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What is rabies?

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VOL: 100, ISSUE: 44, PAGE NO: 31

Rabies is a viral disease caused by the rabies virus, a member of the rhabdovirus family….

 

Rabies is a viral disease caused by the rabies virus, a member of the rhabdovirus family.

 

 

- It is mostly transmitted to humans by dogs.

 

 

- Once established in the body, the disease is fatal.

 

 

- Pre-exposure vaccination is recommended for at-risk individuals.

 

 

- Post-exposure vaccination must be obtained as soon as possible.

 

 

How is it spread?

 

- Dog bites are the most common source of infection.

 

 

- Other animals can also carry the virus including bats, cats, foxes, skunks and monkeys.

 

 

- The virus has in some cases been spread by an animal licking a fresh skin break.

 

 

- Animals may be infectious for five days before their symptoms develop.

 

 

- There is no evidence that rabies can be spread between humans.

 

 

- Before the introduction of screening protocols there were cases of rabies being contracted by corneal transplant.

 

 

Incidence

 

- Human rabies is extremely rare in the UK - about 20 human cases of rabies have been imported into England and Wales since 1946.

 

 

- But the disease is common worldwide, causing an estimated 35,000 to 50,000 deaths each year, mainly in developing countries.

 

 

- One-third to one-half of deaths occur in children under 15.

 

 

- In the past few years rabies-like viruses known as European bat lyssaviruses (EBLs) have been found in bats in the UK.

 

 

- EBLs rarely cross from bats to humans. In 2002 a bat handler died in Scotland from an EBL.

 

 

- In September this year a bat infected with EBL was found in an alley in Staines. Members of the public were advised not to handle any sick or injured bat.

 

 

Symptoms

 

- Itching and tingling at the site of infection.

 

 

- Headache and fever.

 

 

- Spasm of the swallowing muscles, which may lead to hydrophobia.

 

 

- Delirium and convulsions.

 

 

- Paralysis.

 

 

- Respiratory failure.

 

 

The incubation period

 

- Generally 2-8 weeks, but it can be months or, in rare cases, years.

 

 

- The type and location of the bite is thought to influence the length of the incubation period.

 

 

Treatment

 

- Clean all bites with soap and water. Encourage limited bleeding.

 

 

- Wounds on the head, face and neck require extra cleansing.

 

 

- Apply alcohol if available. Do not stitch the wound.

 

 

- Administer post-exposure vaccine without delay as the incubation period can be as short as four days.

 

 

- Travellers need to obtain a modern cell-culture vaccine. If necessary, contact the British embassy or consulate for a supply.

 

 

- Some countries offer locally produced vaccines, given into the abdomen, which are less effective.

 

 

- Five to six doses plus a human rabies immunoglobulin (HRIG) injection are needed.

 

 

- Travellers who have had pre-exposure vaccination only need two doses of post-exposure vaccine and no HRIG as the body is primed to respond.

 

 

Prevention

 

- Do not approach or touch animals that are behaving strangely.

 

 

- Pre-exposure immunisation is recommended for at-risk groups. If bitten the body’s responses can be quickly activated by booster doses of vaccine.

 

 

- Two doses of the rabies vaccine a month apart give adequate cover for 6-12 months. High-risk groups such as vets and animal handlers need more intensive prophylaxis.

 

 

- At-risk groups must be educated about action to take if bitten.

 

 

- Dog vaccination programmes are effective. In areas where 80 per cent of the dog population is vaccinated, rabies cases fall radically.

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