Understanding the threat posed to us by rabies is more important than treating the disease
Probably the oldest infection known to man, the word rabies is derived from the Sanskrit word Rabbahs which means to do violence.
According to the Who World Health Report 1996, the number of human deaths due to rabies is estimated to be at least 40,000 and may be as high as 70,000. An estimated 10 million people receive treatment each year after being exposed to animals suspected of having rabies.
THE FATAL VIRAL DISEASE: Rabies is an infectious disease of animals caused by a virus. Man is occasionally infected and once the infection is established, the outcome is almost invariably fatal. The rabies virus infects the central nervous system, causing encephalopathy and ultimately death. 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 (sleeplessness), anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hyper salivation, difficulty in swallowing and hydrophobia (fear of water). Death usually occurs within days of the onset of symptoms. Among all other members, dogs remain the major vector of rabies throughout the world, particularly in Asia. Everyday an estimated 20-25 dog bite cases are reported to JPMC and Civil Hospital, Karachi, the two largest government hospitals in the city. However, at the same time, rabies is a preventable viral disease.
FURIOUS RABIES: When the virus reaches the CNS (central nervous system) the patient comes down with a headache and fever, and becomes irritable, restlessness and anxiety. This may progress to muscle pains, salivation and vomiting. After a few days to a week the patient may experience a stage of excitement and be wracked with painful muscle spasms, triggered sometimes by swallowing of saliva or water. Hence they drool and learn to fear water (hydrophobia). The patients are also excessively sensitive to air blown on the face. The stage of excitement lasts only a few days before the patient lapses into coma and eventually death.
Once the clinical disease manifests, there is a rapid, relentless progression to invariable death, despite all treatment.
DUMB RABIES: It starts in the same way, but instead of progressing into excitement, the subject retreats steadily and quietly downhill with some paralysis to death. Rabies diagnosis may easily be missed.
CAUSES: Most often rabies transmission occurs through the bite of a rabid animal. Rarely, people contract rabies when saliva from an infected animal comes in contact with their eyes, nose, mouth or a wound. This may occur if you’re licked on an open skin by an infected animal.
Inhaling the rabies virus is another potential route of exposure, but the most in danger of such exposer are laboratory workers.
Doctors don’t consider petting a rabid animal or coming in contact with the blood, urine or feces of a rabid animal as a risk factor for rabies or an exposure that needs treatment.
RISK FACTORS: You’re at greatest risk of contracting rabies if your activities bring you into contact with the rabies virus or a potentially rabid mammal. People at highest risk include veterinarians, animal caretakers or handlers, laboratory workers, cave explorers, forest rangers and people visiting bat-inhabited caves.
You’re also at higher risk if you plan to travel to areas where rabies isn’t well-controlled such as parts of Africa, Asia, Central America and South America.
SEEKING MEDICAL ADVICE: If you think you may have been exposed to an animal with rabies, call your doctor immediately. Quick action is important. Once the earliest signs and symptoms appear, death almost always occurs. Promptly contacting your doctor after a potential rabies exposure greatly increases your chance of surviving. No one in the United States has contracted rabies after receiving prompt and appropriate treatment following an exposure.
If you wakeup and find a bat in your room, it’s possible you had contact with the bat without knowing it. Bats have small teeth that don’t always leave noticeable marks. In the case of small rodents, including squirrels, a bite isn’t likely to transmit rabies, but it’s still best to consult your doctor to make a treatment decision.
SCREENING AND DIAGNOSIS: If you’ve been bitten or have had contact with an animal that may have rabies, taking note of certain information may help your doctor determine your risk of contracting rabies and how to treat you. Take note of the following:
•Where the incident occurred
• The type of animal
•If you were bitten, whether the animal was provoked or confronted
• The vaccination status of a domesticated animal
• Whether the animal can be safely captured to be tested for rabies
• Treatment
If your doctor determines that you were exposed to rabies, treatment begins at once. The sooner you begin the treatment, the greater your chance of recovery.
The treatment for rabies that is administered after an animal bite is called post-exposure prophylaxis. It consists of one dose of rabies immunoglobulin and five doses of rabies vaccine over a 28-day period. Rabies immunoglobulin and the first dose of rabies vaccine are administered as soon as possible after you’ve been exposed and have reported the exposure to your doctor. You’re given the immunoglobulin by injection around the site of the bite and you receive five injections of the vaccine into your upper arm muscle on days 0, 3, 7, 14 and 28.
Immunoglobulin is a disease-fighting protein that provides you with temporary antibodies. The rabies vaccine helps your body start producing its own antibodies. Antibody production takes time, but the antibodies produced by your body provide longer-lasting protection than do the ones contained in rabies immunoglobulin.
The types of rabies vaccines made for rabies control are:
• Inactivated purified rabies vaccine, prepared on verocell (Who recommended).
• Human deployed cell rabies vaccine (HDCV)
• Rabies vaccine absorbed (RVA)
• Purified chick embryo cell vaccine (PCEC)
You might have a mild physical reaction to the vaccines. Watch for reactions such as swelling or redness where the injection occurred. Headache, fever, nausea, muscle aches and dizziness are other possible side effects. Contact your doctor if side effects cause you discomfort.
Do not close the wound by stitches or tight bandage.
PREVENTION: The first thing to do if you’ve been bitten by an animal is thoroughly wash the wound or area of exposure with soap and water. This is one of the most effective methods to decrease the chance of infection.
If soap isn’t available you can use water. But be sure to wash with soap and water as soon as possible. Allowing the wound to bleed can also help clean it.
PREVENTING EXPOSURE TO RABIES:
• Keep your pets and other domesticated animals up-to-date with regular animal rabies shots.
• Keep your dog on a leash when it’s outside of your lawn or yard. Chain it inside your lawn or yard.
• Avoid contact with wild or unfamiliar animals, whether they’re alive or dead.
• Seal or close any openings where animals might find entry into your home.
• Report stray animals or any that act strangely or sick to your local animal control authorities.
• If you’re travelling, avoid direct contact with wild animals and be cautious around dogs in developing countries.
• Beware of stray dogs.
•Educate school going children about stray dogs protection especially a lady-dog with new born puppies.
Understanding the threat posed to us by rabies is more important than treating the disease 
