Rabies: Prevention is a must

Rabies is an acute and highly infectious disease caused by Rabies virus from saliva of a rabid animal. It is primarily a disease of warm blooded animals like dogs, foxes, jackals, mongooses, and wolves. In Bangladesh, almost all cases of rabies occur due to bite of rabid dogs. Rabies is also known as hydrophobia.

Rabies is clinically characterized by a prodromal stage of 3-4 days when there is slight fever, headache, malaise, sore throat, pain or tingling at the site of the bite. Then there is an excitation stage of 2-3 days when the patient is irritable, intolerant to sound and light, fear of water (hydrophobia), increased perspiration, salivation and lacrimation. Then after few days the patient dies.

In animals, rabies may be Dumb or Paralytic type and furious type. In dumb or Paralytic type, the animal is paralysed. Its jaw drops and continuous salivation occurs. In furious type, the animal is restless, excited and aggressive and can bite anybody without provocation. Once rabid, the animal does not survive for more than 7 days.

Rabies is transmitted from rabid animal to others through bites, scratches or licks of rabid animals. Bite of the animal may be unprovoked bite or provoked bite. Unprovoked bite is generally considered as from rabid animal. Rabies occurs usually 3-8 weeks after the exposure. And a rabid can transmit the disease till death.

There is no treatment of rabies. Hundred percent of the patients die within few days. There are ways of prevention of rabies. Since rabies has got no treatment and since it is a fatal disease, steps must be taken so that the disease does not occur. That is rabies must be prevented.

Prevention and control rabies

After an animal bite, scratch or lick, rabies can be prevented by local treatment of the wounds followed by immediate vaccine administration with or without rabies immunoglobulin. This is called post-bite or post-exposure prevention. Immediately the wounds should be washed and flushed thoroughly with soap and running water for a minimum of 15 minutes period. Then vaccine and immunoglobulin should be given as per following schedule:

Category I (Touching or feeding animals or licks on the intact skin):

Treatment: No treatment or vaccination is required.

Category II (Minor scratches or abrasions on the skin without bleeding,

licks on broken skin):

Treatment:    a. Immediate washing and flushing of the wounds.

b. Immediate vaccination.

Category III (Single or multiple bites or scratches with bleeding):

Treatment:    a. Immediate washing and flushing of all wounds

b. Immediate vaccination.

c. Immediate administration of rabies immunoglobulin.

Anti-rabies vaccines:

There are safe vaccines like duck embryo vaccine and cell culture vaccines to prevent rabies. Cell culture vaccines include human diploid cell vaccine, purified chick embryo cell vaccine and purified vero cell vaccine. World Health Organization recommends duck embryo vaccine and cell-culture vaccines for prevention of rabies.

Dosage schedule of vaccine for post-exposure prevention:

Intramuscular schedule: 5 doses of the vaccine are given in the muscle of the upper part of the arm (in the thigh in case of young children) on days 0, 3, 7, 14 and 28. Another booster dose is to be given on day 90. Day 0 indicates the date of first injection.

Abbreviated 2-1-1 intramuscular schedule: One dose of vaccine is given in the right arm and one dose in the left arm on day 0. Then one dose is given in the muscle of the upper part of the arm on day 7 and again on day 21.

2-site Intradermal schedule (2-2-2-0-1-1): One dose at each of two sites into the skin over the muscle of the upper part of the arm is given on days 0, 3 and 7; and at one site on days 28 and 90.

If the person was vaccinated previously, the person should receive three doses of vaccine in the muscle of the upper part of the arm on day 0, 3 and 7.

Licensing and immunizing pet dogs and destruction of stray dogs are also helpful in the control of rabies.

 

Rabies: Prevention is a must

Rabies is an acute and highly infectious disease caused by Rabies virus from saliva of a rabid animal. It is primarily a disease of warm blooded animals like dogs, foxes, jackals, mongooses, and wolves. In Bangladesh, almost all cases of rabies occur due to bite of rabid dogs. Rabies is also known as hydrophobia. Rabies is clinically characterized by a prodromal stage of 3-4 days when there is slight fever, headache, malaise, sore throat, pain or tingling at the site of the bite. Then there is an excitation stage of 2-3 days when the patient is irritable, intolerant to sound and light, fear of water (hydrophobia), increased perspiration, salivation and lacrimation. Then after few days the patient dies. In animals, rabies may be Dumb or Paralytic type and furious type. In dumb or Paralytic type, the animal is paralysed. Its jaw drops and continuous salivation occurs. In furious type, the animal is restless, excited and aggressive and can bite anybody without provocation. Once rabid, the animal does not survive for more than 7 days. Rabies is transmitted from rabid animal to others through bites, scratches or licks of rabid animals. Bite of the animal may be unprovoked bite or provoked bite. Unprovoked bite is generally considered as from rabid animal. Rabies occurs usually 3-8 weeks after the exposure. And a rabid can transmit the disease till death. There is no treatment of rabies. Hundred percent of the patients die within few days. There are ways of prevention of rabies. Since rabies has got no treatment and since it is a fatal disease, steps must be taken so that the disease does not occur. That is rabies must be prevented. Prevention and control rabies After an animal bite, scratch or lick, rabies can be prevented by local treatment of the wounds followed by immediate vaccine administration with or without rabies immunoglobulin. This is called post-bite or post-exposure prevention. Immediately the wounds should be washed and flushed thoroughly with soap and running water for a minimum of 15 minutes period. Then vaccine and immunoglobulin should be given as per following schedule: Category I (Touching or feeding animals or licks on the intact skin): Treatment: No treatment or vaccination is required. Category II (Minor scratches or abrasions on the skin without bleeding, licks on broken skin): Treatment: a. Immediate washing and flushing of the wounds. b. Immediate vaccination. Category III (Single or multiple bites or scratches with bleeding): Treatment: a. Immediate washing and flushing of all wounds b. Immediate vaccination. c. Immediate administration of rabies immunoglobulin. Anti-rabies vaccines: There are safe vaccines like duck embryo vaccine and cell culture vaccines to prevent rabies. Cell culture vaccines include human diploid cell vaccine, purified chick embryo cell vaccine and purified vero cell vaccine. World Health Organization recommends duck embryo vaccine and cell-culture vaccines for prevention of rabies. Dosage schedule of vaccine for post-exposure prevention: Intramuscular schedule: 5 doses of the vaccine are given in the muscle of the upper part of the arm (in the thigh in case of young children) on days 0, 3, 7, 14 and 28. Another booster dose is to be given on day 90. Day 0 indicates the date of first injection. Abbreviated 2-1-1 intramuscular schedule: One dose of vaccine is given in the right arm and one dose in the left arm on day 0. Then one dose is given in the muscle of the upper part of the arm on day 7 and again on day 21. 2-site Intradermal schedule (2-2-2-0-1-1): One dose at each of two sites into the skin over the muscle of the upper part of the arm is given on days 0, 3 and 7; and at one site on days 28 and 90. If the person was vaccinated previously, the person should receive three doses of vaccine in the muscle of the upper part of the arm on day 0, 3 and 7. Licensing and immunizing pet dogs and destruction of stray dogs are also helpful in the control of rabies.