Rabies

What is Rabies?

Rabies is a fatal but preventable viral disease.
It can spread to people and pets through the bites and scratches of an infected animal.
Rabies primarily affects the central nervous system, leading to severe complications if medical care is not received before symptoms appear.

Transmission

Rabies infects mammals, including dogs, cats, livestock, and wildlife.
Rabies spreads to people and animals via saliva, usually through bites, scratches, or direct contact with mucosa (e.g., eyes, mouth, or open wounds).

Symptoms (Initial)

Burning sensations
Headache
Itching
Tiredness
Fever
Tingling

Symptoms (Advanced)

As the virus moves to the central nervous system, it can lead to progressive and fatal inflammation of the:

Brain
Spinal cord

Types of Rabies

Furious Rabies
- Results in hyperactivity, excitable behavior, hallucinations, lack of coordination, hydrophobia (fear of water), and aerophobia (fear of drafts or fresh air).
- Death occurs after a few days if not treated promptly due to cardiorespiratory arrest.
Paralytic Rabies
- Muscles gradually become paralyzed, starting from the wound site.
- A coma slowly develops, and eventually, death occurs.

High-Risk Groups

People who travel to endemic areas
People participating in leisure activities like hunting and camping
People with jobs involving animals

Incubation Period

The incubation period for rabies typically ranges from 2–3 months but may vary from one week to one year, depending on factors such as the location of virus entry and the viral load.

When to Visit the Doctor?

Upon direct physical contact with any wild or unfamiliar animals, especially if bitten or scratched.

Diagnosis

Clinical diagnosis of rabies is challenging without a reliable history of contact with a rabid animal or the presence of specific symptoms such as hydrophobia or aerophobia.
Several tests are necessary to diagnose rabies antemortem (before death) in humans; no single test is sufficient.
- Tests are performed on samples of saliva, serum, spinal fluid, and skin biopsies of hair follicles at the nape of the neck.
Postmortem confirmation of rabies infection is achieved through various diagnostic techniques that detect whole viruses, viral antigens, or nucleic acids in infected tissues (brain, skin, or saliva).

Treatment

There is no approved treatment for rabies once symptoms have appeared.

Pre-exposure prophylaxis (PrEP)

Recommended for people in high-risk occupations:

Laboratory workers handling live rabies and related viruses
People whose professional or personal activities might lead to direct contact with infected animals

PrEP might be indicated before recreational activities or travel in certain areas, and for people living in remote, highly rabies-endemic areas with limited local access to rabies biologicals.

Post-exposure Prophylaxis (PEP)

Accurate risk assessment is crucial for deciding on PEP administration. This prevents the virus from entering the central nervous system.

A well-performed wound risk assessment and PEP protocol consists of:

Extensive wound washing with water and soap for at least 15 minutes soon after exposure
Administration of rabies immunoglobulin or monoclonal antibodies into the wound, if indicated
A course of rabies vaccine

Prevention

Avoid approaching wild and/or infected animals
Wash the skin surface when exposed to touching or feeding the animal
Wash wounds and get immediate vaccination when exposed to an animal bite or scratch to the skin