Awareness On Rabies- World Rabies Day

Rabies is a well-known disease that affects the central nervous system of all warm-blooded animals including humans.

Authors: Dr. Muhammad Ali Tahir, Dr. Muhammad Akram, Dr. Ali Hussain and Dr. Muhammad Muneeb

Introduction

The rabies is a zoonotic disease (can be transmitted from animal to human & vice versa) and causes fatal encephalitis in mammals. For Example, if a rabid dog bites a man, it can transfer the virus and disease to that man. Rabies is one of the fatal diseases on earth and you will have a 99.9% chance of dying if you do not get treatment instantly after getting infected.

Etiology

The causative agent of rabies is the Lyssavirus that belongs to the Rhabdoviridae family. It is a bullet-shaped virus, size about in length 180 nm and diameter about 75 nm containing a single-stranded anti-sense, non-segmented RNA. This virus contains helical nucleocapsid with 30 to 35coils between 4.2 and 4.6 nm in length. The saliva of a rabid animal is the main source of virus transmission.

Importance of rabies day

On September 28, 2007, the first World Rabies Day was commemorated. From 2007 rabies day is observed every year on the same date with a specific theme. World rabies day aims to raise awareness about rabies and suggest the proper ways for the prevention and control of rabies worldwide. Public health organizations arrange events to promote rabies awareness around the world especially on September 28.

Organizations

Global alliance for rabies control GARC is playing an important role in the elimination of rabies from the world. It has been educating people and providing guidance and assistance to organizations working for awareness and vaccination in under-developed countries. Its motto is to end rabies by the end of 2030 by vaccination as there is no treatment available right now.

Other organizations like FAO and WHO are also taking part here and these are working to eliminate this fatal disease. Link of Rabies & One Health Concept: Not only rabies but all the zoonotic diseases have a connection with one health concept. As zoonotic diseases are transferred from animals to humans, unhealthy animals would also result in deterioration of human health

Current status of Rabies disease in Pakistan

Rabies is a neglected disease in Pakistan although the incidence of dog bites in Pakistan is very high. In 2010 more than 97,000 recorded cases of bites were reported by basic health units. Those managed by secondary and tertiary care facilities, private practitioners and spiritual healers. Rabies known as an older and fatal disease to mankind has been taking away precious lives for 4000 years.

Weaker Points of Pakistan Regarding control of Rabies:

• Lack of surveillance system
• Inadequate response and political support.
• Limited access to up-to-date rabies vaccine and immunoglobin.
• Weak collaboration between different Government and health and veterinary Science authorities

Pathogenesis and sources of Transmission

The Lyssavirus mostly present in the saliva of an infected animal and can be transmitted through the saliva of an infected animal due to biting, wounds, or unwrap cuts in fur or mucous membranes of the body. The Lyssavirus enters the body via a wound or by direct contact with mucosal membranes. The rabies virus multiplies inside the bitten muscle or tissue and then it moves towards the central nervous system with @3to 4mm/hour. The virus moves towards the brain via peripheral nerves, after reaching the brain the same virus moves towards salivary glands through peripheral nerves. Biting a rabid animal near to head is fatal, leads to an earlier death.

Signs and symptoms in case of Rabies

The first sign of rabies in the animals especially in rabid dogs is a change in behavior. Even normal can show aggressive behavior or an active animal may become depressed. 

• Animal tries to bite everything even non-food items.
• The voice of the animal is also changed especially pitch and tone Hyper-salivation (salivation increases).
• The animal may become paralyzed either partially or fully (Paralytic from)

The first sign of rabies in humans is pain or itching at the biting site in most of the cases. •

• There is fever, restlessness, headache which may go for 2–4 days.
• The main sign in humans is hydrophobia (fear of water). A person cannot tolerate noise and bright light. An infected person develops a fear of impending death.
• There is excessive sweating.
• Muscles become paralyzed with time, initially at the site of the bite. The patient gradually goes into a coma and death may occur.

Different Phases of Rabies

1. Prodromal phase

This is the first phase and exists for 2 to 3 days. Common sign are apprehension, nervousness, anxiety, and fever noted

2. Furious phase

After the prodromal phase, animals enter into the furious stage and exist for 1to 7 days; cats are prone to developing this phase. Animals become restless, begin to room and more irritable, vicious.

3. Paralytic (dumb) phase

This is the last stage and develops within 2 to4 days after the first signs are noted. Nerve affecting the head and throat are involved, labored breathing and dropping jaws. Animals take a choking sound, weaker, and go into respiratory failure and die.

Treatment

The patient usually needs to go to the health center or hospital for a month for at least three more vaccinations. The patient should thus receive at least 4 injections. It is very important to complete the whole course of vaccinations as recommended by the doctor, otherwise, it becomes risky and fatal for the patient.

Primary vaccination

Three 1.0-mL injections of HDCV or PCEC vaccine should be administered intramuscularly (deltoid area) — one injection per day on days 0, 7, and 21 or 28.

How to avoid dog bites and prevent Rabies

 Insurance of the safety against dog bites for rabies prevention is only hidden in the pursuance of these principles.

• Do not try to run or scream in front of a dog, be still like trees in that case.
• Strictly avoid eye contact with a strange dog
• Never try to pet wild or stray animals, the act of reporting to the wildlife department about it or any other related organization for any abnormal behavior of stray dog without any delay is beneficial.
• A dog younger than 3.5 months of age is preferable over the old one to be a pet.
• Breed-specific behavior should be considered before buying a new dog because of some very aggressive breeds of dogs like such breeds Pit Bull, Chihuahuas, Wolf Dog Hybrids, and German shepherds, etc.
• Do not try to humanize your new dog or treat it as a child/mate.
• Do not kiss or hug your newly purchased dog, it can lead to more confusion or aggressiveness for the animal.

Role of a Veterinarian in Rabies Awareness

1. Veterinarians can play their role in providing awareness to people about the handling of a rabid dog, dog bite prevention, and first aid treatment regarding a dog bite.
2. The veterinarian must engage them to vaccinate themselves as well as their pets against rabies as soon as possible when they buy them.
3. Veterinarians can run a rabies awareness campaign by telling the public about a wide range of hosts (mainly dogs, bats, foxes, jackals, and domestic animals) so people can protect themselves from suspected cases.
4. In areas where domestic and wild animals normally live together, veterinarians should have regular visits and engage owners about vaccination of their animals by explaining to them how deadly disease rabies occurs.
5. A veterinarian should also guide pet owners to place wild and domestic animals separately because wild animals especially dogs are more prone to get an infection.
6. A veterinarian should aware of people regarding the incubation period, signs and symptoms, and handling of a rabid case.
7. They should tell them if a person accidentally exposed to a dog bite, the person should observe the dog for at least 10 days and if he found some peculiar behavior in the dog regarding rabies, he must go for his doctor advisory.
8. In countries like Pakistan stray dogs is a potential source of disease spreading. In this regard, veterinarians can help the nation by providing awareness about controlling the stray dog population (by neutering, killing, or vaccination).
9. So, veterinarians arrange seminars regarding rabies prevention and control in various schools and colleges to guide children as well as young ones about rabies.

Authors: Dr. Muhammad Ali Tahir, Dr. Muhammad Akram, Dr. Ali Hussain and Dr. Muhammad Muneeb