Rabies: Symptoms, causes and treatment

Rabies is a viral disease with a very high fatality rate. It is mostly associated with dog bites. It causes progressive inflammation of the brain and spinal cord, all until the patient's demise.

According to the World Health Organisation (WHO), there are two types of  rabies disease: furious rabies and paralytic rabies.

“Furious rabies causes fear of water, hyperactivity, and excitable behaviour. In some incidents, the patient might also be afraid of fresh air,” states the WHO.

Death from furious rabies usually occurs after a few days as a result of cardio-respiratory arrest.

Paralytic rabies takes a longer time to affect the patient but it also ends fatally. When a patient has this type of rabies, their muscles will gradually become paralysed. This paralysis will start off at the site of the bite or scratch.

This is followed by a coma that ends in death. The WHO cautions that this form of rabies is very easily misdiagnosed, which regularly results in defective treatment methods.

Burden of disease

In Kenya, the Ministry of Health’s 2014 to 2030 Strategic Plan for the Elimination of Human Rabies estimates that up to 2,000 people die annually due to rabies.

This has seen the Ministry of Health (MOH) rank rabies as one of the top five zoonotic diseases in Kenya.

Globally, 60,000 people die from rabies. Of these, 95 per cent of deaths occur in Africa. Data from the WHO shows that the burden of disease is disproportionally borne by rural poor populations where educational awareness on the rabies disease is low.

An estimated half of cases in rural populations are attributable to children under 15 years of age. 

Causes

According to the Ministry of Health (MoH), 98 per cent of all cases of rabies in humans are transmitted by dogs.

“People are usually infected following a bite or scratch by an infected dog. Transmission can also occur when infectious material – usually saliva – comes into direct contact with human mucosa or fresh skin wounds,” MoH says.

“Human-to-human transmission through bite is possible but rare.”

Apart from dogs, it is also possible to get infected after a bite from an infected animal classified as a mammal, for example, a bat.

An infected animal may show certain warning signs. According to the Centre for Disease Control, an infected dog may for instance be very aggressive and make an attempt to bite you.

This dog will also be equally aggressive towards other animals. You may also notice that it is drooling more than normal.

“There are also infected dogs and animals that will look timid and shy and allow you to get close to them before lashing to bite or scratch you,” the CDC cautions.

Other signs you should look out for, CDC says, include a dog that looks sickly, has difficulty swallowing, keeps biting at imaginary things, has trouble moving or looks paralysed, and appears calmer and timid than usual.  

Symptoms

According to the CDC, symptoms of rabies in animals are similar to those in people. These symptoms will vary from early signs that are not specific to the rabies disease, followed by acute neurologic symptoms, then death.

The CDC says the early symptoms will tend to be similar to those of the flu. These will include fever, headache, discomfort and general fatigue.

The patient may also experience and unexplained tingling, pricking, or burning sensation known as paraesthesia at the wound site.

“After the early stage, symptoms of rabies are elevated to cerebral dysfunction, anxiety, confusion, and agitation. This is followed by delirium, abnormal behaviour, hallucinations, fear of water, and insomnia."

These symptoms can last from two to 10 days after which the disease becomes fatal. “Chances of survival after clinical rabies are very minimal. Once clinical signs of rabies appear, the disease almost always ends with death. Treatment at this stage is mostly supportive,” the CDC states.

According to the WHO, rabies spreads to the central nervous system, and triggers a fatal inflammation of the brain and spinal cord.

Treatment

Treatment for rabies is through post-exposure prophylaxis. According to the WHO, this treatment method is designed to stop the rabies virus from getting into your central nervous system.

This treatment should start as soon as the bite has taken place to prevent the onset of symptoms or death.

“Treatment may include extensive washing and local treatment of the bite wound or scratch, administration of potent and effective rabies vaccine that meets the WHO standards, and the administration of rabies immunoglobulin (RIG),” the WHO states.

Per the CDC, a post-exposure prophylaxis programme will consist of one dose of immune globin and four doses of the rabies vaccine over a 14-day period. “Rabies immune globulin and the first dose of rabies vaccine should be given by your health care provider as soon as possible after exposure,” cites the CDC.

Prevention

According to the WHO nipping the cause at the source is the best way to prevent rabies. This involves vaccination of your pet against rabies.

This vaccination must be regular as prescribed by a qualified veterinarian. “Rabies is a vaccine-preventable disease that can be nipped in the bud through vaccination of dogs. This vaccination will reduce dog-related rabies as well as post dog-bite post-exposure prophylaxis care for the patient,” the WHO states.

If you suspect that your pet has contracted rabies, you should promptly consult a qualified veterinarian to handle it.

“If you have been bitten or scratched by an animal, it is very critical that you consult your physician immediately for post-exposure prophylaxis medical care,” the WHO recommends.

Since children are at an increased risk of getting infected by an infected pet, you should teach them how to protect themselves when around new pets and what to do when attacked. Some of the tips you can share with them include: 

• Never approach a dog that’s hissing or attempting to peck, scratch or bite.
• Never go near strange dogs. Always stick with other children when near unfamiliar dogs to avoid accidental scratches, bites or pecks.
• Never feed a dog with their bare hands.
• Keep from touching or rattling a dog before it sees or familiarises with them.
• Always report when scratched or bitten by a dog
• Always ask for permission from you or the dog’s guardian if they intend to play with it.
• Always ask how friendly the dog is.