Bal Bharati Public School

THESIS - Rabies

Author: Tanish Mehra

Stream, class - XI B(PCB)

[23rd November, 2022]

 Acknowledgement

The success and final outcome of this project required a

lot of guidance and assistance from many people and I
am extremely fortunate to have got this all along the
completion of my project work.

I would like to express my special thanks to my teacher

Mrs. Archana Katoch who gave me the golden
opportunity to do this wonderful biology project. I would
also like to thank her for the valuable suggestions and
guidance helpful in various phases in the completion of
this project.
 INDEX
Part- I:

1. Why did I choose this topic

2. What is rabies
i. Transmission and pathogenesis
ii. Epidemiology
iii. Occurrence
iv. Symptoms
3. History of rabies
4. Can it be prevented?
5. Can it be treated/cured? If so, how?
 Why did I choose this topic?

I have always underestimated how utterly

terrifying, deadly and at the same time -
fascinating rabies is. After discovering the various
truths about this disease I decided to make my
project on this topic hoping to learn more about
rabies while educating others as well.
 What is Rabies?

Rabies is the oldest fatal zoonotic diseases, an animal disease transmissible to humans
known to mankind. It is caused by Lyssaviruses of the family Rhabdoviridae and can
affect all mammals including humans. Transmission occurs through exposure to
infectious saliva, mostly via bites of infected animals. Once symptoms of the disease
develop, rabies is inevitably fatal to both animals and humans. However, rabies is
100% preventable - wound cleansing as well as active (vaccine) and passive
(immunoglobulins) immunizations, done as soon as possible after suspect contact with
an animal and following WHO  recommendations can prevent the onset of rabies in
virtually all exposures.

Rabies is widely distributed across the globe. It is estimated that more than 55 000
people die of rabies each year, with 95% of human deaths occurring in Asia and
Africa. Most human deaths follow a bite from an infected dog. Between 30% to 60%
of the victims of dog bites are children under the age of 15. Globally, the most cost-
effective strategy for preventing rabies in people is by eliminating rabies in dogs and
wildlife animals through animal vaccinations.
 The Transmission and Pathogenesis

In most cases the disease is transmitted via the bite of rabid

animals which shed infectious virus with their saliva. The virus
enters the body through transdermal inoculation (i.e. wounds) or
direct contact of infectious material (i.e. saliva, cerebrospinal liquid,
nerve tissue) to mucous membranes or skin lesions. The virus can
not penetrate intact skin.

After entry the virus binds to cell receptors. Viruses may replicate
within striated muscle cells ore directly infect nerve cells.

The virus then travels via retrograde axoplasmatic transport

mechanisms to the central nervous system. Both motor and sensory
fibres may be involved depending on the animal infected.

Once it has reached the CNS, rapid virus replication takes place,
causing pathologic effects on nerve cell physiology. The virus then
moves from the CNS via anterograde axoplasmic flow within
peripheral nerves, leading to infection of some of the adjacent non-
nervous tissues, for example, secretory tissues of salivary glands.
The virus is widely disseminated throughout the body at the time
of clinical onset. With shedding of infectious virus in saliva the
infection cycle of rabies is completed.
 The Epidemiology

All lyssaviruses have evolved closely with distinct natural reservoir

hosts. The latter are animals species in which a pathogen of an
infectious disease are maintained independently. For lyssaviruses,
these are a wide range of mammalian species within the Carnivora
and Chiroptera (bats) orders with a global distribution.

It is generally accepted that bats are the true primary reservoir

hosts of almost all lyssaviruses . However, unlike all other
lyssaviruses, rabies viruses (RABVs) as the type species for
lyssaviruses have established multiple independent transmission
cycles in a broad range of carnivore host reservoirs, where
particular RABV lineages circulate within host conspecifics. From
the primary reservoir hosts the virus is sporadically transmitted to
domestic animals and to humans.

Of all carnivore host reservoirs the domestic dog is responsible for

more than 90% of all human rabies fatalities worldwide.
 Occurrence
Classical rabies caused by RABV occurs worldwide besides some
isolated countries and Western Europe that are regarded rabies
free. Carnivores, especially of the canidae family represent the
principal reservoir species and are responsible for the maintenance
of the infectious cycle and hence for the presence of the disease .
While wildlife rabies maintained by different reservoirs hosts
predominantly occurs in the Northern hemisphere, canine rabies is
by far more important for public health in the developing world.
Here, canine rabies contributes to 99% to the human death toll
causing more than 50.000 human casualties annually. Mainly
developing countries from Asia and Africa suffer from the burden
of the disease. The WHO regards rabies as a neglected disease and
efforts are promoted to establish wider access to appropriate post-
exposure treatment for humans. Dog rabies control by mass
vaccination campaigns and dog population management are
supported and are the only way to control the disease. In South
America tremendous success towards the elimination of canine
rabies has been achieved. In the Americas, bat species are also
reservoir for RABV.
 The Symptoms
The incubation period (the time the virus spreads from the
peripheral nerves near the site of the bite via the spinal cord to the
brain – see transmission and pathogenesis) ranges in general
between 2 and 3 month (2 weeks to 6 years are reported)
depending on the site of infliction, the amount of virus and the
virus strain. Due to its neurotropism all known lyssaviruses cause
severe neurological symptoms as a result of an acute encephalitis.
Therefore, clinical signs in humans and animals are very similar.

The infection progresses in a predictable manner, from the initial

prodormal phase to the manifest as furious or paralytic forms of
rabies; the outcome is almost always fatal.

Humans

After (bite) exposure with a rabid animal, initial symptoms of

rabies are of non-specific nature and may be very similar to those
of other infectious diseases including general weakness or
discomfort, fever, or headache. A first specific clinical sign is
neuropathic pain or a prickling or itching sensation at the site of
the bite. Signs rapidly progress and include cerebral dysfunction,
anxiety, confusion, agitation, delirium, abnormal behavior,
hallucinations, and insomnia. Once clinical signs of rabies appear,
without intensive care, death occurs within 2 weeks after onset of
symptoms. There is no treatment available.

Animals

Infected animals start developing nonspecific signs. Usually they

stop eating and drinking, withdraw, may be lethargic, or showing
fever, vomiting, and anorexia. Due to rapid progression of disease
the animal may become vicious or begin to show signs of paralysis.
Clinical signs include cerebral and cranial nerve dysfunction, ataxia,
weakness, paralysis, seizures, difficulty breathing, difficulty
swallowing, excessive salivation, abnormal behavior, and aggression.

Some rabid animals tend to get aggressive biting at anything, while

others are be somnolent and only bite as soon as people get close to
them in an tempt to look what is wrong with them. Rabies with
atypical clinical signs is increasingly recognized and clinical signs of
rabies may vary greatly from one animal to another. Once the
animals show severe signs they die within 6 to 5 days.
 History of rabies
For thousands of years, rabies has terrified civilizations ever since it
became obvious that the bite of a rabid animal insured an
inevitably horrible death. The origin of the word rabies is either
from the Sanskrit "rabhas" (to do violence) or the Latin "rabere" (to
rage). The ancient Greeks called rabies "lyssa" (violence). Today, the
virus causing rabies is classified in the genus Lyssa Virus".

In India, 3000 B.C., the god of death was attended by a dog as the
emissary of death. In modern day India, rabid dogs still cause the
death of 20,000 people each year. The first written record of
rabies causing death in dogs and humans is found in the Mosaic
Esmuna Code of Babylon in 2300 B.C. where Babylonians had to
pay a fine if their dog transmitted rabies to another person.

In the first century A.D., the Roman scholar Celsus correctly

suggested that rabies was transmitted by the saliva of the biting
animal. He incorrectly suggested a cure for rabies by holding the
victim under water. Those that didn't drown died of rabies. Other
barbaric cures for rabies included burning the wounds with a hot
poker and a "hair-of-the-dog".Homeopathic medicine invokes the
use of "similars", i.e. like cures like. Hairs of the rabid dog were laid
on the wound or ingested by the patient. While a hair-of-the-dog
may cure a hangover, it did nothing to cure rabies.

The most interesting cure for rabies involved the use of madstones
in 18th century America. Madstones are calcified hairballs found in
the stomachs of ruminants such as cows, goats and deer. They were
thought to have curative powers by drawing the madness out of
the bite wound. Madstones were highly prized as more valuable
than rubies and were passed down through generations as "family
jewels". In 1805, a madstone sold for $2000 in Essex County,
Virginia. Abraham Lincoln is reported to have transported his son,
Robert, from Springfield, Illinois to Terre Haute, Indiana for
madstone treatment in 1849 after being bitten by a rabid dog.
Robert survived.

That same year, after proposing to his childhood sweetheart, Edgar

Allen Poe left Richmond, Virginia on a train bound for New York
City. Six days later he was mysteriously found lying in the street
outside Ryan's Saloon in Baltimore, Maryland. It was assumed this
lifelong alcoholic was suffering delirium tremons but when offered
alcohol he refused it and when offered water he had great difficulty
swallowing it. Poe's physician, Dr. Joseph Moran, writes that Poe
slipped in and out of a coma, had hallucinations and alternated
between periods of extreme aggression and periods of perfect
lucidity. He finally slipped into a coma and died four days later.
These are the classic symptoms of rabies. Poe's body showed no sign
of bite wounds but fewer than one third of human rabies victims
show evidence of bite wounds.

The first real treatment for rabies came in the 1880's. A French
chemistry teacher named Louis Pasteur was dabbling with chicken
cholera when he noticed that virulent cultures exposed to the
elements no longer caused disease. He also noted that chickens
given this weakened or "attenuated strain" were immune to
inoculation with fresh, virulent cultures. Pasteur next tried an
attenuated vaccine against anthrax in cattle. It worked! He then
turned his attention to rabies, the scourge of the world. His initial
animal studies were very promising, but Pasteur wanted more time
to purify his attenuated vaccine before trying it on himself.

On July 6, 1885, a 9 year old boy named Joseph Meister was

mauled by a rabid dog. A local doctor treated the wounds and told
the family that the only person who could save Joseph was Louis
Pasteur. After much pleading, Pasteur agreed only after consulting
with a couple of real doctors who said Joseph was a "dead boy
walking". Joseph received 13 inoculations in 11 days and made a
complete recovery. The word leaked out and patients came
streaming in the world over. At the time of Pasteur's death 9 years
later, over 20,000 people had been given his post-exposure
prophylactic vaccine.\

Today in the U.S. many (but not all) of our pets are vaccinated
against rabies. We all remember Cujo and Old Yeller, but cats now
outrank dogs in the number of domestic rabies cases. Many people
still don't think cats need rabies vaccinations. Wild animal rabies
mostly involves raccoons, skunks, foxes and bats with bats being the
most dangerous since rabid bats rarely look sick and they can sneak
in through very narrow spaces day and night to expose us and our
pets.

I don't have the space to tell all the horror tales I've heard. I'll just
share two: 1) A rabid bat flew down a chimney and bit the
unvaccinated indoor housecat. The cat bit the 12 year old girl in
the house. The bat, the cat and the girl all died. 2) A friend called
me hysterically one Sunday. A raccoon (later proved rabid) broke
through her screen door and attacked her four indoor cats, none of
whom had ever had a rabies vaccine. All four of her cats had to be
destroyed. Suffice it to say that many have died, been destroyed or
undergone post-exposure vaccination needlessly.

- Fielding D. O’Niell, DVM, MS

 Prevention
Prevention in Pets
There are several things you can do to protect your pet from
rabies.

First, visit your veterinarian with your pet on a regular basis and
keep rabies vaccinations up-to-date for all cats, ferrets, and dogs.

Second, maintain control of your pets by keeping cats and ferrets

indoors and keeping dogs under direct supervision.

Third, spay or neuter your pets to help reduce the number of

unwanted pets that may not be properly cared for or vaccinated
regularly.

Finally, call animal control to remove all stray animals from your
neighborhood since these animals may be unvaccinated or ill.

Prevention in Humans
Understanding your rabies risk and knowing what to do after
contact with animals can save lives. Any mammal can get rabies,
but the most commonly affected animals in the United States are
raccoons, skunks, bats, and foxes — so the best way to avoid rabies
in the U.S. is to stay away from wildlife. Leave all wildlife alone,
including injured animals. If you find an injured animal, don’t
touch it; contact local authorities for assistance.

Rabies in dogs is still common in many countries outside the United

States, so find out if rabies is present in dogs or wildlife at your
destination before international travel.
Because pets can get rabies from wildlife and then could spread it
to humans, preventing rabies in pets is also an important step in
preventing human rabies cases.

If you do come into contact with a rabid animal, rabies in humans

is 100% preventable through prompt appropriate medical care. If
you are bitten, scratched, or unsure, talk to a healthcare provider
about whether you need PEP.