Rabies, fatal but preventable | Daily News

Rabies, fatal but preventable

A rabid dog
A rabid dog

Here are excerpts from an interview conducted with Dr. Athula Liyanapathirana on Rabies. Dr. Liyanapathirana MBBS (Col) MSc, MD (Community Medicine) is a Consultant Epidemiologist attached to the Epidemiology Unit of the Health Ministry.

Q: What is Rabies?

A: Rabies is a zoonotic (spread from animals to humans) viral disease most often transmitted through a bite of a rabid animal. Rabies is essentially fatal, and prevention is the only way to prevent death.

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

Q: What is the current status of this disease in Sri Lanka?

Dr. Athula Liyanapathirana

A: Despite a steady reduction in the number of human deaths due to rabies during the past few decades, rabies has continued to be a public health problem in Sri Lanka. During the last five years, on average, about 27 people have died of human rabies each year. This seemingly low death rate is however the tip of the iceberg and does not reflect the true burden of the disease. Annually, 250,000 estimated animal bites happen in the country, and over 100,000 people receive post exposure prophylaxes (preventive treatment) from Government hospitals with anti-rabies vaccine (ARV) and rabies immunoglobulins (RIG).

Q: How do people get Rabies?

A: In the vast majority of the cases the rabies virus enters through bites or scratches introducing infective saliva from a rabid animal. The virus can also enter the human body through viral contamination of existing wounds or skin abrasions by licks of a rabid animal, or through exposure of intact mucus membranes such as lips, nasal cavity or the genitals to infected saliva. On rare occasions, the inhalation of virus laden aerosols (fine particles) in laboratories and bat infested caves has caused the disease in humans.

The virus may multiply in muscle cells at the site of introduction, travel to the Central Nervous System (CNS) through nerves, multiplies in the CNS, travel through nerves to many tissues and organs such as the heart, adrenal glands, including salivary glands, where the virus will be execrated with saliva.

In humans, the incubation period or the time taken for symptoms to appear form the time the virus enters the body could vary from 20 days to 90 days in 75% of cases. However, it could be as short as four days and as long as many years.

Q: What should we do if a stray dog or a suspected animal bites us?

A: The first and foremost thing you should do is wash the wound well using soap under running water for at least five minutes. This way you can wash off most of the virus present at the wound site and soap will easily kill the virus.

This is important because the risk of infection also depends on the number of viruses entering the body. Then you should seek advice from a qualified doctor or seek care from a hospital where Post Exposure Prophylaxis (PEP) treatment for rabies is available. Most of the Government Hospitals would offer this treatment. If you are asked to go to another hospital for higher treatment, you should strictly follow that instruction. We have seen many instances where people have succumbed to the disease due to not following medical advice. You can call the rabies unit at the Medical Research Institute (MRI) on 011 269 8660, 011 269 3532 -4 for advice.

Pregnancy or breastfeeding are not contraindications for rabies post exposure treatment. If you are bitten by a domestic animal, it is extremely important to verify the vaccination status of the animal and bring the vaccination records of the animal along with you after verifying the identity of the animal in case there are more than one animal at that premises. This is important because the course of treatment will depend on the vaccination status of the animal. If PEP is started, it is extremely important that you go for all the subsequent doses on the exact date and complete the course of treatment as prescribed. Depending on certain factors including the nature of the wound and the vaccination status of the animal, there could be instances where you are asked to observe any changes in behaviour in the animal for 14 days and immediately report to the hospital if you observe any. Animals could exhibit different behavioural changes. The initial clinical signs would be lethargy, fever, refusal of food and water, difficulty in swallowing, vomiting, diarrhoea, excessive salivation, and frequent straining to urinate and/or defecate.

There are two clinical forms of rabies in carnivores such as dogs and cats; furious form and dumb form. Animals with furious rabies can exhibit behavioural changes such as including increased aggressiveness and barking, fearfulness, restlessness, aimless wandering, biting anything encountered, and convulsions 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 tongue, and throat and respiratory muscles. It is important that this observation should be made by yourself whenever possible or by a responsible person. The animal should be observed daily for the entire period of 14 days, and you should report to the hospital immediately if such change in behaviour is observed.

The rationale behind this 14 day observation is that animals could excrete the virus in their saliva up to 14 days before they develop symptoms. If the animal is not vaccinated, it should be vaccinated immediately after the 14-day observation period. In case the animal dies within the observation period the head should be severed, packed in ice and sent to the MRI, Karapitiya Teaching Hospital or Peradeniya Veterinary Faculty within 24 hours for testing for rabies. You can seek advice from your local Medical Officer of Health (MOH) or the Public Health Inspector (PHI) on this procedure. Care should be taken not to splash any blood on your face, and preferably personal protective equipment (PPE) should be worn before severing the animal head.

Q: What if a family member develops Rabies?

A: Usually rabies is not transmitted from human to human. However, in certain instances such as a sexual partner or a bystander who was attending to the patient maybe offered PEP treatment under special circumstances.

Q: How can we prevent Rabies?

A: In Sri Lanka human rabies is mostly dog mediated. Therefore, prevention of dog rabies is the key to preventing human rabies. A variety of other animals such as cats, cattle, squirrels, racoons, bandicoots, jackals, polecats, wildcats, mongoose and monkeys can also transmit rabies to humans. Dog vaccination is the most cost-effective way of preventing rabies. All domestic dogs should be vaccinated annually. Pups should be vaccinated within 4-6 weeks of birth with a booster dose given in three months followed by annual vaccinations. Records should be maintained for all owned pets including cats with vaccination records. In Sri Lanka there is a large population of “semi-owned” dogs that we call community dogs that live in schools, temples, hospital premises, bazaars and other public premises. It is the responsibility of the persons who feed them and maintain them to make sure these dogs are vaccinated annually. The local MOH office conducts annual dog vaccination programmes to vaccinate domestic as well as community dogs. Domestic dogs can be vaccinated at a government or a private veterinary clinic. It is the responsibility of the pet owner to produce the vaccination records in case of a bite.

Dog bite prevention is also an important strategy in rabies prevention.

Dogs bite for a variety of reasons, but most commonly when threatened, cornered, and scared or not feeling well. We must learn to identify different expressions of a dog as much as possible to be able to anticipate how they will react. Socialization the dog will reduce the chances of it biting. Socializing your pet helps your dog feel at ease in different situations. It's also important to use a leash in public places to have better control of your dog.

Educating yourself and your family about whether to approach and how to approach a dog.

Avoiding risky situations. A dog should not be approached or petted if the dog is: not with its owner, on the other side of a fence—should not reach through or over a fence to pet, sleeping or eating, sick or injured, with her puppies or seems anxious about your presence, playing with a toy, growling or barking, appearing to be avoiding you.

If you want to pet a dog always ask the owner whether you can pet their dog. Gently present the back of your hand first for the dog to smell

Never try to touch the top of their head, first. You should not run toward a dog which can make the dog feel threatened. Never try to tease a dog by barking or growling at it. Anticipate that all dogs can bite at any time, do not assume a dog is ‘safe’ and ‘will never bite. Never leave children with dogs unattended. It is important to learn to understand the body language of dogs.

You should learn and teach your family proper manners around a dog. Never let a child ride or sit on your dog no matter how gentle it is. Never pull its ears or tail.

Unknown animals should never be handled. Puppies may show a playful behaviour when they are infected with rabies. Children should be strictly advised not to pet or handle unknown puppies. Avoiding encountering suspicious dogs and other animals is also important. If any wild animal such as a jackal is spotted in a human habitat it should be informed to the MOH office and / or the WildLife Department immediately.

Habitat control is also important. Proper garbage disposal and refraining from feeding community dogs in public places will help control their population.

Q: What is responsible pet ownership?

A: This concept needs promotion in the Sri Lankan society and an effective method of engaging the community in prevention of rabies. Pet owners have a dual responsibility; one towards the welfare of the pet and the other towards the society and both have a stake in rabies prevention.

Birth control, restriction of movement of their pets, refraining from dumping excess puppies and kittens in public places, vaccinating them against rabies and other vaccine preventable diseases, record maintenance providing them proper nutrition, cleaning and grooming them and training them are the main aspects of responsible pet ownership. Birth control by surgical sterilization or hormonal methods is important in preventing unwanted offspring that will finally end up as community dogs that are unvaccinated. Dog owners should be encouraged to not let their doges roam outside their premises that will expose them to potentially rabid animals as well as pose a biting threat to other people. This needs to be done through creating awareness among pet owners as well as legislation. There are legal provisions in the rabies ordinance and the nuisance ordinance for promoting responsible pet ownership and the Local Government bodies have authority to adopt bylaws under these ordinances. People should also be made aware about these laws and regulations.

Add new comment