Both animals and humans can be vaccinated against rabies as a preventive measure against the spread of this infectious disease. — Filepic
Rabies is a disease transmitted from animals to humans.
The World Health Organization (WHO) estimates that rabies causes over 59,000 human deaths annually worldwide, with 90-95% of the fatalities being recorded in Asia and Africa.
Out of this total, 40% involve children under 15 years of age.
In 2017, both human and canine (dog) rabies cases were reported in Sarawak, which had previously been free of the disease.
According to the Health director-general’s statement, that outbreak caused a total of 35 human rabies cases, with 33 deaths.
Two paediatric (child) patients were reported as the only survivors, although both suffered severe neurological complications.
What is rabies?
Rabies is a preventable viral disease primarily transmitted through the bite of a rabid animal.
The disease is caused by the rabies virus, a rhabdovirus of the genus Lyssavirus.
The virus can infect all warm-blooded animals, particularly mammals, with some species being more likely to transmit the disease.
According to the US Centers for Disease Control and Prevention (CDC), approximately 90% of human rabies cases worldwide are caused by rabid dogs.
In Malaysia, dogs are indeed the principal host of rabies.
Cats may act as alternate hosts, as a result of spillover infections from dogs.
Rabies is primarily transmitted through the saliva of infected animals, which contains a sufficient viral load to infect the nervous system, including the cerebrospinal fluid.
Infected dogs and cats may display various symptoms, such as excessive salivation, staggering or aggression.
Aside from the bite of a rabid animal, humans can also contract rabies through direct contact with the saliva or other bodily fluids of an infected animal on an open wound.
After exposure to the rabies virus, an infected person may initially experience symptoms such as headache, fever, a tingling or pricking sensation at the wound site, and muscle aches.
As the disease progresses, more severe symptoms, including agitation, difficulty swallowing (dysphagia), insomnia and a fear of water (hydrophobia), will develop.
If treatment is delayed, the rabies virus can spread to the central nervous system (i.e. the brain and spinal cord), leading to debilitating symptoms, and ultimately, death.
Managing a rabies bite
Effective post-exposure management immediately after exposure to the rabies virus can prevent death.
This management includes treatment of the wound, administration of the rabies vaccine, and if necessary, administration of rabies immunoglobulin.
When a person is bitten by, or has direct contact with, a rabid animal, it is crucial to seek immediate medical care.
A thorough examination by a doctor is essential for assessing the risk following the bite and determining the appropriate course of action for managing it.
The first course of action is to remove or inactivate the rabies virus at the exposure site using chemical or physical methods.
Prompt local treatment of all bite wounds, scratches or mucosal exposures that may be contaminated with the rabies virus is essential.
First aid measures should include thoroughly washing the wound area with soap and water for at least 15 minutes, and applying povidone-iodine or other suitable disinfectants that can kill and remove the virus.
Taking these immediate first aid measures can help prevent the onset of rabies symptoms and avoid potential death.
Other treatments, such as administration of antibiotics and anti-tetanus, should be provided if required.
The affected individual will receive rabies vaccination as part of post-exposure prophylaxis.
The number of doses required depends on the individual’s previous immunisation status.
For instance, unvaccinated individuals should receive four doses of the vaccine at specified intervals.
In contrast, immunocompromised persons, such as those with leukaemia, with HIV (human immunodeficiency virus) or taking immunosuppressive medicines, should receive an additional dose.
The number of doses may also vary depending on the route of injection.
In addition, individuals identified as at higher risk after evaluation will require the administration of rabies immunoglobulin.
This provides immediate antibodies to attack the rabies viruses until the body responds to the vaccines and actively produces antibodies on its own.
This promotes prompt viral clearance before they can invade the nervous system.
The rabies immunoglobulin is applied by injecting it into the wound and the surrounding tissues.
Protection against rabies
As the saying goes, prevention is better than cure.
Providing the rabies vaccine as a pre-exposure prophylaxis measure to high-risk groups can significantly reduce the risk of infection.
It is highly recommended for individuals likely to be exposed to rabid animals, such as veterinarians, animal handlers, local authority personnel and laboratory staff, to consider routine rabies vaccination.
Additionally, individuals travelling to areas where dog rabies is endemic should also consider getting vaccinated.
Individuals who have received a rabies vaccine should be monitored for potential adverse effects, such as pain or swelling at the injection site, rash, headache, nausea, muscle aches or shivering.
Additionally, there is a possibility of developing an allergic reaction after vaccination, with symptoms including hives, swelling of the face or throat, dizziness or difficulty breathing.
If such symptoms occur, seek immediate medical care for proper monitoring and treatment if necessary.
The best way to avoid rabies is to stay away from areas that may have animals suspected of carrying the virus.
Additionally, the public should avoid handling any wild animals, including stray dogs and cats.
Other than that, pet owners are advised to vaccinate their animals to reduce the risk of rabies, and to prevent their pets from coming into contact with wild animals.
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First aid measures and immediate medical attention are crucial after any incident involving a bite from an animal potentially infected with rabies.
If multiple doses of post-exposure anti-rabies vaccination are required, the affected individual should be prepared for several visits to healthcare facilities.
Missing any of these visits may reduce the effectiveness of rabies prevention.
In summary, rabies is a deadly disease transmitted from animals to humans, primarily through bites from infected animals like dogs.
Immediate post-exposure management, effective pre-exposure vaccination and preventive measures are crucial to prevent fatalities.
Any further enquiries regarding medicines can be submitted to the National Pharmacy Call Center (NPCC) on 1-800-88-6722 on Monday to Friday, from 8am to 5pm, except on public holidays.
Umi Kalthum Mohd Isa is a pharmacist at Hospital Sultan Idris Shah, Serdang, Selangor. This article is courtesy of the Health Ministry’s Pharmacy Practice and Development Division. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
