Dr. Shyam P Lohani

THE danger posed by rabies is the greatest in developing countries in South Asia and Africa with large populations of stray and unvaccinated dogs. Death by rabies is excruciating, and once symptoms start, nearly 100 per cent is definite.
Although necessary scientific evidences and treatment are available to eliminate rabies, around 60,000 people worldwide die from rabies every year and 40 per cent of all deaths occur among children under 15 years of age. About 99 per cent of rabies deaths are due to bites from rabid dogs (WHO, 2021). It is estimated that around 50, 000 people annually receive post-exposure prophylaxis for rabies in Nepal and around 100 deaths occur annually.

Preventable disease
Rabies is a fatal but preventable viral disease and the disease is endemic to 150 countries and territories around the world. Rabies is a preventable viral infection that mainly spreads through a bite from an infected animal. Without early treatment, it is almost always fatal. When bitten or scratched by a rabid animal, it can spread to people and pets. Any mammals are the potential vector to transmit the rabies virus.
The virus is usually transmitted by the saliva of an infected animal either through a bite or scratch. Then it travels through nerve tissue to the brain, and to salivary glands. A person can develop rabies when s/he has been bitten by an infected animal, or saliva from an infected animal reaches into an open wound or through a mucous membrane, such as the eyes or mouth. It cannot pass through intact skin. Rabies is caused by a virus that affects primarily the central nervous system (CNS), in particular the brain.
Once the virus reaches the brain, it can cause hydrophobia and excessive salivation. Eventually, the brain infection leads to convulsion, coma, and death. The animals most likely to transmit the rabies virus to people include pets and farm animals such as cats, cows, dogs, ferrets, goats, horses, and wild animals such as bats, foxes, monkeys, beavers, coyotes, raccoons, skunks, and woodchucks. It has been found that, though rare, the virus has been transmitted to the tissue of organ transplant recipients from an infected organ.
The incubation period is the period between the bite and the onset of symptoms. It usually takes three weeks to three months for a person to develop rabies symptoms once they have contracted the infection. However, according to the World Health Organisation (WHO), incubation periods can range from 1 week to 1 year. The key to combating the rabies virus is a quick response.
The rabies virus infects the central nervous system. Unless the appropriate medical care after a potential rabies exposure is received, the virus can cause disease in the brain, ultimately resulting in death. Rabies can usually be prevented by vaccinating domestic animals and staying away from wild animals. Seeking immediate medical services becomes vital after potential exposures and before symptoms start.
Once a person begins showing signs and symptoms of rabies, the treatment often becomes less successful and the disease almost always causes mortality. Therefore, anyone who may have a risk of contracting rabies should receive rabies vaccinations for protection.
The initial symptoms of rabies are similar to the flu and may last for days. Then other signs and symptoms follow such as fever, headache, nausea, vomiting, agitation, anxiety, and confusion. Later, signs such as hyperactivity, difficulty swallowing, excessive salivation, fear brought on by attempts to drink fluids because of difficulty swallowing water, hallucinations, insomnia, and paralysis, coma, and death.
Rabies used to be known as hydrophobic because it appears to cause a fear of water. When trying to swallow water, intense spasms in the throat are triggered; therefore, even the thought of swallowing water can cause spasms. This is the reason why it is said to cause hydrophobia.

Vaccination
For most people, the risk of contracting rabies is relatively very low. However, there are certain situations that may put us at a higher risk. These risky behaviours include living in an area inhabited by bats, living in a rural area where there is greater exposure to wild animals and little or no access to vaccines and preventive therapy, traveling to countries where rabies is endemic, frequent camping, exposure to wild animals, and children under the age of 15 years old. Other activities that is likely to place people in danger to contract rabies, for example exploring caves where bats live or camping without taking precautions to keep wild animals away from the campsite, and working in a laboratory with the rabies virus.
Rabies in humans can be prevented, after exposure, by post-exposure prophylaxis. Rabies vaccination should be given as soon as possible in order to prevent the infection. The rabies vaccine is given in a series of five shots over 14 days is close to 100 per cent effective in preventing rabies. The WHO has set a goal to reach zero human deaths from dog rabies by 2030. Investing in the prevention of rabies by vaccinating pets in combination with providing post-bite prophylaxis should be the strategies to achieve the goal in countries endemic to rabies.

(Prof. Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)