World Rabies Day

1. Rabies is a zoonosis (a disease that is transmitted from animals to humans) that is caused by a virus. 
2. It is known to be present in more than 150 countries and territories of all continents except Antarctica.
3. Rabies is a 100% preventable disease that causes inflammation of the brain and eventual death. There is no way to stop or retard the progression of the disease once it has begun, and death almost always results within two weeks.
4. Rabies is wide-spread and potentially threatens over 3 billion people in Asia and Africa, where people most at risk live in rural areas with very limited or no access to human vaccines and immunoglobulins.
5. Rabies is present in the nerves and saliva of an infected animal. While human beings usually cannot fight a potential rabies infection without medication, some bird species have been known to develop antibodies and recover from the disease.
6. September 28 is World Rabies Day and it has been recognised as such by the United Nations and marked every year since 2007. The first World Rabies Day campaign took place in September 2007 as a partnership between the Alliance for Rabies Control and the Centers for Disease Control and Prevention, Atlanta, USA (CDC), with the co-sponsorship of the World Health Organization (WHO), the World Organisation for Animal Health (OIE) and the Pan American Health Organization (PAHO/AMRO).The day has been chosen as the World Rabies Day because it is the death anniversary of Louis Pasteur, who developed the first rabies vaccine.
7. There is hope for a cure for rabies. In 2004, American teenager Jeanna Giese became the first known person to have survived an infection of rabies without being vaccinated. She was bitten by a bat on her way back from school, and received no further treatment after the bite wound was treated with hydrogen peroxide. She developed neurological symptoms after 37 days and was eventually diagnosed with rabies. The doctors put Giese into an induced coma to temporarily halt brain function, which they thought would halt the progression of the disease. Giese was given a mixture of ketamine and midazolam to suppress brain activity, and the antiviral drugs ribavirin and amantadine, while waiting for her immune system to produce antibodies to attack the virus. The treatment succeeded and came to be known as the Milwaukee protocol. Though Giese had difficulty with walking and balance for several years hence, she became the first person to be cured of rabies.
8. Similar treatment has proved successful in 2 of another 20 patients so far. Overall, the treatment seems to have a success rate of less than 10%. However, it provides hope for an eventual cure for rabies. Until then, it is best to take precautions to avoid animal bites, and seek immediate and appropriate treatment if bites occur.
9. The problem with rabies is that symptoms do not usually occur immediately, but vaccinations must be taken within 48 hours (and an absolute maximum of a week) to prevent rabies from occurring after a dog bite. The symptoms (if post-exposure treatment is not taken promptly and correctly) usually manifest within one to three months, though there have been cases of symptoms occurring within a week, and after six years. The time lag between the bite and symptoms happens because the rabies virus must reach the central nervous system before the occurrence of symptoms. Additionally, it is thought that the distance of the place of bite from the brain and spinal cord also determines the period of onset of symptoms. According to WebMD, rabies symptoms initially feel like influenza. They include fever and tingling at the site of exposure (the bite). After a few days, the person may develop violent movements, fear of water (hydrophobia), paralysis of the body, inability to consume food, confusion, loss of consciousness and an urge to bite others. Paranoia, anxiety, double vision and hallucinations also may occur. The end result is almost always death. With the progression of the disease, the dog may become very sensitive to light, sound and touch. It may hide in dark places and develop paralysis of the throat muscles, which could result in foaming at the mouth. Paralysis of hind legs is also possible. Loss of appetite, weakness and seizures may also occur. Eventually, the dog dies.
10. According to the National Guidelines on Rabies Prophylaxis (of the Government of India), firstly, it is essential to immediately wash the wound thoroughly with soap and water. This is known to reduce the threat of infection. Next, it is necessary to visit a clinic which provides anti-rabies vaccination as soon as possible. The doctor usually checks the area of the bite and decides treatment based on it known as Post-Exposure Prophylaxis (PEP). The treatment usually involves administration of anti-rabies vaccine on days 0, 3, 7, 14 and 28. Rabies Immunoglobulin (RIG) is also administered. The treatment is given both intra-dermal and intra-muscular. A tetanus shot and a course of antibiotics may also be recommended.
11. There are two types of Rabies Immunoglobulin (RIG), which is essential to prevent rabies (vaccination alone is not enough after being bitten). Either can be provided to the bitten person:
1. Equine Rabies Immunoglobulin (ERIG): ERIG is produced from hyper-immunisation of equine animals. It is cheap and readily available in India. The dose of ERIG is 40 IU per kg body weight of patient.
   
   Purified chick embryo vaccine or purified duck embryo vaccine would be provided in addition to ERIG/HRIG.
   
   
2. Human Rabies Immunoglobulin (HRIG): HRIG is expensive but free from any side effects. The dose of the HRIG is 20 IU per kg body weight. 
12. It is important not to miss out on any anti-rabies doses. If a dose is missed on any day, it is necessary to take it as soon as possible. Abandonement of subsequent doses after the first medication on Day 0 can result in eventual development of rabies.

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