The World Health Organization (WHO) has declared every September 28, as World Rabies Day with a call for action by setting a goal of zero human dog-mediated rabies deaths by 2030, worldwide. World Rabies Day provides a platform to improve awareness. Kindly use your popular column to share highlights about the disease.

Rabies is a zoonotic disease (a disease that is transmitted to humans from animals) that is caused by a virus. The disease affects domestic and wild animals, and is spread to people through close contact with infectious material, usually saliva, via bites or scratches.

Rabies is present on all continents with the exception of Antartica, but more than 95% of human deaths occur in Asia and Africa. Once symptoms of the disease develop, rabies is nearly always fatal. Rabies is a neglected disease of poor and vulnerable populations whose deaths are rarely reported. It occurs mainly in remote rural communities where measures to prevent dog to human transmission have not been implemented according to WHO.

What are the symptoms?
The incubation period for rabies is typically 1–3 months, but may vary from less than one week to above one year. The initial symptoms of rabies are fever and often pain or an unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site. As the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops.

Two forms of the disease can follow. People with furious rabies exhibit; signs of hyperactivity, excited behaviour and hydrophobia (fear of water). After a few days, death occurs by cardio-respiratory arrest.

Paralytic rabies accounts for about 30% of the total number of human cases. This form of rabies runs a less dramatic and usually longer course than the furious form. The muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the under-reporting of the disease.

How is it diagnosed?
No tests are available to diagnose rabies infection in humans before the onset of clinical disease, and unless the rabies-specific signs of hydrophobia are present, the clinical diagnosis may be difficult. Human rabies can be confirmed intra-vitam and post mortem by various diagnostic techniques aimed at detecting whole virus, viral antigens or nucleic acids in infected tissues (brain, skin, urine or saliva).

How it is transmitted?
People are usually infected following a deep bite or scratch by an infected animal. Dogs are the main host and transmitter of rabies.

Rarely, rabies may be contracted by inhalation of virus-containing aerosol or via transplantation of an infected organ. Ingestion of raw meat or other tissues from animals infected with rabies is not a source of human infection.

Awareness on rabies and preventing dog bites

Education on dog behaviour and bite prevention for both children and adults is an essential extension of a rabies vaccination programme 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 measures after a bite. Engagement and ownership of the programme at the community level increases reach and uptake of key messages.

What are the Post-exposure Prophylaxis (PEP)?

Post-exposure prophylaxis (PEP) consists of:

1. Local treatment of the wound, initiated as soon as possible after exposure.

2. A course of potent and effective rabies vaccine that meets WHO recommendations.

3. The administration of rabies immunoglobulin, if indicated.

4. Effective treatment soon after exposure to rabies can prevent the onset of symptoms and death.

Removing the rabies virus at the site of the infection by chemical or physical means is an effective means of protection. Therefore, prompt local treatment of all bite wounds and scratches that may be contaminated with rabies virus is important.

Preventive immunization in people
Human rabies vaccines exist for pre-exposure immunization. These are recommended for people in certain high-risk occupations such as laboratory workers handling live rabies and rabies-related (lyssavirus) viruses; and people (such as animal disease control staff and wildlife rangers) whose professional or personal activities might bring them into direct contact with bats, carnivores, or other mammals that may be infected.

Pre-exposure immunization is also recommended for travellers to rabies-affected, remote areas who plan to spend a lot of time outdoors involved in activities such as caving or mountain-climbing. Expatriates and long-term travellers to areas with a high rabies exposure risk should be immunized if local access to rabies biologics is limited. Finally, immunization should also be considered for children living in, or visiting, remote, high-risk areas. As they play with animals, they may receive more severe bites, or may not report bites.

Recommended first-aid procedures include immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.

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