Rabies

Rabies has been a terrifying disease for centuries, often associated with animal bites and uncontrollable behaviour. Despite being vaccine-preventable, rabies continues to claim tens of thousands of lives globally every year. In many developing nations, the lack of awareness, delayed treatment, and poor access to healthcare contribute to the persistence of this disease. Educating communities about rabies, its risks, and preventive measures can save countless lives.

Rabies is a viral infection caused by the rabies virus, a member of the Lyssavirus genus. It primarily affects mammals and is transmitted through saliva, usually via bites or scratches from an infected animal. Once the virus enters the body, it travels through peripheral nerves to the brain, leading to inflammation and ultimately causing encephalitis. If left untreated after exposure, rabies is almost always fatal once symptoms manifest.

India

India accounts for approximately 36% of the world’s rabies deaths, according to WHO. The disease is endemic and causes around 20,000 deaths annually. Most cases are due to dog bites, especially in rural areas where access to post-exposure prophylaxis (PEP) is limited.

Worldwide

Globally, rabies causes an estimated 59,000 human deaths each year, predominantly in Asia and Africa. Although eradicated in many high-income countries through vaccination and animal control, rabies remains a significant public health issue in low- and middle-income nations.

There are two main types of rabies based on symptoms:

1. Furious Rabies – The more common form, characterised by hyperactivity, hallucinations, and aggression.
2. Paralytic Rabies – Less common and more subtle, leading to muscle weakness and gradual paralysis.

Rabies is caused by the rabies virus, transmitted mainly through:

• Animal bites – Especially from dogs, bats, raccoons, foxes, and skunks.
• Scratches – If the skin is broken by an infected animal.
• Saliva contact with open wounds or mucous membranes – Rare but possible.

The virus enters the peripheral nerves and travels to the brain, where it replicates rapidly, causing severe neurological damage.

Rabies symptoms appear in stages and can take days to months to develop after exposure. Early signs resemble the flu:

• Fever
• Headache
• Fatigue
• Irritability
• Pain or tingling at the wound site

As the disease progresses:

Furious Rabies

• Anxiety and confusion
• Hallucinations
• Hydrophobia (fear of water)
• Aerophobia (fear of air drafts)
• Muscle spasms
• Agitation and aggressive behaviour

Paralytic Rabies

• Gradual muscle weakness
• Paralysis beginning at the site of the bite
• Coma
• Death
   

Diagnosing rabies is complex and often based on symptoms, especially in endemic areas. Common methods include:

• Medical history and physical examination – Recent animal bites or exposure are critical clues.
• Saliva tests – Detect virus presence using RT-PCR.
• Skin biopsy – Tests on nerve-rich tissues at the nape of the neck.
• Cerebrospinal fluid analysis – Looks for antibodies.

In animals, rabies is usually confirmed via post-mortem brain tissue analysis.

There is no effective treatment once clinical symptoms appear. However, prompt post-exposure prophylaxis (PEP) is highly effective if administered before symptoms develop:

1. Wound care – Wash the wound thoroughly with soap and water for at least 15 minutes.
2. Rabies Immunoglobulin (RIG) – For immediate passive immunity. (Berirab P 300 IU Injection)
3. Rabies Vaccine – A series of injections to stimulate active immunity. (Rabivax S Vaccine)

PEP must be started as soon as possible after exposure. Once symptoms appear, the disease is almost always fatal.

There is no alternative medicine that can cure rabies. However, complementary approaches can aid post-exposure care:

• Aloe vera gel – May provide local relief for bite wounds.
• Turmeric – Known for its anti-inflammatory properties.
• Holy basil – Used in traditional medicine, although not scientifically proven for rabies.

These therapies should never replace PEP and are only supportive.

The risk of contracting rabies increases with:

• Living in rabies-endemic regions
• Being unvaccinated
• Working with animals (vets, animal handlers)
• Exposure to wild or stray animals
• Poor access to medical care

Rabies can lead to serious complications, especially once symptoms develop:

• Paralysis
• Seizures
• Coma
• Cardiac arrest
• Respiratory failure
• Death

Even survivors of experimental treatments like the Milwaukee Protocol face long-term neurological issues.

individuals at high risk of exposure can take steps to protect themselves:

• Get pre-exposure vaccination
• Avoid unfamiliar animals
• Keep emergency contacts and vaccine locations handy
• Wear protective gear when working with animals

For survivors (very rare), long-term care involves:

• Neurological therapy
• Psychological support
• Physiotherapy

1. "Only dog bites cause rabies." – Bats, cats, raccoons, and foxes can also transmit the virus.
2. "You only need a shot if you see symptoms." – By then, it’s often too late.
3. "Rabies vaccines cause serious side effects." – Vaccines are generally safe and well-tolerated.
4. "Children don’t get rabies." – Children are at higher risk due to frequent animal interactions.

Seek immediate medical attention if:

• You’ve been bitten or scratched by an animal
• You’ve been in contact with animal saliva
• A pet or wild animal shows erratic behaviour
• You are travelling to a high-risk country

Early medical care is crucial for successful prevention.

• Should I get a pre-exposure rabies vaccine?
• How soon should I get treated after an animal bite?
• What are the side effects of rabies vaccines?
• Is it safe to vaccinate pregnant or breastfeeding women?
• How do I monitor my pet for rabies symptoms?

If someone has been exposed or is under observation for rabies:

• Provide emotional support and reassurance
• Ensure timely medical follow-ups
• Educate their family on precautions
• Encourage vaccination of household pets

If the person is undergoing post-exposure treatment:

• Accompany them to appointments
• Help them adhere to the vaccination schedule
• Assist with documentation and reporting
   

Rabies remains one of the most preventable yet deadly diseases globally. Timely vaccination, awareness, and proper wound care can save lives. In countries like India where the disease is still prevalent, public health initiatives and responsible pet ownership are essential to reduce incidence rates. With a global push for zero rabies deaths by 2030, individual and community participation is vital.