Rabies is a viral, zoonotic, vaccine-preventable disease. Once clinical symptoms appear, rabies is virtually 100% fatal. In up to 99% of cases, domestic dogs are responsible for transmitting the rabies virus to humans. However, rabies can affect both domestic and wild animals. It is spread to people and animals through bites or scratches, usually through saliva.
Rabies is present on all continents except Antarctica, with more than 95% of human deaths occurring in the Asian and African regions. Rabies is one of the Neglected Tropical Diseases (NTDs) that predominantly affects poor and vulnerable populations living in remote rural areas. Approximately 80% of human cases occur in rural areas. Although effective human and immunoglobulin vaccines for rabies exist, they are not readily available or accessible to those who need them.
Globally, rabies deaths are rarely reported and children between the ages of 5 and 14 are frequent victims. Managing a rabies exposure, where the average cost of rabies post-exposure prophylaxis (PEP) is currently estimated to average US$108, can be a catastrophic financial burden for affected families, whose income average daily can be as low as US$1–2 per person.
Each year, more than 29 million people around the world receive a post-bite vaccination. This is estimated to prevent hundreds of thousands of rabies deaths annually. Globally, the economic burden of dog-borne rabies is estimated at US$8.6 billion per year.
Eliminating rabies in dogs
Rabies is a vaccine-preventable disease. Vaccinating dogs is the most cost-effective strategy to prevent rabies in people. Dog vaccination reduces deaths attributable to dog-borne rabies and the need for PEP as part of dog bite patient care.
Rabies awareness and dog bite prevention.
Education on dog behaviour and bite prevention for both children and adults is an essential extension of a rabies vaccination program and can decrease both the incidence of human rabies and the financial burden of treating dog bites. . Increasing awareness of rabies prevention and control in communities includes education and information on responsible pet ownership, how to prevent dog bites, and immediate care steps after a bite. Participation and ownership of the program at the community level increase the reach and acceptance of the key messages.
Immunization of people
The same vaccine is used to immunize people after an exposure (see PEP) or before exposure to rabies (less common). Pre-exposure immunization is recommended for people in certain high-risk occupations, such as laboratory workers handling live rabies and rabies-related viruses (lyssaviruses); and people (such as animal disease control personnel and park rangers) whose professional or personal activities may bring them into direct contact with bats, carnivores, or other mammals that may be infected.
Pre-exposure immunization might also be indicated for outdoor travellers and expatriates living in remote areas with a high risk of rabies exposure and limited local access to rabies biologics. Finally, immunization of children living in or visiting such areas should also be considered. While playing with the animals, they may receive more severe bites or may not report the bites.
The incubation period for rabies is usually 2-3 months but can vary from 1 week to 1 year, depending on factors such as the location of virus entry and viral load. Initial symptoms of rabies include fever with unusual or unexplained pain and tingling, pricking, or burning sensation (paresthesia) at the wound site. As the virus spreads to the central nervous system, progressive and fatal inflammation of the brain and spinal cord develops.
There are two forms of the disease:
Furious rage results in signs of hyperactivity, excitable behaviour, hydrophobia (fear of water), and sometimes aerophobia (fear of drafts or the outdoors). Death occurs after a few days due to cardiorespiratory arrest. Paralytic rabies accounts for about 20% of the total number of human cases. This form of rage follows a less dramatic and generally longer course than the furious form. The muscles are gradually paralyzed, beginning at the site of the bite or scratch. A coma slowly develops, and eventually, death ensues. The paralytic form of rabies is often misdiagnosed, contributing to underreporting of the disease.
Current diagnostic tools are not adequate to detect rabies infection before the onset of clinical illness, and unless rabies-specific signs of hydrophobia or aerophobia are present, clinical diagnosis can be difficult. Human rabies can be confirmed intravitam and postmortem by various diagnostic techniques that detect whole virus, viral antigens, or nucleic acids in infected tissues (brain, skin, or saliva)
People generally become infected after a deep bite or scratch from a rabid animal, with transmission to humans from rabid dogs accounting for up to 99% of cases. In the Americas, bats are now the main source of human rabies deaths, as transmission through dogs has been mostly interrupted in this region. Bat rabies is also an emerging public health threat in Australia and Western Europe. Human deaths after exposure to foxes, raccoons, skunks, jackals, mongooses, and other wild carnivorous host species are very rare, and rodent bites are not known to transmit rabies.
Transmission can also occur if saliva from infected animals comes into direct contact with human mucosa or fresh skin wounds. Contraction of rabies by inhalation of virus-containing aerosols or by transplantation of infected organs has been described but is extremely rare. Transmission from person to person through bites or saliva is theoretically possible but has never been confirmed. The same applies to transmission to humans through the consumption of raw meat or milk from infected animals.
Post Exposure Prophylaxis (PEP)
Post-exposure prophylaxis (PEP) is the immediate treatment of a bite victim after exposure to rabies. This prevents entry of the virus into the central nervous system, resulting in imminent death. PEP consists of:
- Extensive washing and local treatment of the bite or scratch wound as soon as possible after a suspected exposure;
- a potent and effective rabies vaccine course that meets WHO standards; Y
- administration of rabies immune globulin (RIG), if indicated.
- Starting treatment soon after exposure to the rabies virus can effectively prevent the onset of symptoms and death.
Extensive wound washing
This first aid measure includes immediately and thoroughly rinsing and washing the wound for a minimum of 15 minutes with soap and water, detergent, povidone-iodine, or other substances that kill and kill the rabies virus.
Integrated bite case management
If possible, veterinary services should be alerted, the biter identified, removed from the community and quarantined for observation (for healthy dogs and cats) or sent for immediate laboratory examination (dead or euthanized animals showing signs of rabies clinics). PEP should be continued during the 10-day observation period or while awaiting laboratory results.
Treatment can be discontinued if the animal is shown to be free of rabies. If a suspected animal cannot be captured and examined, then a full PEP course must be completed. Joint contact tracing by public health and veterinary services is encouraged to identify additional animals suspected of rabies and victims of human bites, with the aim of applying preventive measures accordingly.