<i>Rabies: A neglected zoonotic disease</i>
Rabies is a zoonotic disease (a disease that is transmitted to humans from animals) that is caused by a virus. Rabies infects domestic and wild animals, and is spread to people through close contact with infected saliva (via bites or scratches).
World Rabies Day (September 28) highlights the impact of human and animal rabies and promotes how to prevent and stop the disease by combating it in animals. 55000 people die every year from rabies, an average of one death every 10 minutes. There are safe and effective vaccines available for people who have been bitten by an animal that might have the disease, but usage in developing countries is low due to the high cost.
Being a vaccine-preventable disease, it is still a significant public health problem in many countries of Asia and Africa. Most of the victims are children: 30–50% of the reported cases of rabies—and therefore deaths—occur in children under 15 years of age.
Most of the children who die from rabies were not treated or did not receive adequate post-exposure treatment. Although the efficacy and safety of modern cell culture vaccines have been recognized, some Asian countries still produce and use nervous tissue vaccines, which are less effective, require repeated visits to the hospital and often have severe side-effects. Moreover, these patients do not receive the necessary rabies immunoglobulin, because of a perennial global shortage and because of its high price, so that it is unaffordable in countries where canine rabies is endemic.
Most rabies victims die at home rather than being admitted to a hospital in abysmal conditions. These circumstances add to the notorious lack of surveillance data. Underestimating the health implications of rabies leads many high ranking decision-makers in public health and animal health to perceive rabies as a rare disease of humans resulting from a bite of an uneconomically important animal (the dog). Therefore, rabies usually falls between two stools and is not dealt with appropriately either by the Ministry of Health or the Ministry of Agriculture.
Symptoms: The first symptoms of rabies are flu-like, including fever, headache and fatigue, and then progress to involve the respiratory, gastrointestinal and/or central nervous systems. In the critical stage, signs of hyperactivity (furious rabies) or paralysis (dumb rabies) dominate. In both furious and dumb rabies, some paralysis eventually progresses to complete paralysis, followed by coma and death in all cases, usually due to breathing failure. Once symptoms of the disease develop, rabies is fatal. Without intensive care, death occurs during the first seven days of illness.
Treatment after exposure: Recommended treatment to prevent rabies depends on the category of the contact:
• Category I: touching or feeding suspect animals, but skin is intact
• Category II: minor scratches without bleeding from contact, or licks on broken skin
• Category III: one or more bites, scratches, licks on broken skin, or other contact that breaks the skin; or exposure to bats
Post-exposure care to prevent rabies includes cleaning and disinfecting a wound, or point of contact, and then administering anti-rabies immunisations as soon as possible. Anti-rabies vaccine is given for Category II and III exposures. Anti-rabies immunoglobin, or antibody, should be given for Category III contact, or to people with weaker immune systems.
When humans are exposed to suspect animals, attempts to identify, capture or humanely sacrifice the animal involved should be undertaken immediately. Post-exposure treatment should start right away and only be stopped if the animal is a dog or cat and remains healthy after 10 days. Animals that are sacrificed or have died should be tested for the virus.
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