Rabies

Lack of awareness about rabies

Rabies tends to be more common in areas where people have limited understanding of the disease and its transmission. Rural regions often see more cases, mainly because of insufficient knowledge about prevention and proper response to dog bites.

Contact with unvaccinated dogs

Dogs are the primary carriers of the rabies virus. Being around stray or unvaccinated dogs significantly increases the likelihood of exposure to the infection.

Residence in endemic regions

People living in regions where rabies is widespread—especially where control over stray animals and wildlife is poor—are at an increased risk of contracting the disease.

Age-related vulnerability

Children are more susceptible to rabies because they are more likely to be bitten by animals. Most pediatric cases involve bites to the arms and face.

Anyone bitten or scratched by an animal should seek medical attention immediately, as rabies cannot be identified by simply observing an animal’s appearance.

Although lab tests are available for confirmation, relying solely on test results can delay treatment, which is dangerous given how rapidly rabies progresses.

Animal testing

The animal responsible for a bite or scratch is often tested to determine if it’s rabid. This can help avoid unnecessary stress and treatment for the victim if the animal tests negative.

A commonly used diagnostic method is the direct fluorescent antibody (DFA) test, which detects rabies antigens in the brain tissue of an euthanized animal.

Healthy pets, like vaccinated cats or dogs, are not always tested immediately but are kept under observation for 10 days. Further steps are taken depending on their condition during this period, in consultation with local health authorities.

Human testing

Rabies can be confirmed in people by identifying the virus, its genetic material, or related antigens in bodily tissues. Common diagnostic methods include:

• Lumbar puncture: A sample of cerebrospinal fluid is extracted from the lower back using a needle to check for viral presence.
• Nuchal skin biopsy: Considered highly reliable during the early stage of infection, this involves examining a skin sample from the neck under a microscope using immunofluorescent staining.
• Real-time polymerase chain reaction (RT-PCR): This technique amplifies viral RNA from a saliva sample, making detection more accurate.

Blood tests:

These aren't typically used for diagnosis since antibodies can take time to appear, but they help assess vaccine response. Two common methods are:

• Fluorescent antibody virus neutralization (FAVN) test
• Rapid fluorescent focus inhibition test (RFFIT)

Imaging:

These are helpful in detecting brain inflammation caused by rabies:

• MRI (Magnetic Resonance Imaging) of the brain
• CT (Computed Tomography) scan of the head

Specialists to consult

Rabies is a critical health emergency. Any unusual animal bite or scratch should prompt immediate wound cleaning and medical consultation. Doctors will assess the bite and determine the risk. Experts who may be involved include:

• General physician
• Infectious disease expert
• Neurologist
• Neurosurgeon

Controlling the disease in animals

Rabies can be prevented through vaccination. Ensure your pets—dogs, cats, ferrets, and certain livestock—are routinely vaccinated. A booster is recommended if a vaccinated animal is attacked by a wild animal.

Vaccination in humans

The same vaccines used for animals are also administered to humans post-exposure. In certain cases, people receive the vaccine even before potential exposure.

Modern rabies vaccines, known as cell culture and embryonated egg-based vaccines (CCEEVs), are more effective and cause fewer side effects than older nerve-tissue vaccines.

Pre-exposure vaccination for high-risk groups

Vaccination is advised for individuals who are at a higher risk of exposure, such as:

• Veterinarians and animal handlers
• Veterinary students
• Researchers studying wildlife or rabies
• Travelers to countries where rabies is prevalent

Children living in high-risk areas with limited access to immunoglobulin may also benefit from pre-exposure vaccination. The schedule typically involves intramuscular or intradermal administration on days 0, 7, and either day 21 or 28.

Booster doses are only necessary for those who face ongoing exposure risks. Even if previously vaccinated, individuals exposed to the virus still require post-exposure treatment.

Vaccination after a bite

If bitten by an animal suspected of rabies, immediate vaccination is crucial. Those who haven’t been vaccinated previously receive a 4-dose regimen: the first dose right after the bite, followed by doses on days 3, 7, and 14.

If the person has already been vaccinated, only 2 booster doses are needed—one immediately and another on day 3.

Precautions before vaccination

Certain conditions can affect the immune response. Let your doctor know if you:

• Had a prior allergic reaction to a rabies vaccine
• Suffer from severe allergies
• Are HIV-positive
• Have cancer
• Are on immunosuppressive medications
• Are pregnant or breastfeeding

Despite these, confirmed exposure to a rabid animal still warrants vaccination.

Side effects of rabies vaccines

Most side effects are mild and short-lived. Common ones include:

• Pain, redness, or swelling at the injection site
• Headache
• Nausea
• Stomach discomfort
• Muscle pain
• Dizziness

Less commonly:

• Skin rashes
• Joint pain
• Fever

Reducing Exposure to Animals

The safest approach to rabies is avoiding potential exposure altogether. Key precautions include:

• Avoid touching injured animals—call authorities instead.
• Don’t pet or feed unfamiliar animals, particularly in areas with known rabies cases.
• Stay away from stray dogs and cats when traveling.
• Keep your pets from roaming freely.
• Don’t leave pet food or garbage outside, as it attracts wild animals.
• Refrain from keeping wild animals as pets.
• Report any odd behavior in pets to a veterinarian promptly.
• Teach children to avoid stray animals and report any bite or scratch.

Spreading awareness

Understanding the risks and prevention of rabies is critical. While rabies is deadly, it can be prevented through prompt medical attention and vaccination.

Raising public awareness about responsible pet care, avoiding animal bites, and immediate wound care can drastically reduce rabies cases. Educational efforts targeting both adults and children are key to controlling the spread of this preventable disease.

Steps to Take After Being Bitten or Scratched by an Animal (Especially a Dog)

Immediately clean the affected area using soap and water, as this significantly lowers the risk of infection.

Rinse the wound thoroughly under running water for around 15 minutes.

Provide basic first aid, which includes applying an antiseptic or antiviral solution like iodine.

If possible, try to safely capture the animal in a secure container or at least note down its characteristics. Do not put yourself in harm’s way.

Reach out to your general physician without delay and inform them about the incident.

Notify the local health department and animal control, giving them a full description of the animal involved.

Avoid bandaging the wound unless advised by a doctor.

If the animal can be located, it should be kept under surveillance for 10 days.

What to Do If Your Pet is Bitten or Scratched by Another Animal (Especially a Dog)

Wear protective gloves while cleaning your pet’s wounds.

Immediately contact your veterinarian for further guidance.

Post-Exposure Prophylaxis (PEP)

Once rabies symptoms appear, there's no definitive treatment available. Hence, early preventive action is crucial. PEP must begin as soon as possible, even before rabies is confirmed, to prevent the virus from reaching the brain. This preventive approach includes:

• Thorough Wound Cleansing: Immediately wash the wound using soap, water, disinfectants, and povidone-iodine for no less than 15 minutes to eliminate or neutralize the virus.
• Rabies Immunoglobulin (RIG): Administered for rapid protection while waiting for the vaccine to take effect.
• Rabies Vaccination: The first vaccine dose is given right after exposure, followed by additional doses on days 3, 7, and 14. Individuals with compromised immune systems may receive a fifth dose on day 28.

The rabies virus spreads through the peripheral nerves and invades the central nervous system, potentially leading to severe neurological issues such as encephalomyelitis. As the virus advances, it can affect various organs, especially the salivary glands. In severe cases, it can result in the total breakdown of the nervous system, ultimately causing death. Complications include:

• Seizures
• Muscle twitching (fasciculations)
• Hallucinations or psychotic symptoms
• Loss of speech (aphasia)
• Autonomic system disturbances
• Paralysis
• Coma
• Heart and lung dysfunction
• Multi-organ failure
• Cardiac arrest
• Low blood pressure (hypotension)
• Disorientation or confusion
• Lower limb paralysis
• Difficulty swallowing due to throat spasms
• Sleep disturbances
• Breathing failure (apnea)
• Death

Rabies is a life-threatening illness that typically necessitates hospital care. However, caregivers at home can provide vital support by:

• Ensuring the patient remains calm and emotionally stable
• Avoiding direct contact with the patient’s saliva or open wounds
• Keeping the environment quiet and peaceful
• Reducing exposure to triggers like bright lights, loud noises, and drafts
• Encouraging restful sleep to reduce agitation
• Maintaining adequate fluid intake