Unmasking The Ruthless Rabies

CEBU, Philippines - Rabies is considered a neglected disease that is 100 percent fatal but 100 percent preventable. Effective and safe vaccines to prevent the disease in human and animals have been available for decades. The term is derived from the Latin word rabies, “madness”. The word may also be related to the Sanskrit rabhas, which means “to do violence”.

None of these deaths would have occurred as we have all of the tools necessary to prevent rabies from infecting and killing both humans and animal. However, its elimination is hampered by poverty and ignorance about the disease and its prevention.

In the Philippines, although rabies is not among the leading causes of morbidity and mortality, rabies is considered a significant public health problem for two reasons; it is one of the most acutely fatal infection which causes the death of 200-300 Filipinos annually, and the Philippines ranked number six among the countries with the highes reported incidence of rabies in the world. The ranking went as high as number three in 2000.

According to the World Health Organization, rabies occurs in more than 150 countries and territories. Worldwide, more than 55,000 people die of rabies every year. Studies reveal that dogs are the source of 99 percent of human rabies deaths. Every year, more than 15 million people worldwide receive a post-exposure preventive regimen to avert the disease – this is estimated to prevent 327,000 rabies deaths annually.

Immediate 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. Therefore, immediate treatment of all bite wounds and scratches that may be contaminated with rabies virus is important. Once bitten, recommended first-aid procedures include immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.

Animal Bite Treatment Centers (ABTCs) can be found everywhere in the Philippines. Most of them are government centers and some are privately owned. Yet, many people are not aware of these treatment centers. Some of them seek a “tandok” treatment, which is not safe and effective.

On Tandok’s

“Tandok” is a popular indigenous healing practice used in the treatment of dog and even snake bites. It is an invasive treatment where the “healer” cuts the skin approximately one centimeter in depth and puts the suction material – usually a funnel-shaped carabao horn, to remove supposedly rabies or venom. The healing session ends when the “healer” perceives that all rabies or venom have been sucked out. This is a dangerous procedure and may result to tetanus, hepatitis and other infections. It also results to problems of delayed referral of life-threatening conditions such as rabies and snake bites to legitimate medical practitioners.

ABTCs

ABTCs are established in every province where patients are referred and provided post-exposure treatment. The ABTC is a health facility where immunizing agents are administered. It has at least one physician and one nurse, trained on the management of animal bite victim. This facility utilizes intra-dermal administration of vaccine and has the capability to manage hypersensitivity reactions to the vaccine. There are close to 300 ABTCs around the country and 27 here in Central Visayas.

Eliminating Rabies In Dogs

Rabies is a vaccine-preventable disease. The most cost-effective strategy for preventing rabies in people is by eliminating rabies in dogs through vaccination. Vaccination of animals (mostly dogs) has reduced the number of human (and animal) rabies cases in several countries, particularly in Latin America. However, recent increases in human rabies deaths in parts of Africa, Asia and Latin America suggest that rabies is re-emerging as a serious public health issue.

Preventing human rabies through control of domestic dog rabies is a realistic goal for large parts of Africa and Asia, especially here in the Philippines and is justified financially by the future savings of discontinuing post-exposure prophylaxis for people.

Preventive Immunization In People

Safe, effective vaccines also exist for human use. Pre-exposure immunization in people is recommended for travelers to high-risk areas in rabies-affected countries, and for people in certain high-risk occupations such as laboratory workers dealing with live rabies virus and other lyssaviruses, and veterinarians and animal handlers in rabies-affected areas. As children are at particular risk, their immunization could be considered. All human cases of rabies were fatal until a vaccine was developed in 1885 by Louis Pasteur and Emike Roux.

Rabies Facts

Rabies is a zoonotic disease. This means that it is a disease that is transmitted to humans from animals that is caused by a virus. The disease infects domestic and wild animals, and is spread to people through close contact with infected saliva by means of bites or scratches. Rabies is present in all continents with the exception of Antartica, but more than 95 percent of human deaths occur in Asia and Africa. Once symptoms of the disease develop, rabies is nearly always fatal.

The incubation period for rabies is typically one to three months, but may vary from less than a week to less than a year. The initial symptoms of rabies are fever and often pain or an unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site.

As the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops. Two forms of the disease can follow. People with furious rabies exhibit signs of hyperactivity, excited behavior, hydrophobia (fear of water) and sometimes aerophobia (fear of air). After a few days, death occurs by cardio-respiratory arrest.

No tests are available to diagnose rabies infection in humans before the onset of clinical disease, and unless the rabies-specific signs of hydrophobia or aerophobia are present, the clinical diagnosis may be difficult. Post mortem, the standard diagnostic technique is to detect rabies virus antigen in brain tissue by fluorescent antibody test.

People are infected through the skin following a bite or scratch by an infected animal. Dogs are the main host and transmitter of rabies. Transmission can also occur when infectious material – usually saliva – comes into direct contact with human mucosa or fresh skin wounds. Human-to-human transmission by bite is theoretically possible but has never been confirmed.Rarely, rabies may be contracted by inhalation of virus-containing aerosol or via transplantation of an infected organ. Ingestion of raw meat or other tissues from animals infected with rabies is not a source of human infection.