Rabies: A Major Health Problem

Rabies is a preventable disease of mammals, including man, most often transmitted through the bite of an infected animal.

The rabies virus is bullet-shaped and is classified in the “rhadoviridae” virus family. Rabies is a fatal disease affecting the Central Nervous System and part of the brain, ultimately causing death.

Factors that may contribute to the outcome of rabies exposure include:

• Virus Variant

• Route and Severity of Exposure

• Location of the Exposure

• Host Species

• Individual Host factors such as:

• Age

• Host Immune Defense

Early Symptoms:

• Fever

• Headache

• General Malaise as the disease progresses,

• Neurological symptoms appear and may include:

• Insomnia

• Anxiety

• Confusion

• Slight or partial paralysis

• Excitation

• Hallucinations

• Agitation

• Hyper

• Salivation

• Difficulty in swallowing

• Hydrophobia – fear of water, and

• Aerophobia – fear of air

Facts and Figures

• Death usually occurs within 1-7 days from the onset of symptoms.

• In 1999, the Philippines ranked 3^rd in the number of rabies cases, worldwide. Every year, 300 – 400 Filipinos die of rabies with a 100 percent case fatality rate.

• In 2000, Central Luzon was included in the top 5 regions (Reg. 3, 4, 5, 11, and 12) with the most number of human rabies cases.

• 98 percent of human rabies is due to dog bites.

• There were more rabies cases among males than females; ages ranged from 1 – 14 years old.

Infectious Path of the Rabies Virus

1. A man is bitten by a rabid animal (i.e. dog).

2. The rabies virus enters through wounds/breaks in the skin.

3. The rabies virus multiplies then spreads through the nerves to the spinal cord and brain.

4. Incubation periods range from 3 weeks to 2 years (rarely more than 10 years).

5. When the Virus reaches the brain, main begin to show signs of disease.

6. The rabid man dies within 1 – 7 days of becoming sick.

Other routes of transmission

1. Inhalation of aerosolized virus in closed areas (i.e. rabid bats, laboratories for rabies diagnostics.

2. Tissue transplant from an undiagnosed rabid donor as documented in corneal transplantation.

What to do after bitten by animal

Victim:

• Wash wound thoroughly with soap and water.

• Apply alcohol/iodine to the exposed part.

• Seek immediate medical attention.

• Go to the nearest health center or hospital for the proper care of the wound and to assess the risk for rabies exposure.

Factors to consider before giving Post Exposure Treatment

• Nature of bite exposure

• The geographic location of the incident

• The type of animal that was involved

• How the exposure occurred (i.e. provoked or unprovoked)

• The vaccination/clinical status of the animal involved

• Whether the animal can be safely captured and observed for signs and symptoms of rabies

• Laboratory results of the animal examined

Categories of Wound Exposure

1. Touching/feeding of animals

2. Nibbling of uncovered skin, scratches/abrasions without bleeding, and/or licks on broken skin.

3. All head and neck bites. Single or multiple transdermal bites. Contamination of mucous membrane with saliva. Exposure to a rabid patients through bite or non-bite exposure (mouth to mouth resuscitation, licking of intact mucosa such as eyes, lips, and vulva).

Post Exposure Treatment

Provide Post Exposure Treatment (PET) which prevents rabies. It consists of active and/or passive immunization.

• Active Immunization

Vaccine is administered to induce anti-body and T-cell production in order to neutralize circulating rabies virus. It induces an active immune response (in 7 – 10 days after vaccination) and confers immunity for two years. Vaccines are given in a series of intramuscular or intradermal injections that require patients to make up to 5 visits to an animal Bite Treatment Center.

• Passive Immunization

Rabies immunoglobulin is concurrently given for immediate protection of patients with category III exposure. Protection last for a month only, that is why vaccines must always be given.

An Ounce of Prevention

• Submit dogs and cats for regular immunization.

• Avoid direct contact with unfamiliar animals.

• Maintain control of your pets by keeping domestic animals under direct supervision.

• Keep pets on a leash.