Rabies is an infectious viral disease that causes brain inflammation and is spread by the saliva of infected animals. It’s usually transmitted through a bite or scratch. In most countries, the most common vector is dogs. But rabies can also be transmitted by bats, foxes, or skunks. Rabies is a frightening condition because once you start showing symptoms, it can mean certain death. Anyone at risk of contraction, such as vets or game rangers, should get a rabies vaccine.
Research shows that 59,000 people die of rabies in Asia and Africa. Nearly all the rabies infections are caused by dogs. Whenever you’re bitten by a wild animal, seek medical attention immediately. For treatment to work, it has to be administered before symptoms manifest.
How does rabies work?
It is a ribonucleic acid (RNA) virus of the rhabdovirus family that affects the body by entering the nervous system then affecting the brain or replicating muscle tissue then entering the nervous system. When rabies enters the nervous system, the virus causes inflammation of the brain.
There are two forms of rabies:
- Furious (encephalitic) rabies: hyperactivity, hydrophobia and hallucinations
- Paralytic rabies: paralysis and coma
Rabies is carried in the saliva of infected animals. The virus can be transmitted through bites and also if the saliva of an infected animal comes in contact with an open wound or mucus membrane. The virus can’t pass through unbroken skin. Any large mammals can transmit rabies except rats and rabbits, which research shows rarely become infected.
Symptoms
Rabies has five main stages:
- Incubation
- Prodrome
- Acute neurological period
- Coma
- Death
Incubation
This is when the virus incubates and develops, just before symptoms appear. It usually lasts 2-3 months. But it can take any time from a week to a year. This depends on where the virus enters the body and the volume of infected saliva. If the bite is closer to the brain, symptoms will manifest faster.
Prodrome
Prodrome refers to the early onset symptoms of a disease. In this stage, flu-like symptoms appear. This includes fever, headache, anxiety, malaise, sore throat, cough, nausea, vomiting, and irritation at the bite area.
Acute neurologic symptoms
This is the main stage of symptoms for the rabies virus. Treatment at this stage will not be effective. The symptoms include:
- Confusion
- Aggression
- Partial paralysis
- Involuntary muscle twitches
- Convulsions
- Difficulty breathing
- Stiff neck
- Producing a lot of saliva
- Frothing at the mouth
- Rabies causes a fear of water because trying to swallow causes painful throat spasms.
- Hallucinations
- Insomnia
- Permanent erection in men
- Fear of light
Coma and death
When a patient enters this stage, they could die within three days. No patients have survived the coma stage.
Diagnosis and Treatment
Doctors have to diagnose that a patient has contracted rabies. If there is no way to confirm that the animal has rabies, doctors have to use exclusion to confirm. Prodrome symptoms are similar to other diseases such as influenza and herpes.
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Doctors can also conduct a rabies-specific viral culture and compare the cells of the infected patient to confirm. This is done through a polymerase chain reaction (PCR) test or monitoring cerebrospinal fluid. No single test is enough to confirm or disprove rabies. When taking a patient who has been bitten by an animal to the hospital, try to get every detail about what symptoms the animal was displaying. Sometimes, the biting animal may need to be euthanised and taken to a laboratory for further testing.
When bitten by any animal, clean and disinfect the bite immediately. This also applies if the animal licks an open wound. Clean the affected area with warm soapy water within 15 minutes of the incident. You can also use iodine or detergent. This helps reduce the viral particles. After this, seek medical attention.
During the prodrome stage, some treatments can be administered such as the rabies vaccine. People have survived after getting treatment during the early symptoms stages but this is extremely rare. Once the acute neurological symptoms develop, survival is impossible. At this stage, doctors will try to make the patient as comfortable as possible since they may need assistance breathing.
Should you get the rabies vaccine?
Unlike other vaccines, the rabies vaccine isn’t offered routinely. It’s reserved for people who are at the highest risk of exposure. This includes vets, game park workers, animal wranglers, or anyone who works closely with animals and can receive bites. Patients also get the vaccine when they are bitten by a rabid animal.
The rabies vaccine contains an inactive form of the rabies virus to trigger an immune response when the body is exposed to active rabies viral particles. The antibodies help the body fight future infections as well. The vaccine is administered in the upper arm. For professionals who need a preventative preexposure shot, three injections are given over 28 days. Patients who have already been exposed to rabies get four vaccine doses and the rabies immune globulin (RIG) near the bite. This tries to prevent the virus from causing further infection.
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Challenges in managing rabies
To reduce incidents, pet owners should get their animals regularly vaccinated. In the US and Canada, bait is dropped containing oral vaccines to reduce the number of wild animals with rabies. Travellers should also not be allowed to bring in some animals from other countries. For people who live in high-risk areas, regular vaccination is recommended. More awareness is needed about the risks surrounding rabies.
In areas with large numbers of stray dogs, a census needs to be conducted to ensure that all animals are accounted for. Oral vaccinations should be given using food left out in the open. Residents are also encouraged to report animals displaying symptoms to relevant authorities to have them euthanised and disposed of safely. People are also encouraged to keep their pets indoors, avoid touching wild animals, and keep bats out of homes.
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Understanding Rabies:
The number of deaths caused by the disease is grossly underestimated because of a poor survailance system in the country… another challenge we don't have a census to know the dog population: Dr Kahariri Sam #YourWorld pic.twitter.com/yZF2Kuj7gN
— NTV Kenya (@ntvkenya) August 29, 2023
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