Q1. What is rabies?
– Rabies is a disease transmitted from animal to humans, which is caused by a virus. There are two clinical manifestation of rabies – frantic and paralytic. Frantic rabies is most common form of human rabies
Q2. How is rabies transmitted?
The rabies virus invades the nervous system of mammals. It is primarily transmitted from the rabid animal’s saliva when it bites or scratches someone.Licks to wounds or grazed and broken skin, or to the lining of the mouth and nose, can also transmit the disease.
Dogs are responsible for 96% of human rabies cases in South-East Asia, but there are also reports of human rabies due to bites of cats, mongooses, jackals, foxes, wolves and other carnivorous animals. Rabies due to monkey and rat bites is rare. Horses and donkeys get aggressive and bite ferociously when they are rabid. Cattle and buffaloes do not bite when they are rabid, but precautions should be taken while examining sick animals that are salivating.
Q3. How does one treat an animal bite?
If a person is bitten by an animal:
Wounds should be washed and flushed immediately with soap and water for 10-15 minutes. If soap is not available, flush with water alone. This is the most effective first-aid treatment against rabies.
Wounds should be cleaned thoroughly with 70% alcohol/ethanol or povidone-iodine, if available.
As soon as possible, take the person to a healthcare facility for further treatment
Q4. What should not be done with an animal bite wound?
Avoid
Applying irritants to the wound such as chilli powder, plant juices, acids or alkalis.
Covering the wound with dressings or bandages.
Q5. How does rabies develop humans?
After entering the human body, the rabies virus progresses from the innermost layer of tissue below the human skin (called subcutaneous tissue), or from muscle, into peripheral nerves (i.e. the nerves in the body which are outside the brain or spinal cord).
The virus migrates along nerves to the spinal cord and brain at an estimated speed of 12–24 mm a day.The infected person exhibits behavioural changes and clinical signs when the virus reaches the brain. The incubation period ranges from a few days to several months, and can be as long as 1 year.
Q6. What are the factors that influence the development of rabies?
Factors that may influence development of rabies infection include:
type of exposure
severity of the bite
the amount of rabies virus introduced
the animal responsible for the bite
the immune status of the victim
site of the bite – head and neck wounds, as well as wounds in highly innervated areas such as fingers, generally have shorter incubation periods due to the proximity of the viral inoculation to nerve tissue.
Q7. How long does it take for cats and dogs to develop rabies, and how long does a rabid animal survive?
The incubation period ranges from a few days to several months, whereas the duration of illness –until death – varies from 1 to 7 days.
Q8. What are the clinical features of rabies in dogs?
Dog rabies is characterized by changes to its normal behaviour, such as:
biting without any provocation
eating abnormal items such as sticks, nails, faeces, etc.
running for no apparent reason
a change in sound e.g. hoarse barking and growling or inability to make a sound
excessive salivation or foaming at the angles of the mouth – but not hydrophobia (fear of water).
Q9. What are the signs and symptoms of rabies in humans?
Human rabies has the following signs and symptoms:
pain or itching at the site of the bite wound (in 80% of cases)
fever, malaise, headache lasting for 2–4 days.
hydrophobia (fear of water)
intolerance to noise, bright light or air
fear of impending death
anger, irritability and depression
hyperactivity
at a later stage the mere sight of water may provoke spasms in the neck and throat
the duration of illness is usually 2–3 days, but might stretch to 5–6 days or more when receiving intensive care support.
Q10. Is there any specific treatment for arabies patient?
There is no specific treatment once rabies develops. There is almost nothing that can be done apart from keeping the patient comfortable, and free from physical pain and emotional upset.
Precautions should be taken by the caregiver to avoid bites and saliva contamination of mucous membranes and wounds by using personal protection equipment.
Keep the patient in a quiet room with subdued light and protect them from stimuli (e.g. loud noises, cold air) that are likely to increase spasms and convulsions.
Sedation with diazepam 10 mg every 4–6 hours, supplemented by chlorpromazine 50–100 mg, or intravenous morphine if necessary, will help to control muscular spasms and excitability.
Feeding orally is usually impossible. Fluids should be given intravenously.
Q11. Is rabies always fatal?
Human rabies caused by the classical rabies virus continues to be almost 100% fatal, with no specific treatment available anywhere in the world.
There are only seven recorded cases of human rabies survivors in the world, who received intensive nursing care. Almost all of them received preventive/pre-exposure rabies vaccination that might have modified the course of illness. Only one case of human rabies caused by a bat bite did not receivepre-exposure vaccination but survived. However, this case was not caused by the classical rabies virus.
Q12. Is simply observing the biting dog or cat for 10 days without starting treatment justified?
No. In countries where rabies is prevalent in a large population of dogs and cats, it is compulsory to start treatment and keep the biting dog/cat under 10 days of observation. If the animal remains healthy during the observation period then post-exposure prophylaxis (PEP) can be converted into pre-exposureregimen, i.e. the vaccine taken will be to prevent rabies if bitten in the future.
Q13. Under what conditions do we have to take anti-rabies vaccination after being bitten?
Post-exposure rabies prophylaxis (PEP) is compulsory if you are bitten by a dog, cat or other animal that is rabid or is suspected to be infected with rabies.
PEP is required under following conditions:
If the bite has broken the skin and the wound is bleeding.
If a mucous membrane has been exposed to saliva from a suspect animal.
If the animal that has bitten someone
is killed
disappears during the observation period
displays unusual, erratic behaviour
if laboratory tests of brain material from the suspected or rabid animal is positive.
Q14. Do you have to take vaccination against rabies if a vaccinated dog bites you?
No, not if the dog is properly vaccinated against rabies and the efficacy of the vaccine is confirmed by laboratory evidence. Otherwise an appropriate post-exposure prophylaxis (PEP) should be given.
Q15. If I am bitten by a rat do I require post-exposure prophylaxis (PEP)?
Rat rabies has been reported from some Asian countries but is extremely rare. It is not necessary totake PEP in bite cases by house rats. However, it is prudent to take PEP in consultation with an infectious disease physician when bitten by wild rats/rodents.
Q16. What should be done if I am bitten by a bat?
There is no evidence-based information on human rabies cases due to bat exposure in the South-EastAsia Region. However, there are reports of zero positivity against bat rabies virus in the bat population in Thailand. Therefore, it is recommended that you thoroughly wash the bite wound and consult an infectious disease physician. It is also recommended not to play with or handle sick or dead bats.
Q17. Is PEP necessary if milk or milk products from an infected animal are consumed?
No. There is no laboratory or epidemiological evidence that the consumption of milk or milk products from rabid animals transmits the disease. However, it is not advisable to consume milk from rabid animals.
Q18. Can consumption of meat from an infected animal transmit rabies?
The consumption of raw meat from an infected animal requires PEP. Cooked meat does not transmit rabies; however, it is not advisable to consume meat from an infected animal.
Q19. Is there a single-dose human rabies vaccine which will provide life-long immunity?
No. There is no single-dose rabies vaccine available anywhere in the world which can provide life-long immunity. Single-dose vaccines are available, but they only provide immunity for a limited period oftime.
Q20. Is it possible to develop rabies from the vaccination?
No. All rabies vaccines for human use are inactivated. Human rabies vaccines undergo a series of quality control tests such as potency, toxicity, safety and sterility. It is not possible for the rabies vaccination to cause the disease.
Q21. What can be done for rabies prevention and control?
Be responsible by vaccinating pet dogs or cats against rabies, as recommended by veterinarians or animal health workers.
Keep the dog vaccination certificate safe and present it during annual vaccination.
Do not sell or consume milk or meat from rabid or suspected rabid cows or buffalos.
Q22. What is the rabies vaccination schedule for pet dogs?
Puppies are often obtained from reliable dog breeders where bitches are vaccinated against rabies. These puppies get maternal antibodies against rabies for 3 months and therefore it is recommended to vaccinate at 3 months of age, then at 9 months of age and revaccinate annually. Puppies and dogs must be given anthelmintic drugs regularly before vaccination.
If the puppies adopted are street dogs, the first vaccination should be given as the same protocol (at 3 months of age, 9 months, and yearly boosters). Alternately, first vaccination can be given as early as 2 months of age. Precautions should be taken infirst 3 months of age.
If adult street dogs are adopted, then the first vaccination should be given as soon as possible, and a local veterinarian should be consulted.
website source: http://animalbitecenters.thefilipinodoctor.com/abc-faq/
