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Rabies

Rabies is an acute encephalitis (infection of the brain) caused by a virus believed to be infectious for most mammals. Transmission of the virus is usually through a bite. Transmission also can occur by exposure of a scratch, abrasion, open wound or mucous membrane to saliva or brain material of a rabid animal. The virus has an affinity for the central nervous system tissue and travels along the peripheral nerves to the brain. Once the virus is established in the brain the disease is seldom reversible and usually fatal. The average incubation period varies from 20-90 days after exposure and depends on the following circumstances: a) severity of bite or laceration, b) location of bite (incubation periods may be shorter after bites on head, neck, and fingertips, than bites on the trunk or lower extremities due to extensive nerve endings in the former areas), c) age of the victim (children have faster onset). Two clinical patterns may be manifest and are referred to as "dumb" or paralytic rabies and furious rabies (prone to bite).

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2 types:

1. Furious “classical” rabies (dogs): hydrophobia, aerophobia + convulsions / paralysis

2. Dumb “paralytic” rabies (bats): paralysis similar to Guillan Barre in development.

If someone is bitten by a cat, dog or any animal:

• Wash the wound immediately with soap and running water for at least five minutes
• See a physician immediately, even for minor wounds
• If your pet bites someone or has been bitten, immediately confine the pet and contact the local animal control officer or public health agency and check with your veterinarian for treatment and rabies vaccination history.
• If the bite is from a wild or stray animal, DO NOT try to capture the animal unless you are sure you can do so without incurring injury.
• Do not destroy the animal which has bitten a human or other animal. Contact the local animal control officer or public health agency.
   

Treatment

• Wound cleansing

• WHO classifies bites into 3 categories:

  • Category I :Touching, feeding of animals or licks on intact skin no exposure therefore no treatment if history reliable.
  • Category II: Minor scratches or abrasions without bleeding or licks on broken skin and nibbling of uncovered skin. Use vaccine alone.
  • Category III: Single or multiple transdermal bites, scratches or contamination of mucous membrane with saliva (i. e. licks). Use immunoglobulin plus vaccine.

• Anti-rabies serum (RIG)

• Start vaccination: There are two WHO approved vaccination schedules:

  • Classical 5 dose intramuscular regime (“ Essen” regimen): one dose of the vaccine should be administered on days 0, 3, 7, 14 and 28 in deltoid region or, in small children, into the antero- lateral area of the thigh muscle.
  • As an alternative, the 2- 1- 1 regimen may be used. Two doses are given on day 0 in the deltoid muscle, right and left arm. In addition one dose in the deltoid muscle on day 7 and one on day 21.

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