What is Rabies

What is Rabies?

·        Rabies is a zoonotic (spreads from animals to humans) viral disease most often transmitted through a bite of a rabid   animal. It is essentially fatal once symptoms develop. However, it is nearly 100% preventable through prompt and   proper prophylactic treatment after a potential exposure to the rabies virus. Prevention of the disease is the only way   to evade death.

·        Rabies virus can infect all mammals including humans. It infects the central nervous system of mammals causing acute   encephalitis in which the brain becomes inflamed, finally causing death.

What is the current status of rabies in Sri Lanka?

·    Rabies has continued to be a public health problem in Sri Lanka. Over the last decade, the annual number of rabies deaths has been stagnating around 25-30.

·  Annually 250,000 estimated animal bites happen in the country, and over 100,000 people receive post-exposure prophylaxes (PEP) / preventive treatment; with anti-rabies vaccine (ARV) along with rabies immunoglobulins (RIG) if indicated from government hospitals. 

How is rabies contracted?

·     In the vast majority of cases, the rabies virus enters the body, through bites or scratches introducing infective saliva from a rabid animal. The virus can also enter through viral contamination of existing wounds or skin abrasions by licks of a rabid animal or through the exposure of intact mucus membranes such as lips, eyes, and nasal and oral cavities to infected saliva.

·    The virus may multiply in muscle cells at the site of introduction, travel to the central nervous system (CNS) through nerves, multiply in the CNS, and travel through nerves to many tissues and organs such as the heart, adrenal glands, including salivary glands.

·        In the majority of human cases, the incubation period (the time taken for symptoms to appear from the time the virus enters the body) is 1–3 months. However, it could be as short as, less than 1 week and rarely longer than 1 year.

The following are not considered exposures:

1.     Contamination of intact skin with saliva of a proven rabid /suspicious/stray animal.

2.     Petting, bathing or coming into contact with utensils of a proven rabid/suspicious/stray animal

3.     Eating leftovers which were previously eaten by a proven rabid/suspicious/stray animal

4.     Drinking water from a well where an animal has fallen and died

5.     Drinking raw milk of a rabid cow or goat (however, drinking raw milk from a suspected/confirmed rabid animal is strongly discouraged)

6.     Bites from cold-blooded animals (reptiles, amphibians) and pecks by birds

7.       House rat bites

What should be done in the case of an animal bite?

There is a risk of contracting rabies through exposure to a variety of mammals (please see section 5 below) predominantly dogs.

·    First and foremost, the wound/site of exposure should be washed thoroughly, using soap under running water for at least 5 minutes. This way you can get rid of most of the virus present at the wound/exposure site.

Then the wound/exposure site should be cleaned with 70% alcohol (surgical spirit) or povidone-iodine.

These steps will reduce the risk of infection because the risk of infection also depends on the number of viruses entering the body (inoculum).

·        If exposed (bitten, scratched or licked on a mucous membrane or damaged skin) to any form of mammal, it is essential to seek medical advice immediately from a qualified doctor or seek care from a hospital. Most government hospitals would offer post-exposure prophylaxis (PEP) i.e., preventive treatment for rabies. If advised to go to another hospital for PEP treatment, this instruction should be strictly followed without delay. There have been many instances where people have succumbed to the disease due to poor adherence to medical advice.

Anti-rabies vaccines and rabies immunoglobulins used for rabies PEP treatment are safe in pregnancy and breastfeeding. Therefore, not contraindicated in pregnant and breastfeeding women.

·        Advice could be sort from the Medical Research Institute (MRI) on 011 269 8660 and 011 269 3532 -4.

·        Before seeking medical advice after an exposure, it is extremely important to verify the vaccination status of the animal and the animals’ vaccination records should be produced at the time of seeking care whenever possible. In the event where there is more than one animal on the premises, the identity of the animal involved should be verified. This is important because the course of treatment will also depend on the vaccination status of the animal.

However, seeking medical advice should not be unduly delayed if the vaccination status of the animal cannot be readily verified.

Once post-exposure prophylaxis (PEP) treatment is initiated……….

·      PEP treatment is a series of vaccines given at specific intervals. It is essential to complete the full course of vaccines for optimal protection. If PEP is started, it is extremely important that all the subsequent doses are taken on the exact date and that the course of treatment is completed as prescribed.

·        It is not essential to go to the same hospital where PEP was initiated for the subsequent doses. You can get them from any PEP providing hospital in the country on the due date, upon producing the PEP vaccination card.

When you are asked to observe an animal following an exposure…..

Whether PEP treatment is initiated or not it is necessary to monitor the animal involved closely for any changes in behaviour or signs of ill health for 14 days of the exposure and immediately report to the hospital if,

è Any changes are observed

è The animal dies or

è Goes missing. 

 It is important that this observation is made by a responsible and competent person.

·     The animal should be monitored daily for the entire 14-day period, and should report to the hospital immediately if such change in behaviour or signs of ill health is observed, the animal dies or goes missing.

·        If the animal is not vaccinated, it should be vaccinated immediately after the 14-day observation period.

How to send a dead animal/animal head for laboratory confirmation of rabies

·      In case the animal dies within the observation period or a dead animal is suspected of having rabies the animal should be decapitated and sent to the Medical Research Institute (MRI) Colombo, Karapitiya Teaching Hospital or Peradeniya veterinary faculty immediately to test for rabies.  In the case of small animals such as squirrels, the whole animal should be sent.

·      Animal heads should be sent within 8 hours of death. If it takes more than 8 hours the sample could be sent in ice within 24 hours.

·        Initial signs in the animal may include,

-         Any behavioural change

-         Lethargy

-         Fever

-         Refusal of food and water

-         Difficulty in swallowing

-         Vomiting, diarrhoea

-         Excessive salivation

-         Frequent straining to urinate and/or defecate

-         Changes in sound of the bark

-         Dropped jaw

There are two clinical forms of rabies in carnivores such as dogs and cats; the furious form and the dumb form.

·        Animals with furious rabies can exhibit signs such as,

-         Increased aggressiveness and barking

-         Fearfulness

-         Restlessness

-         Aimless wandering

-         Biting anything encountered

-         Convulsions/fits in the body

·        Animals with dumb rabies would show,

-         more confused like clinical signs such as withdrawal from the society

-         partial or complete paralysis of different parts of the body including the limbs, resulting in inability to walk.

Both forms eventually end up in death

·   You should seek advice from your area medical officer of health (MOH) or the public health inspector (PHI) on this procedure.

·        If the animal brain is tested positive for rabies, immediately inform:

è The area MOH/PHI

è The institution where PEP treatment was initiated

è Any other persons exposed to the same animal (in order to seek PEP treatment)

è Owners of other animals exposed to the rabid animal

·    If other animals have been exposed to the rabid animal immediately keep the animal isolated without having any contact with it. Inform the area MOH/PHI for further advice.

·      The exposed animal must be placed in strict isolation and closely monitored for any development of signs of rabies. If an exposed animal is currently vaccinated, it should be revaccinated immediately and closely observed for 45 days.

·        If an animal is bitten or exposed by a wild/stray or a suspected rabid animal it should also be regarded as an exposure  to rabies.

How to prevent Rabies?

Apart from dogs a variety of other animals such as cats, cattle, giant squirrels (rock squirrels), bandicoots, jackals, polecats, wildcats, mongoose, civet cats, monkeys, bats and squirrels, can transmit rabies to humans. In Sri Lanka, as human rabies is mostly dog-mediated prevention of dog rabies is the key to preventing human rabies.

·        Dog vaccination is the most effective way of preventing rabies. All dogs should be vaccinated annually. Pups should be vaccinated within 4- 6 weeks of birth with a second dose given in three months of the 1^st dose followed by annual booster doses.

·        Vaccination records should be maintained for all pets including cats.

·        In Sri Lanka there is a large population of “semi-owned” dogs known as community dogs that live in schools, temples, hospital premises, bazaars and other public premises.

·        It is the responsibility of the persons who feed and maintain them to make sure these dogs are vaccinated annually. The area MOH office conducts annual dog vaccination programmes to vaccinate domestic as well as community/stray dogs. 

·        Domestic/community dogs can also be vaccinated at a government or private veterinary clinic.

·        It is the responsibility of the pet owner to produce the vaccination records in case of a bite.

·        When obtaining pups make sure their mother is properly vaccinated.

·        Avoid feeding / caring for / handing / bringing home stray pups and dogs. 

·        Responsible pet ownership is an important strategy of prevention rabies. 

Legal Provisions on rabies prevention;

·        Under several ordinances and acts such as the Rabies ordinance and the Nuisance ordinance, pet owners are legally bound to ensure that their pets pose no health threat or nuisance to the public.

·        Any person who knowingly provides resort to a dog shall be regarded as the owner of the dog. Any such owner would be civilly and criminally liable for violating any clause of these ordinances. 

For further information please call the rabies unit at the Medical Research Institute (MRI) on 011 269 8660, 011 269 3532 -4.

Leaflets

1.      What should be done in the case of an animal bite

2.      When you are asked to observe an animal following an exposure

 Responsible pet ownership

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