Rabies

What is rabies?

Rabies, or "hydrophobia," is a fatal viral infection of the nervous system transmitted by animals to humans. A patient in contact with an infected animal can receive rabies virus of the family Rhabdoviridae carried in the saliva of the infected animals, causing nervous system symptoms of seizures, hallucinations, and paralysis. Currently, cases of infected rabies are uniformly fatal since there is no medication to treat the disease. However, rabies is eminently preventable by prophylactic vaccination against rabies.

What causes rabies?

Rabies is caused by the saliva of infected animals that transmit the disease through animal bites, scratching, and mauling that cause skin break or animal licks on an abrasion wound or mucous membranes of the eyes, nose, and mouth. Transmission can occur through eating raw, infected meat and organ transplantation.

What animals are the carrier of the rabies virus?

Rabies carriers are warm-blooded mammals such as dogs, cats, bats, foxes, raccoons, and many other wild animals. Stray dogs are most likely to transmit rabies to humans.

What are the symptoms of rabies?

After being infected with rabies, symptoms are not apparent initially. The patient first manifests rabies signs and symptoms approximately three weeks to 3 months after being infected. In some cases, it may take up to a year. The time to symptom onset depends on the wound depth, density of innervation, the number and size of the wounds, and the viral inoculation quantity. The rabies virus (RABV) will migrate from the bite wound to the nervous system and brain. Rabies virus infection can be divided into three stages as follows:

1. Prodromal phase
   In the prodromal phase, patients may have a fever, headache, sore throat, shivering, nausea, vomiting, agitation, body ache and pain, restlessness, insomnia, loss of appetite, severe irritation of the bitten area, and tingling of the skin. This phase may last an average of 2–10 days.
2. Acute neurologic phase
   In the acute neurologic phase, patients will suffer from 2 main conditions: 
   • Encephalitis, the patient may experience fever, wind phobia, hydrophobia, spasms, delirium, hallucinations, and insomnia.
   • Flaccid paralysis, the patient may experience muscle contraction and weakness.
3. Coma phase
   In the coma phase, the patient experiences respiratory failure, cardiac arrest, and death. This phase lasts two weeks.

What should we do if bitten by an infected animal?

Patients bitten or scratched by a dog or other animal in any part of the body should follow the below instructions:

1. Wash the wounds thoroughly and repeatedly with soap and water for at least 15 minutes, dry them, and apply topical antiseptic, such as povidone-iodine.
2. If the biting animal has an owner, ask the owner for a record of the animal's rabies vaccination. Observe the animal for at least ten days to ensure that the animals do not show signs of
3. Contact a healthcare provider as soon as possible. The doctor will prescribe a rabies vaccine(post-exposure prophylaxis/PEP), including a tetanus shot and antibiotic. If the biting animal has a high risk for rabies, the doctor may give both the vaccine and anti-rabies immunoglobulins, which provide passive immunity against the virus.

How many doses of the rabies vaccine are required to provide protection?

The Ministry of Public Health and the Thai Red Cross Society advise 1–5 doses of rabies vaccines for those who have never received rabies vaccination. There are 2 routes of rabies vaccine injections.

1. Intradermal vaccination (ID) 
2. Intramuscular vaccination (IM) 

Rabies vaccination is a very safe and effective vaccine. The vaccine can be injected regardless of gender or age, including children and pregnant women. It is imperative to receive the first dose of vaccine as soon as possible after the bite and complete the vaccination according to the number of doses prescribed by the doctor to prevent rabies.

How can we prevent rabies?

Rabies is preventable. For safety, keep the cleanliness and hygiene of our pets and keep them away from wild animals to reduce the risk of exposure. Ensure that you follow the following practices:

• Bring pets such as dogs and cats to get rabies vaccinations prescribed by the veterinarian and repeat the vaccination annually.
• Provide housing for pets, keep them in cages or indoors at night, and don't let them roam outside.
• Do not touch wild animals or allow pets to come in direct contact with wild animals to reduce the risk of being bitten.
• If you find stray dogs or dogs that look suspicious of having rabies, contact the relevant municipal officer or local authorities immediately.
• Preexposure vaccination against rabies is recommended for people at high risk, such as veterinarians, zoo workers, those who work in laboratories with rabies virus, frequent travelers to foreign countries or remote areas, campers, and hikers, as the vaccines can reduce the risk of rabies

Rabies is a fatal viral infection for which there is no curing medicine at present. Patients with rabies not treated appropriately and promptly will eventually die. To prevent the virus from causing death, it is vital for the person who has been bitten or exposed to the animal to receive the first vaccine from a healthcare provider and to provide comprehensive treatments and care as soon as possible.