Written by Arda Kizilkaya
Rabies is a fatal but vaccine-preventable viral disease spreading to people and animals via saliva, usually through bites, scratches, or contact with mucosa (e.g. eyes, mouth, and open wounds). If clinical symptoms appear, rabies is virtually 100% fatal. Rabies primarily affects the central nervous system made up of the brain and spinal cord, leading to severe brain disease and death if medical care is not received before symptoms start. If a person or an animal is suspected of rabies exposure, that person or animal must be given immediate medical attention. Medical care following a rabies exposure is called PEP(post-exposure prophylaxis). PEP includes wound care, a dose of HRIG(human rabies immune globulin), and a series of four or five rabies vaccines, which must be administered immediately after exposure. This care is critical to prevent the disease from developing. It is nearly 100% effective if administered promptly. 60,000 Americans per year receive PEP after a potential rabies exposure.
Symptoms
The incubation period for rabies is usually 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. The first symptoms of rabies include generic signs like fever, pain, and unusual or unexplained tingling, pricking, or burning sensations at the wound site. As the virus spreads to the central nervous system, progressive and fatal inflammation of the brain and spinal cord starts to develop. Rabies in people can be managed but very rarely cured, and not without severe neurological disabilities.
There are two forms of rabies: Furious rabies results in hyperactivity, excitable behavior, hallucinations, lack of coordination, hydrophobia(being afraid of water), and aerophobia(being afraid of flying). Death occurs soon after due to cardio-respiratory arrest.
Paralytic rabies accounts for about 1/5 of the total number of human cases. Paralytic rabies runs a less dramatic and usually longer course than the furious form. Starting from the wound site, muscles gradually become paralyzed. A coma slowly develops and soon after, death occurs. This form of rabies is often misdiagnosed, which contributes to the under-reporting of the disease.
Diagnosis
Clinical diagnosis of rabies is difficult without a reliable history of contact with an animal that has rabies or specific symptoms of hydrophobia or aerophobia. Accurate risk assessment is a necessity for deciding on PEP administration. If death is inevitable, offering comprehensive and compassionate palliative care is recommended. Postmortem confirmation of rabies infection is done by various diagnostic techniques that detect whole viruses, viral antigens, or nucleic acids in infected tissues (brain, skin, or saliva) If possible, the biting animal should be tested.
Prevention
Understanding the risk of rabies and knowing what to do after contact with rabid animals can help save lives. Every mammal can get rabies, but the most commonly affected animals in the US are raccoons and skunks.
The best way to avoid rabies is to leave all wildlife alone, including injured animals. If you find an injured animal, do not approach it and contact local authorities for assistance. Rabies in dogs is still common in many countries outside the US, so find out if rabies is present in dogs or wildlife at your destination before international travel, particularly if you intend to stay for a long period and if you plan to go beyond the usual tourist destinations into local villages.
Since pets can also get rabies from wildlife and can then spread it to humans, preventing rabies in pets is also an important step in preventing human rabies cases. If you do make contact with an animal with rabies, rabies in humans is preventable through appropriate medical care. If you are bitten or scratched, talk to a medical professional about potential treatment options.
References:
About rabies. (2024, May 14). Rabies. https://www.cdc.gov/rabies/about/index.html Dalton,
M. (2023, June 8). Rabies. NFID. https://www.nfid.org/infectious-disease/rabies/ Rabies. (2023, September 20). World Health Organization (WHO). https://www.who.int/news-room/fact-sheets/detail/rabies
Rabies: Causes, symptoms, treatment & prevention. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/13848-rabies
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