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