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cats. It can be transmitted when infectious material, usually saliva, comes into direct contact with a victim·s fresh skin lesions. Rabies may also occur, though in very rare cases, through inhalation of virus-containing spray or through organ transplants. Rabies is considered to be a neglected disease, which is 100% fatal though 100% preventable. It is not among the leading causes of mortality and morbidity in the country but it is regarded as a significant public health problem because (1) it is one of the most acutely fatal infection and (2) it is responsible for the death of 200-300 Filipinos annually.
Symptoms of Rabies
Symptoms usually develop between 20 and 60 days after exposure. Rabid animals may become aggressive, combative, and highly sensitive to touch and other kinds of stimulation. And they can be vicious. This is the "furious" form of rabies, the kind traditionally associated with mad dogs. There is also a "dumb" form of the disease in which the animal is lethargic, weak in one or more limbs, and unable to raise its head or make sounds because its throat and neck muscles are paralyzed. In both kinds of animal rabies, death occurs a few days after symptoms appear, usually from respiratory failure. In humans, the course is similar. After a symptom-free incubation period that ranges from 10 days to a year or longer (the average is 30 to 50 days), the patient complains of malaise, loss of appetite, fatigue, headache, and fever. Over half of all patients have pain (sometimes itching) or numbness at the site of exposure. They may complain of insomnia or depression. Two to 10 days later, signs of nervous system damage appear, hyperactivity and hypersensitivity, disorientation, hallucinations, seizures, and paralysis. Death may be sudden, due to cardiac or respiratory arrest, or follow a period of coma that can last for months with the aid of life-support measures.
Prevention of Rabies
The advent of scientific medicine makes rabies control possible, not by cure but by prevention. Unlike other immunizations, the rabies vaccine is administered after exposure to the virus. This unusual technique is successful because the rabies virus takes a comparatively long time to induce disease, a minimum of 10 days, and in rare cases, up to a year.
Diagnosis No tests are available to diagnose rabies infection in humans before the onset of clinical disease. mongooses and other wild carnivore host species are very rare. Dogs are the main host and transmitter of rabies. Treatment after exposure Effective treatment soon (within a few days. Transmission can also occur when infectious material ± usually saliva ± comes into direct contact with human mucosa or fresh skin wounds. the clinical diagnosis may be difficult. Rarely. 14. raccoons. Counting the first day of vaccine treatment as day 0. This "passive" immunity helps protect patients during the period before the rabies vaccine causes their own immune system to counter the virus (active immunity). Human-to-human transmission by bite is theoretically possible but has never been confirmed. it should be started as soon as possible after exposure. Human deaths following exposure to foxes. Ingestion of raw meat or other tissues from animals infected with rabies is not a source of human infection. 7.and the dose of virus received.The length of the incubation period apparently depends on both the location of the wound . Transmission People are infected through the skin following a bite or scratch by an infected animal. Post mortem. patients who have not previously been vaccinated for rabies also receive an injection of rabies immune globulin (RIG) on the day they get the first vaccine (day 0). In addition to vaccine. Local treatment of the wound Removing the rabies virus at the site of the infection by chemical or physical means is an effective means of protection. injections are administered on days 0. jackals. No matter where the wound. They are the source of infection in all of the estimated 55 000 human rabies deaths annually in Asia and Africa. Latin America and western Europe. and immediate medical attention. and unless the rabies-specific signs of hydrophobia or aerophobia are present. the longer the incubation . the standard diagnostic technique is to detect rabies virus antigen in brain tissue by fluorescent antibody test. authorities emphasize that the first and most valuable preventive measure is thorough cleaning of the site with soap and water. Therefore. Bats are the source of most human rabies deaths in the United States of America and Canada.the farther from the brain. prompt local treatment of all bite wounds and scratches that may be contaminated with rabies . rabies may be contracted by inhalation of virus-containing aerosol or via transplantation of an infected organ. Bat rabies has also recently emerged as a public health threat in Australia. and 28. If rabies vaccine treatment is called for. Post-exposure prevention consists of local treatment of the wound. and immediate vaccination. administration of rabies immunoglobulin (if indicated). 3. skunks. RIG is prepared from the blood of persons who have been immunized against rabies and contains antibodies to the rabies virus. but as soon as possible) after exposure to rabies can prevent the onset of symptoms and death.
in Africa. . Children living in or visiting rabies-affected areas are at particular risk. Who is most at risk? Dog rabies potentially threatens over 3.virus is important. local treatment of the wound y y Other factors that should be taken into consideration when deciding whether to initiate post-exposure prevention include: the likelihood of the implicated animal being rabid the clinical features of the animal and its availability for observation and laboratory testing. Recommended first-aid procedures include immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water. Travellers with extensive outdoor exposure in rural high-risk areas where immediate access to appropriate medical care may be limited should be considered at risk regardless of duration of their stay. as the average cost of rabies post-exposure prophylaxis after contact with a suspected rabid animal is US$ 40 in Africa and US$ 49 in Asia. In India. contamination of mucous membrane with saliva from licks. minor scratches or abrasions without bleeding Category III ± single or multiple transdermal bites or scratches. licks on broken skin. Recommended treatment The recommended post-exposure prophylaxis depends on the type of contact with the suspected rabid animal (see table). no exposure) Category II ± nibbling of uncovered skin.e. on average 40 % of postexposure prophylaxis regimens are given to children aged 5±14 years. rabies is most common in children aged under 15. Post-exposure measures None Immediate vaccination and local treatment of the wound Immediate vaccination and administration of rabies immunoglobulin. about 2/100 000 population at risk) are estimated to occur annually. detergent. Poor people are at a higher risk. frequent or increased danger of exposure to rabies virus ± either by nature of their residence or occupation ± is also at risk. the vaccination status of the suspected animal alone should not be considered when deciding whether to initiate prophylaxis or not. Table: Recommended post-exposure prophylaxis for rabies infection Category of exposure to suspect rabid animal Category I ± touching or feeding animals. 20 000 rabies deaths (that is. Although all age groups are susceptible. Anyone in continual. povidone iodine or other substances that kill the rabies virus. exposures to bats. licks on intact skin (i. the corresponding figure is 24 000 (about 4/100 000 population at risk). In developing countries. People most at risk live in rural areas where human vaccines and immunoglobulin are not readily available or accessible. and the majority are male.3 billion people in Asia and Africa. where the average daily income is about US$ 1±2 per person.
and is justified financially by the future savings of discontinuing post-exposure prophylaxis for people. However. effective vaccines also exist for human use. The most cost-effective strategy for preventing rabies in people is by eliminating rabies in dogs through vaccination. Preventing human rabies through control of domestic dog rabies is a realistic goal for large parts of Africa and Asia. Preventive immunization in people Safe. recent increases in human rabies deaths in parts of Africa. WHO response . Vaccination of animals (mostly dogs) has reduced the number of human (and animal) rabies cases in several countries.Prevention Eliminating rabies in dogs Rabies is a vaccine-preventable disease. and veterinarians and animal handlers in rabies-affected areas. Asia and Latin America suggest that rabies is re-emerging as a serious public health issue. and for people in certain high-risk occupations such as laboratory workers dealing with live rabies virus and other lyssaviruses. Pre-exposure immunization in people is recommended for travellers to high-risk areas in rabies-affected countries. their immunization could be considered if living in or visiting high risk areas. As children are at particular risk. particularly in Latin America.