Rabies: what you need to know now

Rabies kills more than 60 000 people a year worldwide with more than 95% of deaths occurring in Africa, and is endemic to South Africa.

It is 100% fatal but also 100% preventable through vaccination. It has the highest case-fatality rate of any infectious disease known to man, because there is no proven cure or treatment available once there are signs of an infection. However, if proper medical treatment is received immediately after exposure to the bite or scratch of a rabid animal, rabies infection can be halted before symptoms of the disease are present, and the disease can be prevented.

Unfortunately few pet owners living in cities and suburbia appreciate that rabies can affect them too. This is not a disease of farm animals; it can be carried and transmitted by any warm blooded animal and in South Africa 99% of human deaths from rabies have come from dog bites.

Rabies: transmission

Rabies is a viral disease that is transmitted through the saliva or nervous system tissues of an infected mammal to another mammal. You don’t need a serious dog bite for the virus to be transmitted; a small tear in the skin is enough. The rabies virus infects the central nervous system and causes severely distressing neurological symptoms, disease in the brain, and, ultimately, death.

Rabies is a zoonotic disease, which means that it can pass from other animals to humans.

Unfortunately, by the time a patient has clinical symptoms of rabies there is very little that can be done except palliative care. Medical teams can use sedation and tranquillisers to prevent the patient suffering from the distressing symptoms, but no cure exists.

If you think your pet has been bitten by a rabid animal

Get him or her to your vet immediately, and warn the vet ahead that you are coming. If your pet is up-to-date on his rabies vaccinations, then a booster should be administered immediately and your pet should be observed for a period of time, according to local legal requirements.

Your veterinarian should report the biting incident to the local health department so that the potential rabies case can be monitored.  The animal that bit your pet should be identified to the local animal control office, and if it is still at large, animal control can capture and submit it for diagnostic testing.  If rabies is not present in the tissues of the biting animal, the exposed pet that is up-to-date with its vaccinations is not at risk for rabies.  If there is no way to confirm whether the biting animal was rabid, then veterinary experts usually assume exposure to rabies, and the bitten pet should receive a booster shot and be observed for a period of time.

If the biting animal was rabid, and your pet was not up-to-date with their rabies booster or was not vaccinated at all, then the local public health officer may recommend that the pet be immediately euthanased.  If your pet bites someone and you cannot prove he has had his rabies vaccination, in the event of a rabies outbreak the State vet has the right to euthanase your pet, with or without your consent.Pets, with up to date rabies vaccination that have been exposed to a wild animal should be given a booster shot and observed for a period of time.

Rabies: prevention

  1. Vaccination: the best and only way to properly protect yourself and your pets is to have your pet vaccinated. Dogs must be vaccinated at 12-16 weeks and again, within 9 months. It’s easiest to get the first vaccination at 12 weeks and then a month later at 16 weeks. After the second vaccination, rabies vaccinations are administered at least every three years, although due to recent rabies outbreaks in the country veterinarians are now recommending yearly vaccination. Cats are vaccinated at 12 weeks of age and then within 9 months of the first vaccination. The repeat vaccination programme follows what is recommended for dogs (see above). Vaccinating your pet will not only save their lives but can protect the people and other animals it comes into contact with too. Vaccinations in pets are given under the skin at the nape of the neck. Most animals tolerate these injections very well as they are not painful. Generally there are no side effects though some animals may see a bit drowsy for 24 hours after vaccination. A very small percentage of animals will show an allergic reaction but this is very rare and is treatable.
  2. Keep your distance: if you are unsure of other animals’ vaccination status, keep your pets away from them.
  3. Educate your family: teach them about the risks and how to avoid exposure, and to let you know if they have encountered stray animals or animals behaving oddly. Help everyone in your family know what to do in the event of a dog bite. This includes child minders, gardeners and family and friends.
  4. If you are at high risk, have yourself vaccinated: People who, through their work may come into contact with animals that may be infected (game rangers, veterinarians, animal welfare and laboratory workers) can be vaccinated against the virus. If you believe you are at high risk (ie you work with large numbers of animals in a welfare or farm setting), you can ask to be vaccinated by your general practitioner. The start up vaccination programme for people is Day 0, Day 7, Days 21/28 and a year later and then every three years.

Symptoms to watch out for

We’ve all heard of the rabid dog foaming at the mouth and acting aggressively but the more common form of rabies in dogs is called dumb rabies and these symptoms are progressive paralysis of the limbs, distortion of the face and difficulty swallowing. Owners may think the dog has something stuck in their mouths or throat. The dog then becomes comatose and dies.

Symptoms of furious rabies include aggression, excitability and suddenly eating strange things like stones, earth and rubbish. Paralysis eventually sets in and the rabid animal may not be able to eat or drink. Hydrophobia (fear of water) is not a sign of rabies in dogs; this is a feature of rabies in humans. The dog will eventually die from a violent seizure.

What do I do if I suspect I’ve been bitten by a rabid animal?

  1. Wash and flush the bite wound thoroughly with soap and water, for at least 10 minutes under running water.
  2. Consult a doctor immediately so that treatment is not delayed.
  3. Your doctor will likely give you a series of vaccinations. Keep a record of the dates of each injection and be sure to complete the course. The doctor should not suture the wound as this will spread the virus in the exposed area.
  4. Depending on the severity (category) of the injury, your doctor may also inject rabies immunoglobulin around the wound.

Rabies symptoms in humans

The first symptoms are usually flu-like, including fever, headache and fatigue, which then progresses to involve the respiratory, gastrointestinal and/or central nervous systems.

Early symptoms are often vague, but can include:

  • Fever
  • Headache
  • Sore throat
  • Fatigue
  • Loss of appetite
  • Nausea and vomiting
  • Tingling and intense itchiness at the site of the bite after the wound has healed
  • Anxiety and difficulty sleeping

As the virus progresses, the symptoms become more distressing until death occurs. These include:

  • Severe agitation
  • Aggressive, uncontrollable behaviour
  • Inability to swallow
  • Excessive salivation
  • Seizures
  • An irrational fear of water, triggered when water is offered to drink (hydrophobia)

Sometimes people with rabies do not have these dramatic symptoms, but gradually become completely paralysed and slip into a terminal coma. This form of rabies is more difficult to recognise.

There may be signs of hyperactivity (‘furious’ rabies) or paralysis (‘dumb’ rabies). In both furious and dumb rabies, there is progressive paralysis, followed by coma. Death occurs during the first 7 days of illness.

Department of Health COVID-19 updates available at www.sacoronavirus.co.za

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