Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The vast majority of rabies cases reported to the Centers for Disease Control and Prevention (CDC) each year occur in wild animals like raccoons, skunks, bats, and foxes.
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Rabies remains a problem in most countries of Southeast Asia, where stray dogs and cats are common. Financial, political, and cultural issues are the main barriers to public health authorities’ controlling the disease in animals.1 Local people and travelers in this area are inevitably at risk of exposure to the rabies virus if bitten or licked by an infected animal. Pre-exposure prophylaxis is an excellent preventive measure against rabies in travelers. However, it is expensive, and the cost-benefit relationship is not clear, so that it has limited application in general travel-medicine practice.
Stray dogs roam around most SE Asia and especially around temples. Usual not a problem but use caution.
The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. The early symptoms of rabies in people are similar to that of many other illnesses, including fever, headache, and general weakness or discomfort. As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of these symptoms.
Despite evidence that control of dog rabies through programs of animal vaccination and elimination of stray dogs can reduce the incidence of human rabies, exposure to rabid dogs is still the cause of over 90% of human exposures to rabies and of over 99% of human deaths worldwide.
When should I seek medical attention?
The rabies virus is transmitted through saliva or brain/nervous system tissue. You can only get rabies by coming in contact with these specific bodily excretions and tissues.
It’s important to remember that rabies is a medical urgency but not an emergency. Decisions should not be delayed.
Wash any wounds immediately. One of the most effective ways to decrease the chance for infection is to wash the wound thoroughly with soap and water.
See your doctor for attention for any trauma due to an animal attack before considering the need for rabies vaccination.
Your doctor, possibly in consultation with your state or local health department, will decide if you need a rabies vaccination.
What materials can spread rabies?
Rabies virus is transmitted through saliva and brain/nervous system tissue. Only these specific bodily excretions and tissues transmit rabies virus. If contact with either of these has occurred, the type of exposure should be evaluated to determine if postexposure prophylaxis is necessary.
Contact such as petting or handling an animal, or contact with blood, urine or feces does not constitute an exposure. No postexposure prophylaxis is needed in these situations.
Rabies virus becomes noninfectious when it dries out and when it is exposed to sunlight. Different environmental conditions affect the rate at which the virus becomes inactive, but in general, if the material containing the virus is dry, the virus can be considered noninfectious.
What kind of animal did you come in contact with?
Any mammal can get rabies. The most common wild reservoirs of rabies are raccoons, skunks, bats, foxes, and coyotes. Domestic mammals can also get rabies. Cats, cattle, and dogs are the most frequently reported rabid domestic animals
In all instances of potential human exposures involving bats, the bat in question should be safely collected, if possible, and submitted for rabies diagnosis. Rabies postexposure prophylaxis is recommended for all persons with bite, scratch, or mucous membrane exposure to a bat, unless the bat is available for testing and is negative for evidence of rabies.Post exposure prophylaxis should be considered when direct contact between a human and a bat has occurred, unless the exposed person can be certain a bite, scratch, or mucous membrane exposure did not occur.
Small rodents and other wild animals
Small rodents like squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, and mice) and lagomorphs including rabbits and hares are almost never found to be infected with rabies and have not been known to transmit rabies to humans.
What type of exposure occurred?
Rabies is transmitted only when the virus is introduced into a bite wound, open cuts in skin, or onto mucous membranes such as the mouth or eyes.
Other factors to consider when evaluating a potential rabies exposure include the natural occurence in the area, the biting animal’s history and current health status (e.g., abnormal behavior, signs of illness), and the potential for the animal to be exposed to rabies (e.g., presence of an unexplained wound or history of exposure to a rabid animal).
A currently vaccinated dog, cat, or ferret is unlikely to become infected with rabies.
When an exposure has occurred, the likelihood of rabies infection varies with the nature and extent of that exposure. Under most circumstances, two categories of exposure — bite and nonbite — should be considered.
Any penetration of the skin by teeth constitutes a bite exposure. All bites, regardless of body site, represent a potential risk of rabies transmission, but that risk varies with the species of biting animal, the anatomic site of the bite, and the severity of the wound.
Bites by some animals, such as bats, can inflict minor injury and thus be difficult to detect.
Was the bite from a provoked or an unprovoked attack? Bites inflicted on a person attempting to feed or handle an apparently healthy animal should generally be regarded as provoked. If it was an unprovoked attack, that’s more likely to indicate that the animal is rabid.
The contamination of open wounds, abrasions, mucous membranes, or theoretically, scratches (potentially contaminated with infectious material from a rabid animal) constitutes a nonbite exposure.
Nonbite exposures from terrestrial animals rarely cause rabies. However, occasional reports of rabies transmission by nonbite exposures suggest that such exposures should be evaluated for possible postexposure prophylaxis administration.
Other contact by itself, such as petting a rabid animal and contact with blood, urine, or feces of a rabid animal, does not constitute an exposure and is not an indication for post exposure vaccination.
Is the animal available for testing?
A healthy domestic dog, cat, or ferret that bites a person should be confined and observed for 10 days. Any illness in the animal during the confinement period or before release should be evaluated by a veterinarian and reported immediately to the local public health department.
If signs suggestive of rabies develop, postexposure prophylaxis should be initiated. The animal should be euthanized and its head removed and shipped, under refrigeration, for examination by a qualified laboratory.
If the biting animal is stray or unwanted, it should either be confined and observed for 10 days or be euthanized immediately and submitted for rabies examination.
Skunks, raccoons, foxes and bats that bite humans should be euthanized and tested as soon as possible. The length of time between rabies virus appearing in the saliva and onset of symptoms is unknown for these animals and holding them for observation is not acceptable.
After exposure to wildlife in which rabies is suspected, prophylaxis is warranted in most circumstances. Because the period of rabies virus shedding in wild animal hybrids is unknown, these animals should be euthanized and tested rather than confined and observed when they bite humans.
Vaccination should be discontinued if tests of the involved animal are negative for rabies infection
Regardless of the risk of rabies, bite wounds can cause serious injury such as nerve or tendon laceration and local and system infection. Your doctor will determine the best way to care for your wound, and will also consider how to treat the wound for the best possible cosmetic results.
For many types of bite wounds, immediate gentle irrigation with water or a dilute water povidone-iodine solution has been shown to markedly decrease the risk of bacterial infection.
Wound cleansing is especially important in rabies prevention since, in animal studies, thorough wound cleansing alone without other postexposure prophylaxis has been shown to markedly reduce the likelihood of rabies.
You should receive a tetanus shot if you have not been immunized in ten years. Decisions regarding the use of antibiotics, and primary wound closure should be decided together with your doctor.
Rabies Post exposure Vaccinations
For people who have never been vaccinated against rabies previously, postexposure anti-rabies vaccination should always include administration of both passive antibody and vaccine.
The combination of human rabies immune globulin (HRIG) and vaccine is recommended for both bite and nonbite exposures, regardless of the interval between exposure and initiation of treatment.
People who have been previously vaccinated or are receiving preexposure vaccination for rabies should receive only vaccine.
Adverse reactions to rabies vaccine and immune globulin are not common. Newer vaccines in use today cause fewer adverse reactions than previously available vaccines. Mild, local reactions to the rabies vaccine, such as pain, redness, swelling, or itching at the injection site, have been reported. Rarely, symptoms such as headache, nausea, abdominal pain, muscle aches, and dizziness have been reported. Local pain and low-grade fever may follow injection of rabies immune globulin.
The vaccine should be given at recommended intervals for best results. Talk to your with your doctor or state or local public health officials if you will not be able to have shot at the recommended interval. Rabies prevention is a serious matter and changes should not be made in the schedule of doses.
People cannot transmit rabies to other people unless they themselves are sick with rabies. The prophylaxis you are receiving will protect you from developing rabies, and therefore you cannot expose other people to rabies. You should continue to participate in your normal activities.
What is the risk for my pet?
Any animal bitten or scratched by either a wild, carnivorous mammal or a bat that is not available for testing should be regarded as having been exposed to rabies.
Unvaccinated dogs, cats, and ferrets exposed to a rabid animal should be euthanized immediately. If the owner is unwilling to have this done, the animal should be placed in strict isolation for 6 months and vaccinated 1 month before being released.
What are the signs and symptoms of rabies?
The first symptoms of rabies may be very similar to those of the flu including general weakness or discomfort, fever, or headache. These symptoms may last for days.
There may be also discomfort or a prickling or itching sensation at the site of bite, progressing within days to symptoms of cerebral dysfunction, anxiety, confusion, agitation. As the disease progresses, the person may experience delirium, abnormal behavior, hallucinations, and insomnia.
The acute period of disease typically ends after 2 to 10 days. Once clinical signs of rabies appear, the disease is nearly always fatal, and treatment is typically supportive.
Disease prevention includes administration of both passive antibody, through an injection of human immune globulin and a round of injections with rabies vaccine.
Once a person begins to exhibit signs of the disease, survival is rare. To date less than 10 documented cases of human survival from clinical rabies have been reported and only two have not had a history of pre- or post exposure prophylaxis
Rabies in humans is 100% preventable through prompt appropriate medical care. Yet, more than 55,000 people, mostly in Africa and Asia, die from rabies every year – a rate of one person every ten minutes.
The most important global source of rabies in humans is from uncontrolled rabies in dogs. Children are often at greatest risk from rabies.
They are more likely to be bitten by dogs, and are also more likely to be severely exposed through multiple bites in high-risk sites on the body. Severe exposures make it more difficult to prevent rabies unless access to good medical care is immediately available.
Rabies is found on all continents except Antarctica. In most countries, the risk of rabies in an encounter with an animal and the precautions necessary to prevent rabies are the same as they are in the United States. When traveling, it is always prudent to avoid approaching any wild or domestic animal.
In certain areas of the world, including but not limited to parts of Africa, Asia, and Central and South America, rabies in dogs is still a major problem, and access to preventative treatment may be hard to get. The importance of rabid dogs in these countries, where tens of thousands of people die of the disease each year, cannot be overstated