It’s only appropriate that when the entire world is looking forward towards an effective vaccine against Covid 19, we talk about the disease against which the first successful vaccine was prepared throwing open a tremendously successful field of vaccine therapy.
World Rabies Day is celebrated every year on 28th September by WHO since 2007 in memory of Louis Pasteur, the father of Microbiology and science of vaccinology to reinforce the resolve to eliminate this zoonotic disease from planet earth by 2030, which kills around 60 thousand innocent people year after year of which 20,000 are children. One third of total cases and deaths in same proportion sadly are from Indian subcontinent of which majority are from India.
This totally eradicable disease is currently prevalent in over 100 countries mostly in poor countries of Asia and Africa where costly post exposure prophylaxis alone engulf billions of rupees which can be easily put to better use.
Rabies is an almost certain fatal disease but fortunately it’s nearly 100% preventable disease. However, it requires enhanced public education, cooperation of masses and collaboration with different stakeholders which include veterinarians, pet lovers and government agencies.
99% of rabies, (a lyssa viral disease) are caused by dog bite through its infected saliva. Only one percent of the cases are transmitted through bites of other carnivores or forest dwelling animals.
Capturing and vaccinating stray dogs which are potential transmitters and carriers of the disease by use of pallet guns or food mixed vaccines and mandatory pet and dog vaccination are extremely important measures. Transmission chain Can be broken only If uninterrupted herd immunity against the virus in the canine population is achieved by vaccinating about 70% population of dogs within the geographical boundary with updated vaccine against strains of the causative virus.
Making people understand what animals (dogs) and human patients of rabies look like when they are infected with rabies virus is very important part of early treatment. People should also know the likely changes in animal behaviour such as unprovoked bite or unusual aggression as sign of rabies infection in dogs .People should also understand that anyone bitten by such an animal should be brought to the notice of treating doctor immediately. Generally burning and tingling sensation in the area around the bite along with fever and muscle ache etc are the earliest suggestive clinical features in human rabies. Later on when disease advances picture suggestive of bulbar involvement emerges such as difficulty in articulating and swallowing liquid, a stage of HYDROPHOBIA which gives the disease it’s much popular name.
At this stage no definitive treatment works and patients succumb to disease. Interestingly human rabies patient’s bite has not been found to transmit this viral disease.
Post exposure prophylaxis in the form of cleaning the suspected wounds with soap and water for at least fifteen minutes followed by application of iodine/alcohol over the wound is very important on the spot measures and can not be over emphasised.
Post exposure prophylaxis by the use of intramuscular or Intra Dermal vaccine, and immediate simultaneous rabies immunoglobulin administration if required, as advised by the doctor based on the severity of animal exposure has been the cornerstone of management.
Bite by unidentified or lost animals should be treated as rabies infected and post exposure prophylaxis treatment should be instituted without undue delay. Lost animals if located afterwards should be observed for changes in their behaviour or if found dead should be deemed as suffering from rabies.
Till such time that suspect dogs are being observed (generally for ten days period) vaccine administration should proceed as scheduled and completed or discontinued if so required.
Generally, vaccine is administered in five dosage on day 0,3,7,14 and 28 Intra muscularly over deltoid or anterolateral thigh region in children. It can be given Intra dermally also with modified protocol. Intra - dermal route is far more cost effective with comparable efficacy if used properly.
Rabies immunoglobulin should be given in serious bite cases immediately or within seven days of incidence @ 20iu/kg body weight dosage once only. Half of it should be infiltrated around the wound and the remaining half at anterolateral thigh intramuscularly.
Pre-exposure prophylaxis is for those who handle such rabies animals and to those who are visiting rabies endemic zones. It has similar protocol for vaccine administration as in post exposure prophylaxis.
Unfortunately, due to poor quality of education people in large numbers fall pray to quacks and thugs even in modern times specially in villages and remote parts of our country. Government should ensure that School Syllabus carry enough material on health-related issues and ignite scientific temper in young minds.
(The Author is currently professor of medicine at Manipal Tata Medical college, Jharkhand)
