If you live in any developing nation, at-least the ones in Asia or Africa, you have surely heard of RABIES , a deadly Viral disease that Kills more than 60,000 humans and millions of animals worldwide, more than 95% of which occur in Asia and Africa. If you haven’t, the information below can save your life or that of someone you may know.
Rabies is one of the most common, preventable yet fatal diseases that is transferred from Animals to Humans (human to human transfer is unheard of except a recent case of organ transplant). In the developed nations the primary cause of rabies in humans is through exposure to wildlife, including Bat, raccoon and coyote bites. However majority of cases in developing countries are due to Dog Bites.
A few chilling facts
Now that we have your attention let us clear the misinformation first:
Don’t hate the Dog: A Dog may be the primary carrier of the rabies virus in India but its not fair to label it as the cause and use it to inhumanely control their population by destroying and killing the healthy ones.
A Dog itself is the victim here who having contracted the virus from another animal, goes on to suffer extensively from the diseases before being put down or suffering a painful death.
Its not fair to brand the Dog as the evil here and assume ridding the country of dogs will bring us salvation from Rabies. The world needs to follow the example of developed nations, like USA and most countries of western Europe, where vaccination of Dogs and Cats have virtually eradicated the disease and the few cases that pop up, are usually due to Bats or wild animals.
Culling healthy and rabid dogs alike, as being done in India by a lot of states, actually increases the problem as dogs lose trust in humans and are difficult to catch, sterilize and vaccinate. Reality however seems to elude the government here.
Hydrophobia (fear of water) is not a rule: Rabid dogs have been known to swim and drink water and so have humans. Hydrophobia is a possible symptom of Rabies but not a thumb-rule and you should not wait for these symptoms in dogs or humans before seeking treatment. Once this symptom appears, death is Fait accompli. The disease is synonymous to and often alternatively called Hydrophobia because the victim has difficulty swallowing anything, and shows panic when presented with liquids to drink despite increasing thirst and high Salivation. Any thoughts or mentions of drinking can cause intense spasms in throat and Larynx.
What RABIES really is
Rabies is a Zoonotic, neurotropic disease caused by a number of Lyssaviruses including the Rabies virus and the Australian Bat lyssavirus that can affect and be transmitted by any warm blooded Mammal.
Primarily transmitted through Saliva of the infected animal through a bite or a scratch, the virus travels through the peripheral nerves to reach the Central Nervous system of the host. Since it doesn’t enter the bloodstream, the immune system is not triggered and the virus, unchallenged, causes acute inflammation of the brain (Encephalitis) eventually leading to a host of symptoms and Death.
Early Symptoms may be as few as a Fever and a tingling or numbness at the site of bite. As the disease progresses, the symptoms may progress to include:
followed by certain DEATH
The Progress of Disease and transmission:
The virus, once inside the body, usually takes 2 – 12 weeks to show symptoms and depends upon the location, severity, amount of virus introduced and the distance it has to travel to reach the Central Nervous system. However people have been reported to show symptoms up-to 6 years after exposure and died so the exposure-to-symptom window is indeed large. However, once the symptoms manifest themselves, it takes the virus 2-10 days to kill the victim. There are few exceptions to that.
The Salivary glands are concentrated with the virus in the infected animal and cause excessive drooling. This is the primary way the virus transmits itself.
Fortunately, Rabies has a treatment that’s 100% effective if started immediately and before the onset of any symptoms. There is no cure if the symptoms become visible. None.
There has been only 3 reported cases of Rabies survival where a unique method called the Milwaukee Protocol was used. The protocol has its own controversies and you can read more about it here. However it has a survival rate of 8-20% which is better than none. If you know someone who is invariably going to die of rabies, its worth a try so do let the doctors know.
What you should do if you have been bitten or scratched:
If you don’t know the animal and cannot be sure if its vaccinated against rabies, you need to get yourself the post-exposure Treatment (Post Exposure Prophylaxis or PEP) but before you do there are a couple of things you could do minimize the risk and a few you shouldn’t:
The treatment protocol is defined differently based on 2 criteria:
Category of Exposure:
The treatment protocol will change depending upon the type of contact you had with the animal. Here is a ready reckoner :
Observation of the involved Animal:
If at all possible, the Dog or Cat who has bitten you should be kept in a 10 day observation. If the animal remains healthy in that period, your doctor may modify your treatment schedule by converting post exposure prophylaxis (after bite treatment) to Pre- exposure vaccination ( before bite immunization) by skipping the vaccine dose on day 14 and administering it on day 28 while using Essen Schedule. This logic is however only applicable to the observation of Dogs and Cats and not applicable if you have been bitten by any other animal. Your Doctor will be in the best position to advise. If the animal cannot be observed, the entire Post Exposure protocol for vaccination is followed.
1. Vaccination status of the biting Animal: Vaccinations fail. There can be numerous reason for that including, poor administration, poor quality of the vaccine, poor health of the animal or the simple fact that there are no vaccines that can give long term immunity against Rabies. Vaccination status of your dog is no guarantee that he cannot be rabid.
2. Provoked vs Unprovoked Biting: Whether provoked or unprovoked, a dog bite should be taken equally seriously and the necessary vaccination protocol be followed.
3. Bite by wild animals: All bites by wild animals should be treated as a category 3 bite and treated accordingly.
4. Bite by Rodents or Bats: You can ignore bite by rodents or bats in India as no rabies cases have been reported here due to them. Not so much in United States, where Bats are the primary rabies carriers.
Post Exposure Treatment (Treatment protocol after being bitten or scratched)
Post exposure Treatment consists of 2 Vaccines:
1. Rabies Immunoglobin (RIG) : Also known as the Anti Rabies Serum, RIGs are readymade antibodies that will let your body survive the initial phase of infection before your body can produce its own bodies through the subsequent vaccinations.
These are administered in close proximity to the bite site where they neutralize the virus that has entered through your wound.
2. Anti Rabies Vaccines (ARV): These are the vaccines that will give you active immunity from the rabies virus and are administered in India using the ESSEN Protocol, which consists of 5 vaccines on Day 0, 3, 7, 14 and 28 where day 0 is the is the first day of vaccination. Needless to add, make sure you get started immediately after the bite.
Additional Note: You may require Tetanus Prophylaxis as well depending on the extent of injury and an antibiotic course to prevent any infection in the wound. Unless necessary, do not suture and/or cover the wound.
Pre Exposure Vaccination (Immunization Protocol)
If you work with animals, are a Veterinarian or deal with Rabies infections as part of your job, you must get Pre Exposure Prophylaxis done. The schedule for the same is quite simple and requires 3 doses of ARV injections on Day 0, 7 and either day 21 or 28 where day 0 means the day you got the first injection.
Its also recommended that you get your antibody count checked every 6 months for the first 2 years and then every 2 years and if needed, get booster doses of the vaccine. If you get bitten and have been immunized, you will still need 2 shots of the vaccine on Day 0 and Day 3.
It may all sound too much but the risk is simply too great to be complacent about and the vaccinations process is painless (unlike the old method) and uses a hypodermic needle that you won’t even feel
By the way, for the technically inclined or our friends from the medical fraternity, here is a handy set of guidelines issued by the National Centre for Disease Control, Govt. of India for Rabies. Do read it or download and keep a copy handy.