the stray animals.
  • Vaccination against rabies by a qualified veterinarian should be made compulsory.
  • All pets should be registered with the local authorities and a license should be required to keep a pet.
  • Authorities should conduct surprise raids and should check the vaccination status of the pets.
  • There should be a provision for heavy penalty/imprisonment of the defaulter owner and euthanization of the unvaccinated pet.
  • No wild animal should be allowed to be kept as pet under any circumstances.
  • Euthanise the unvaccinated pet if it bites anyone.
  • Euthanise the pet if it is not vaccinated and is bitten by a rabid animal.

References

  1. World Health Organization. WHO Expert Committee on Rabies, 8th report. WHO Tech Rep Ser 874 Geneva, WHO 1992; 19-25.
  2. WHO World Survey of Rabies. World Health Organization, Geneva. 1998(34)28-59.
  3. Dutta JK. Human rabies in India: Epidemiological features, management and current methods of prevention. Trop Doct 1999;29:196-201.
  4. Baer GM. Control of rabies infection in animals and humans. In:Kurstak E (Ed). Marcel Decker, New York, 1984:81-96.
  5. Sehgal S. Medical and veterinary aspects of rabies prevention and control in India. Indian J Community Health, 1996;2:18-19.
  6. Warrell DA, Warrell MJ. Human rabies and it's prevention on overview. Rev. Infect. Dis. 2000;10:S726-S731.
  7. Pierre P, Jean-Paul S. Vaccines for domestic animals. In : George M Baer (Ed). The Natural History of Rabies Boston: CRC Press. Inc. 1991:445-459.

Civil Veterinary Hospital,
Vill Naushehra Pannuan,
Tehsil Tarn Taran,
Amritsar, Punjab
E-mail : [email protected]

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