Concerned parents, watch out for rabies

Concerned parents, watch out for rabies

By Donya Betancourt

SANUR, Bali (JP): Fear of rabies from animal bites is one of
the most common reasons for visits to the medical emergency room.

Rabies is a viral infection of the central nervous system and
causes acute encephalitis in all warm-blooded hosts, including
humans. The outcome is virtually 100 percent fatal once symptoms
develop.

The World Health Organization (WHO) reported in 1998 that
between 35,000 and 50,000 people died from rabies, while 10
million people had been given the rabies vaccine each year.

Early symptoms of rabies in humans are nonspecific, consisting
of fever, headache and general malaise. As the disease
progresses, neurological symptoms appear and may include
insomnia, anxiety, confusion, slight or partial paralysis,
excitation, hallucinations, agitation, hypersalivation,
swallowing difficulties and hydrophobia (fear of water).

Once clinical signs of rabies appear, the disease is nearly
always fatal and treatment is typically supportive. Non-lethal
exceptions are extremely rare, with only a few cases reported and
each case had some form of vaccination.

The majority of dog-related attacks occur to children aged
between six and 11 years old. The rabies infection occurs in
warm-blooded animals throughout the world; dogs, cats, bats,
skunks, raccoons and foxes.

In animals, as in humans, the principal symptoms of rabies is
encephalitis. The incubation period for rabies in an infected dog
varies from between 14 and 180 days, for humans it is an extreme
variable ranging from nine days to seven years but usually
between 20 and 180 days peaking at between 30 and 60 days.

We know most transmissions are through the salivary glands.
However, do remember that transmission can also occur from non-
bite exposures; scratches by animal claws are dangerous because
animals lick their claws. There is no treatment for rabies after
symptoms of the disease appear.

How can we prevent infection from rabies?

There is a rabies vaccine regimen that provides immunity to
rabies when administered after an exposure (postexposure
prophylaxis), or for protection before an exposure occurs
(preexposure prophylaxis).

Preexposure prophylaxis is given for high-risk groups, such as
veterinarians, animal holders or anyone who has frequent contact
with animals. Preexposure prophylaxis consists of three doses of
rabies vaccine given on days 0, 7 and 21 or 28.

Postexposure prophylaxis (PEP) is indicated for persons
possibly exposed to a rabid animal. Possible exposure includes
animal bites or mucous membrane contamination with infectious
tissue, such as saliva.

PEP should begin as soon as possible after an exposure. There
have been no vaccine failures in the United States (i.e. someone
developed rabies) when PEP was given promptly and appropriately
after an exposure. Administration of rabies PEP is a medical
urgency -- not a medical emergency. Regimen is five doses of
rabies vaccine over a 28-day period. The first dose of rabies
vaccine should be given as soon as possible after exposure.

Additional doses of rabies vaccine should be given on days 3,
7, 14 and 28 after the first vaccination. Current vaccines are
relatively painless and are applied to an adult's arm or a
child's thigh.

If you are exposed to a potentially rabid animal, wash the
wound thoroughly with soap and water and seek medical attention
immediately. A health care provider will care for the wound and
will assess the risk of rabies exposure.

PEP in USA recommend one dose of rabies immunoglobulin and
five doses of rabies vaccine. Observation and restraining the dog
or cat for 10 days is recommended. Why 10 days? Because from the
time rabies is introduced to the brain until symptoms are shown
is a maximum of 10 days. Rabies can be transmitted to others only
if there is virus in the saliva. So, if the dog was bitten by a
rabies-infected animal but the virus is in a peripheral nerve and
not in the saliva than it won't spread the virus to humans.

In conclusion, rabies is a fatal disease that should be taken
seriously. If you are bitten by an animal, you should clean your
wound immediately, tie up or chain the animal for 10 days and go
to see the doctor to get a rabies vaccine with or without
immunoglobulin depending on your doctor's advice.

-- The writer is a pediatrician based in Sanur, Bali. Questions?
Contact her at drdonya@hotmail.com, or
features@thejakartapost.com