RABIES

Rabies, a viral infection, targets the central nervous system and affects warm-blooded mammals, including humans. Although human cases are uncommon in the United States, the virus poses a severe threat if not promptly treated before symptoms manifest, boasting a staggering mortality rate of 99.9%.

Causes

The rabies virus instigates the infection, primarily It is transmitted through bites, scratches, or saliva from infected animals.

Transmission Sources

Rabies predominantly lurks in wild mammals like coyotes, raccoons, skunks, bats, and foxes in the U.S. However, domestic pets such as dogs and cats, along with livestock like horses and cattle, can also contract this viral infection, often due to lack of vaccination. While U.S. regulations mandate rabies vaccination for dogs, many other countries lack such stringent laws, contributing to higher instances of this viral infection among dogs globally.

The spread

Typically, this viral infection spreads through deep bites or scratches from infected animals. The virus can also be transmitted through direct contact with infected saliva or nervous system tissue, posing risks through cuts in the skin or mucous membranes like the eyes, nose, or mouth.

Rare Human Cases

Human rabies cases remain exceedingly rare in the United States, with bats being the primary source of infection due to their inconspicuous bites or scratches. Beyond bats, exposure to rabid dogs in other countries ranks as the second leading cause of this viral infection fatalities among Americans and the primary cause elsewhere.

Types of Rabies

This viral infection manifests in two distinct forms, each characterized by unique symptoms and progression:

1. Furious Rabies:

Symptoms: Notable for inducing hyperactivity and hallucinations, where individuals may display extreme excitability or exaggerated movement. Additional symptoms include hydrophobia (fear of water) and sometimes aerophobia (fear of fresh air or drafts).
Progression: Over a span of a few days, furious rabies progresses to a fatal outcome marked by cardiorespiratory arrest, resulting in the cessation of heart activity and breathing.

2. Paralytic Rabies:

Symptoms: Paralytic rabies primarily presents as paralysis and coma. Muscle paralysis typically initiates at the site of the bite or scratch, gradually rendering the individual unable to move.
Prevalence: This form of viral infection accounts for approximately 20% of human cases and is frequently misdiagnosed due to its subtle onset and progression.
Progression: Individuals afflicted with paralytic rabies progressively slip into a state of coma before succumbing to the disease.

Rabies Risk Factors

Low Risk in the U.S.: Due to stringent vaccination laws for pets, particularly dogs, the risk of this viral infection transmission from domestic animals is low in the United States.
Global Concern: However, globally, humans face a higher risk of this viral infection transmission from dogs, with children being particularly vulnerable due to increased likelihood of multiple bites and severe exposure.
High-Risk Groups: Certain individuals face elevated risks of the viral infection exposure, including laboratory workers dealing with the virus, veterinarians handling potentially infected animals, spelunkers exploring caves inhabited by bats, and travelers visiting regions wherethe viral infection is prevalent and access to medical care may be limited.

The Phases of Rabies

This viral infection follows a distinct progression from exposure to its devastating conclusion, marked by several phases:

1. Incubation Phase:

Timeline: Following exposure to the rabies virus, the incubation phase ensues, during which the virus resides in the body for days to weeks before infiltrating the nervous system.
Symptoms: Notably, no symptoms manifest during this phase, creating a deceptive calm before the storm.

2. Prodromal Phase:

Onset: Once the rabies virus penetrates the nervous system, the prodromal phase commences, characterized by the virus’s migration through nerve cells towards the brain and spinal cord, causing nerve damage along the way.
Symptoms: During this phase, flu-like symptoms emerge as the immune system endeavors to combat the virus. Nerve damage may provoke sensations of tingling, pain, or numbness at the site of the bite or scratch.
Duration: The prodromal phase typically spans 2 to 10 days, signifying the escalating battle within the body.

3. Acute Neurologic Phase:

Progression: In this critical phase, the rabies virus intensifies its assault on the central nervous system, inflicting significant damage to the brain and spinal cord.
Symptoms:
- Furious Rabies: Individuals afflicted with furious rabies exhibit symptoms such as aggression, seizures, and delirium, reflecting the virus’s profound impact on cognitive and behavioral functions.
- Paralytic Rabies: Conversely, those with paralytic rabies experience weakness and paralysis that gradually spreads from the site of the bite to other parts of the body.
Duration: Furious rabies typically persists for a few days to a week, while paralytic rabies can extend up to a month, prolonging the suffering of the afflicted individuals.

4. Coma:

Terminal Stage: For many individuals, coma marks the final stage of a rabies infection, signifying the irreversible progression towards death.
Outcome: Eventually, rabies exacts its ultimate toll, claiming the lives of those ensnared in its relentless grip.

Symptoms and progression of Rabies

This viral infection symptoms typically don’t manifest immediately after exposure. The virus can remain dormant in the body for a period ranging from 1 to 3 months, termed as the “incubation period.” Symptoms emerge as the virus traverses the central nervous system and reaches the brain.

Early Symptoms:

Fever and General Weakness: The initial indication of infection often includes fever accompanied by feelings of fatigue, weakness, headaches, or flu-like symptoms.
Localized Symptoms: Individuals may experience coughing, sore throat, muscle pain, nausea, vomiting, or diarrhea. Moreover, pain, tingling, or burning sensations may occur at the site of the wound.

Progression of Symptoms:

Neurological Symptoms: As the virus progresses through the central nervous system, more severe symptoms emerge, including:
Inability to sleep (insomnia)
Anxiety and confusion, affecting various aspects such as movement, cognition, and emotions.
Brain dysfunction leading to partial paralysis, hyperactivity, agitation, and hallucinations.
Seizures, excessive salivation, difficulty swallowing, and abnormal behavior.
Rapid breathing (hyperventilation), increased heart rate, muscle twitching, and unequal pupil sizes.
Neck stiffness, particularly associated with paralytic rabies.

Late-stage Symptoms and Complications:

Hydrophobia: A characteristic symptom of furious rabies, hydrophobia manifests as an intense fear of water during the late stages of infection. Those afflicted with hydrophobia experience muscle spasms triggered by the sight, sound, or taste of water.
Progression to Coma and Organ Failure: Over time, these symptoms progress, potentially leading to coma, and eventually, failure of the heart or lungs, culminating in death.

Treatment

While there are no approved treatments for this viral infection once symptoms manifest, swift action following potential exposure to the virus can prevent its deadly progression. Here’s what you need to know:

1. Seeking Immediate Medical Attention:

If you suspect exposure to this viral infection, contact a healthcare professional without delay.
Clean any wounds resulting from bites or scratches by wild or potentially infected animals promptly with soap and water. Further wound care instructions will be provided by your healthcare provider.

2. Post-Exposure Prophylaxis (PEP):

To prevent the rabies virus from taking hold and causing infection, your healthcare provider will administer a series of vaccinations, commonly referred to as PEP.
Additionally, if you have not been previously vaccinated against this viral infection, an antibody treatment near the wound site may be administered to bolster protection against the virus.
These medications serve as preventive measures, thwarting the virus’s ability to travel to the brain and trigger this viral infection.
It’s important to adhere to the prescribed vaccination schedule outlined by your healthcare provider to ensure optimal protection.

3. Tetanus Shot:

Depending on the nature of the wound and your vaccination history, you may require a tetanus shot if you haven’t received one in the past 10 years. This additional precautionary measure safeguards against tetanus infection.

4. Safety During Pregnancy:

Pregnant individuals need not worry, as rabies shots are deemed safe for both the mother and the unborn baby. Seeking prompt medical attention and adhering to the recommended preventive measures remain crucial, even during pregnancy.

Understanding the Rabies Vaccine

Following exposure to the rabies virus, timely administration of post-exposure prophylaxis (PEP) medication, including human rabies immune globulin (HRIG) and the rabies vaccine, is essential in preventing the onset of rabies infection. Here’s what you need to know about the rabies vaccine and its administration:

1. Human Rabies Immune Globulin (HRIG):

Purpose: HRIG is administered as a shot to individuals who have never received a rabies vaccine before. It provides immediate antibodies to combat the rabies virus until the body can generate its own immune response.
Function: Antibodies are proteins produced by the immune system to fight off harmful viruses like rabies.
Administration: HRIG is injected only once, typically immediately following exposure to the virus.

2. Rabies Vaccine:

Purpose: The rabies vaccine is administered alongside HRIG to prevent this viral infection after exposure to the virus.
Function: The vaccine stimulates the body’s immune system to recognize and destroy the rabies virus before it can reach the brain and cause infection.
Administration: The vaccine is administered in the arm, not the stomach, and consists of a series of four doses.

Possible Side Effects

Mild side effects from the rabies vaccine may include pain, itching, or swelling at the injection site, nausea, headache, dizziness, and muscle pain.
Serious side effects should be reported to your healthcare provider promptly for further evaluation and management.

Vaccine Schedule

HRIG Administration: HRIG is administered immediately after exposure, typically as a single injection.
Rabies Vaccine Schedule:
- Day 0: First rabies vaccine shot administered as soon as possible after exposure.
- Day 3: Second rabies vaccine shot.
- Day 7: Third rabies vaccine shot.
- Day 14: Fourth and final rabies vaccine shot in the series.
If previously vaccinated against rabies, individuals receive shots only on days 0 and 3 after exposure, omitting the subsequent doses.

Identifying Rabies in Animals

Recognizing this viral infection in animals isn’t always straightforward. While some may envision aggressive behavior and foaming at the mouth, the reality is more nuanced. Here’s what you need to know about identifying rabid animals and minimizing your risk of exposure:

1. Behavioral Cues:

Unusual Behavior: Contrary to common perception, most wild animals infected with this viral infection tend to display shy or timid behavior, deviating from their typical demeanor.
Caution Advised: If an animal behaves unusually, such as acting aggressively or attempting to bite, it’s best to exercise caution and avoid interaction.

2. Safety Measures:

Avoid Contact: Follow these common-sense guidelines when encountering stray or wild animals:
- Never pet a stray dog or cat.
- If you observe an animal exhibiting strange behavior or aggression, contact your local animal control for assistance.
- Refrain from touching wild animals, even if they appear deceased, as they may still pose a risk of rabies transmission.

Preventing Rabies

This viral infection is a preventable disease, but swift action is crucial if you suspect exposure to the virus. Here’s what you can do to safeguard yourself and your pets from this viral infection:

1. Immediate Medical Attention:

Seek medical care promptly if you’ve been bitten, scratched, or had potential contact with a rabid animal.
Post-exposure prophylaxis (PEP) vaccine doses administered before the virus reaches the brain are 100% effective in preventing rabies.

2. Pet Care Practices:

Schedule regular checkups for your pets with a veterinarian and ensure they are up to date with rabies vaccinations.
Supervise outdoor activities for pets to prevent wandering and potential encounters with rabid animals.
Consider spaying or neutering your pets to curb the population of strays and reduce the risk of rabies transmission.

3. Community Involvement:

Report stray animals to local animal control authorities to address potential risks associated with unvaccinated or sick animals.
Promptly wash animal bites or scratches with soap and water to minimize the risk of infection.

4. Wildlife Interaction:

Avoid direct contact with wildlife, including injured animals. Instead, seek assistance from animal control or local authorities for safe handling and removal.
Before traveling abroad, research the presence of rabies in dogs or wildlife at your destination to take appropriate precautions.

5. Pre-exposure Prophylaxis (PrEP):

Consider pre-exposure prophylaxis (PrEP) if traveling to areas with a high risk of rabies or working closely with animals known to carry the virus.
PrEP involves a series of rabies vaccine doses administered before potential exposure to the virus, providing an added layer of protection.

6. Additional Medical Attention:

Even if you’ve received PrEP doses of the vaccine, seek medical attention after possible exposure to the viral infection.
Two additional vaccine doses are required to prevent the virus from progressing to the brain, ensuring comprehensive protection.

Prognosis

This viral infection sounds scary, but here’s the good news: you can completely avoid getting sick if you act fast after being exposed.

Imagine getting scratched or bitten by an animal that might have rabies. Here’s what happens:

The Race Against Time: The rabies virus travels slowly. If you get treated before it reaches your brain, you’re completely fine! This treatment involves a shot of special medicine (human rabies immune globulin) and a few more shots of a vaccine over two weeks.
Early Action Saves Lives: The key is to see a doctor right away after possible exposure. Rabies can take weeks or even months to show symptoms, but once it infects your brain, it’s too late. There’s no medicine to fight it off at that point.

So, remember: this viral infection is 100% preventable with a quick vaccine after exposure. Don’t be afraid, get the shots and stay healthy!

FAQs

Why the Fear of Water?

This viral infectioncomes in two forms, one of which causes a fear of water called hydrophobia. This is because the virus attacks the nervous system, causing muscle spasms in the throat when the person or animal tries to drink.

Is this viral infection Curable?

There’s good news! this viral infection is completely curable if treated early enough, before the virus reaches the brain. This involves a shot of rabies immune globulin and a series of rabies vaccines over two weeks. Getting these shots right away is crucial. Once symptoms appear, this viral infection is almost always fatal, with very few survivors.

How Long Does Rabies Survive Outside the Body?

The rabies virus is a fragile fellow. Once outside its host, it dies quickly when exposed to sunlight and dries out. The exact time depends on the environment, but generally, a dry surface likely won’t harbor infectious rabies virus. Still, it’s always best to avoid touching wild animals, dead or alive.

How Long Does Dog with Rabies Live?

After exposure, the rabies virus takes a while to travel to the dog’s brain, anywhere from 3 to 12 weeks. During this period, the dog appears healthy. Once the brain is affected, symptoms develop, and the dog usually dies within a week.

Sources

Mayo Clinic
Cleveland Clinic
The Humane Society of the United States
Global Alliance for Rabies Control
WebMD
World Health Organization
Centre for Disease Control