The Dreadful Disease Called Rabies

Basic Points

• Rabies is a vaccine-avoidable viral disease which occurs in more than 150 countries and territories.
• Carnivores(especially dogs) are the origin of the bigger number of human rabies deaths, contributing up to 99% of all rabies transmissions to humans.
• Rabies eradication is achievable by vaccinating dogs.
• Infection causes tens of thousands of deaths every year, mainly in Asia and Africa.
• 40% of populace who are bitten by suspect rabid animals are children under 15 years of age.
• Instant wound washing with soap and water after contact with a suspect rabid animal can be life-saving.
• Annually, more than 15 million people globally obtain a post-bite vaccination. This is estimated to prevent hundreds of thousands of rabies deaths yearly.

---

Rabies is a virulent viral disease that is almost invariably destructive following the commencement of clinical signs. In likely 99% of human instances, the rabies virus is transmitted by tame dogs. Rabies affects domestic and wild animals, and is disseminate to people through scratches from claws or bites, mostly through saliva.

Rabies is present on all mainlands with the exclusion of Antarctica, likewise 95% of human deaths occur in Africa and Asia.

Rabies is a disregarded disease of poor and susceptible populations whose deaths are not frequently accounted for and where human vaccines and immunoglobulin are not readily obtainable. It occurs mainly in remote rural communities where children in the age of 5–14 years are recurrent victims.

The average cost of rabies preventive treatment after contact(also called post-exposure prophylaxis) can be the cost of dreadful losses for poor populations, since a course of PEP can cost US$ 40 in Africa and US$ 49 in Asia, where the typical everyday income is about US$ 1–2 per person.

Prevention

Eradicating rabies in carnivores

Rabies is a dreadful disease preventable by a potent vaccine. Vaccinating dogs is the main cost-effective programme for preventing rabies in humans. Dog vaccination will reduce the deaths caused by rabies and also bring about the requirement for Preventive treatment after contact with rabies as a part of dog bite patient care.

Preventive vaccination in people

The very same effective and safe vaccines can be used for pre-exposure vaccination. This is prescribed for travelers who devote a lot of time outdoors, particularly in rural areas, involved in activities like bicycling, hiking etc likewise for long-term travellers and expatriates living in areas with a notable risk of contact with dog bites.

Pre-exposure vaccination is also suggested for humans in certain high-risk jobs like laboratory workers dealing with live rabies virus and other viruses associated with rabies like lyssaviruses, and humans connected to any events that might bring them skillfully or otherwise into direct contact with bats, cats, dogs, and other vertebrates in rabies-affected areas. As kids are thought about to be at higher risk since they tend to play with animals, may get more serious bites, or may not report bites, their vaccination could be regarded if thriving in or visiting high-risk areas.

Clinical Manifestations

Incubation time for rabies is typically 1–3 months, but may vary from <1 week to >1 year, which depends on factors like location of rabies entry and rabies viral load. The early symptoms of rabies are high body temperature and frequent pain or a remarkable tingling, pricking or burning sensation (paraesthesia) at the injury site. As the virus disseminates via the central nervous system (CNS), increasing, fatal inflammation of the brain and spinal cord forms.

Two forms of rabies can result. Human beings with furious rabies exhibit signs of hyperactivity, titillated behaviour, hydrophobia (fear of water) and occasional aerophobia (fear of flying). After a few days, death occurs by cardiorespiratory capture.

Paralytic rabies makes for about 30% of the total number of human cases. This form of rabies runs a less striking and usually longer progression than the furious form. The muscles gradually become paralyzed, beginning at the site of the bite or scratch. A coma gradually develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed, adding to the low reporting of the disease.

Diagnosis

As a matter of fact, no screening are obtainable to diagnose rabies infection in human beings before the dawning of clinical disease, and unless the definite signs of hydrophobia or aerophobia are existent, the clinical diagnosis may be burdensome. Human rabies can be confirmed intra-vitam and post mortem by different diagnostic techniques targeted at recognizing whole virus, viral antigens or nucleic acids in infected tissues (saliva, urine, brain or skin).

Dissemination

Mostly, human beings are usually infected resulting from a deep bite or scratch by an infected animal. Dogs are the principal host and transmitter of rabies. They are the origin of human rabies deaths in Africa and Asia in more than 95% of all occurrences.

Bats are the source of most human rabies deaths in the Americas. Not long ago, bat rabies has appeared as a public health danger especially in western Europe and Australia. Human deaths following vulnerability to raccoons, shunks, foxes, mongooses and other wild carnivore host species are very rare.

Dissemination of this disease can also take place when infectious material – generally saliva – comes into immediate contact with human mucosa or fresh skin injuries. Human-to-human transmission by bite is hypothetically possible but has never been established.

Rarely, rabies may be developed by inhalation of aerosol that contains virus or through transplantation of an infected organ. Ingestion of uncooked meat or other tissues from rabies-infected animals is not a confirmed source of human infection.

Preventive Treatment After Contact.

This is also called post-exposure prophylaxis (PEP) and this means the treatment of a bite victim that is begun instantly after contact with rabies in order to prevent rabies from entering the central nervous system(CNS) which would lead to impending death. It includes the following such as:

• treatment of the injury in a traditional or local way, set up as soon as possible after exposure;
• a course of efficacious rabies vaccine that satisfies WHO standards; and
• the provision of rabies immunoglobulin (RIG), if recommended.

It is worthy to note that effective treatment soon after contact with rabies can prevent the onset of symptoms and death.

Treatment of the injury in a local or conventional way

This entails first-aid of the injury which consists of urgent and rigorous flushing and washing of the injury for at least 16-20 minutes with soap and water, povidone iodine or other substances which eliminate the rabies virus.

Approved Preventive treatment after contact

Provision of approved preventive treatment after contact is suggested below depending on the severity of the contact administering with the uncertain rabid animal:

Table: The Classifications of contact and approved preventive therapy after contact
Classifications of contact with suspect rabid animal	Preventive treatment measures
Class I – touching or feeding animals, licks on intact skin	None
Class II – nibbling of uncovered skin, slight scratches or abrasions without bleeding	Instant vaccination and local treatment of the injury
Class III – single or multiple scratches or bites, licks on broken skin; contamination of mucous membrane with saliva from licks, contacts with bats.	Instant vaccination and administration of rabies immunoglobulin; local treatment of the injury

Each of class II and III exposures evaluated as carrying a risk of developing rabies require preventive treatment after contact. This risk is escalated if:

• the biting vertebrate is a recognized rabies reservoir or vector species;
• the animal looks sick or shows an unusual behaviour;
• an injury or mucous membrane was contaminated by saliva of the animal;
• the bite was unwarranted; and
• no vaccination has been done on the animal.

In developing countries, the vaccination status of the suspected animal should not only be contemplated when determining whether to initiate prophylaxis or not.

The World Health Organization keeps on promoting human rabies prevention through the eradication of rabies in dogs including wider utilization of the intradermal route for approved preventive treatment(also called PEP) which decreases volume and with the cost of cell-cultured vaccine by 60% to 80%.

World Health Organization reaction

Rabies, a terrible zoonotic disease, demands close co-ordination within human and animal health sectors at the national, regional and continental levels.

A global system to reach zero human rabies deaths by 2030 was begun by WHO and the World Organisation for Animal Health in December 2015, together with the Global Alliance for Rabies Control and Food and Agriculture Organization(FAO) of United Nations.  This approach spots the first time that the human and animal health sectors have come together to embrace a simple strategy against this destructive but massively overlooked disease.

Better steps have been made in some countries such as South Africa, Tanzania and Philippines where proof of concept projects as part of a Bill & Melinda Gates Foundation programme led by WHO not long ago disclosed that a reduction in human rabies is possible through a combination of interventions requiring dog vaccination, enhanced access to PEP, and increased surveillance and public awareness raising. The path towards assisting, encouraging and extending the rabies programmes to new territories and countries has been to start small, indicate success and cost-effectiveness, and ensure community engagement.

Stockpiles of dog and human rabies vaccine have had a catalytic end result on rabies eradication efforts. The World Health Organization is working to assemble forecasts on the supply of human and dog vaccines and the necessity for rabies immunoglobulin, to know the global manufacturing capacity and to explore bulk acquisition alternatives for countries through WHO/UNICEF (human vaccine and RIG) and OIE/WHO (animal vaccine) mechanisms.

However, the utilization of stimulus packages include technical and material support to kick-start rabies prevention schemes for endemic countries and regions has turned out to be successful. By enabling the implementation of proven control strategies, these give rise to sustainable rabies eradication programs and could wonderfully be spread to neighbouring regions and countries.

This dreadful disease(rabies) disseminated by dogs has been eradicated in many Latin American countries, including Uruguay, Chile, Costa Rica, Panama, most of Argentina, the states of São Paulo and Rio de Janeiro in Brazil, and other large parts of Mexico and Peru.

A lot of countries in the World Health Organization(WHO) South-East Asia Region have started eradication campaigns in line with the aim of regional eradication by 2020. Bangladesh initiated an eradication programme in 2010 and, through the management of dog bites, mass dog vaccination and raised availability of vaccines free of charge, human rabies deaths reduced by 50% throughout 2010–2013.