GO COMPILATION

Immediate measures are required if bitten by a rabid dog. First, take a series of anti-rabies injections.

RABIES IS a disease (caused by the rabies virus) primarily of animals, including both wild and domestic animals and human beings. Although people usually associate rabies with dogs, among domesticated animals, rabies today is more likely to be found in cats.

Cats, dogs and cattle account for nearly 90 percent of rabies cases in domestic animals, with horses, sheep and goats making up the remaining cases. Other wild species in this country in which rabies is commonly found include bats, foxes and rodents. The rabies virus, present in the saliva of an infected animal, is usually spread by a bite or scratch that punctures the victim’s skin.

SPREAD

RABIES is almost always contracted by exposure to a rabid animal. There are several ways in which rabies can be transmitted: a) By the bite of an infected animal, b) By a scratch, abrasion, or open wound coming in contact with infectious material (i.e. blood or saliva of an infected animal), c) By mucous membrances coming in contact with infectious material, d) By the airborne route : There are a few documented cases of rabies being contracted in caves where bats reside and in laboratories that work with the virus. e) By human-to-human contact (e.g., a corneal transplant from an unknown infected individual).

The virus has a strong affinity for cells of the nervous system. It enters nerve cells at the site of the wound, travels to the brain, and then follows other nerve pathways to muscles and organs that are especially affected by rabies. There are at least two other ways in which humans have been known to have contracted rabies, both extremely rare. Two people were exposed by breathing the air in caves inhabited by rabid bats. And six people contracted rabies following implants of corneas from donors who had undiagnosed rabies.

The virus concentrates in the salivary glands, which explains why it is usually spread by bites. It also invades and damages the muscles involved in drinking and swallowing.

Most human victims, and apparently lower animals as well, suffer excruciating pain on swallowing liquids. Though they suffer from thirst, animal and human rabies victims can be terrified by the sight of water, hence another name for the disease, hydrophobia.

SYMPTOMS

SYMPTOMS usually develop between 20 and 60 days after exposure. Rabid animals may become aggressive, combative and highly sensitive to touch and other kinds of stimulation. And they can be vicious. This is the "furious" form of rabies, the kind traditionally associated with mad dogs.

There is also a "dumb" form of the disease in which the animal is lethargic, weak in one or more limbs, and unable to raise its head or make sounds because its throat and neck muscles are paralysed. In both kinds of animal rabies, death occurs a few days after symptoms appear, usually from respiratory failure.
In humans, the course is similar. After a symptom-free incubation period that ranges from ten days to a year or longer (the average is 30 to 50 days), the patient complains of malaise, loss of appetite, fatigue, headache and fever. Over half of all patients have pain (sometimes itching) or numbness at the site of exposure. They may complain of insomnia or depression.

Two to ten days later, signs of nervous system damage appear, hyperactivity and hypersensitivity, disorientation, hallucinations, seizures, and paralysis. Death may be sudden, due to cardiac or respiratory arrest, or follow a period of coma that can last for months with the aid of life-support measures.

PREVENTION

UNLIKE other immunisations, the rabies vaccine is administered after exposure to the virus. This unusual technique is successful because the rabies virus takes a comparatively long time to induce disease, a minimum of ten days and, in rare cases, up to a year.

The length of the incubation period apparently depends on both the location of the wound - the farther from the brain, the longer the incubation - and the dose of virus received. Treatment requires prompt scrubbing of the site with lot of water and soap, application of alcohol on the wound, followed by local administration of RIGs i.e. rabies immunoglobulin around the site of bite and five doses of tissue culture vaccine including human diploid cell rabies vaccine, administered in the arm on days 0,3,7,14 and 28 after exposure. Do not apply prickle concentrate, kerosene oil, petrol, mobile oil, etc on the wound. Do not go for spiritual/magical/tantrik way of curing. These are of no use and lack scientific credibility.

Prognosis. Exposure of man to a rabid animal does not always result in rabies. If preventive treatment is obtained promptly following a rabies exposure, most cases of rabies will be prevented. Untreated cases will invariably result in death.

Control Rabies. (a) Exposure to rabies may be minimised by removing all stray dogs and cats as well as having all pets vaccinated. (b) Wild animals should not be kept as pets. (c) Do not allow bats to live in your house. Remember: bats may carry rabies. (d) If you hunt, use gloves while skinning animals in particular while handling nervous tissue or organs, spine and brain for example. (e) Avoid picking up dead or abandoned animals, and do not capture or eat animals that do not look or act normal.

If rabies vaccine treatment is called for, it should be started as soon as possible after exposure. Counting the first day of vaccine treatment as day zero, injections are administered on days zero, three, seven, 14 and 28.

In addition to vaccines, patients who have not previously been vaccinated for rabies also receive an injection of Rabies Immune Globulin (RIG) on the day they get the first vaccine (day zero).

RIG is prepared from the blood of persons who have been immunised against rabies and contains antibodies to the rabies virus. This "passive" immunity helps protect patients during the period before the rabies vaccine causes their own immune system to counter the virus (active immunity).