What is Rabies
Rabies is a zoonotic (spreads from animals to
humans) viral disease most often transmitted through a bite of a rabid animal.
It is essentially fatal once symptoms develop. However, it is nearly 100%
preventable through prompt and proper prophylactic treatment after a potential
exposure to the rabies virus.
·
Rabies virus can infect all mammals including
humans. It infects the central nervous system of mammals causing acute encephalitis where the brain becomes inflamed, finally causing death.
What is the
current status of rabies in Sri Lanka
·
Rabies has continued to be a public health
problem in Sri Lanka. Over the last decade, the annual number of rabies deaths
has been stagnating around 25-30.
· Annually 250,000 estimated animal bites happen in the country, and over 100,000 people receive post-exposure prophylaxes (PEP) i.e. preventive treatment; with anti-rabies vaccine (ARV) along with rabies immunoglobulins (RIG) if indicated from government hospitals.
How is rabies
contracted?
·
In the vast majority of cases, the rabies virus
enters the body, through bites or scratches introduces infective saliva from a
rabid animal. The virus can also enter through viral contamination of existing
wounds or skin abrasions by licks of a rabid animal or through the exposure of
intact mucus membranes such as lips, eyes, and nasal and oral cavities to
infected saliva.
·
The virus may multiply in muscle cells at the
site of introduction, travel to the central nervous system (CNS) through
nerves, multiply in the CNS, and travel through nerves to many tissues and
organs such as the heart, adrenal glands, including salivary glands.
·
In the majority of human cases, the incubation
period (the time taken for symptoms to appear from the time the virus enters
the body) is 1–3 months. However, it could be as short as, less than one week and rarely longer than one year.
The
following are not considered exposures:
1.
Contamination of intact skin with saliva of a
proven rabid /suspicious/stray animal - however it is advised to wash the exposed skin with soap and water.
2.
Petting, bathing or coming into contact with
utensils of a proven rabid/suspicious/stray animal
3.
Eating leftovers which were eaten by
a proven rabid/suspicious/stray animal
4.
Drinking water from a well where an animal has
fallen and died
5.
Drinking raw milk from a rabid cow or goat
(however, drinking raw milk from a suspected/confirmed rabid animal is strongly
discouraged)
6.
Bites from cold-blooded animals (reptiles, amphibians)
and pecks by birds
7.
House rat bites
What should be done in the case of an animal bite,
There is a risk of contracting rabies through
exposure to a variety of mammals (please see below under section " How to prevent rabies ") predominantly
dogs.
·
First and foremost, the wound/site of exposure
should be washed thoroughly, using soap under running water for at least 5
minutes. This way you can get rid of most of the virus present at the
wound/exposure site.
Then
the wound/exposure site should be cleaned with 70% alcohol (surgical spirit) or
povidone-iodine.
These
steps will reduce the risk of infection because the risk of infection also
depends on the number of viruses entering the body (inoculum).
·
If exposed (bitten, scratched or licked on a
mucous membrane or damaged skin) to any form of mammal, it is essential to seek
medical advice immediately from a qualified doctor or seek care from a
hospital. Most government hospitals would offer post-exposure prophylaxis (PEP)
i.e., preventive treatment for rabies. If advised to go to another hospital for
PEP treatment, this instruction should be strictly followed without delay.
There have been many instances where people have succumbed to the disease due
to poor adherence to medical advice.
Anti-rabies
vaccines and rabies immunoglobulins used for rabies PEP treatment are safe in
pregnancy and breastfeeding. Therefore, not contraindicated in pregnant and
breastfeeding women.
·
Advice on PEP could be sought from the Medical Research
Institute (MRI) on 011 269 8660 and 011 269 3532 -4.
·
Before seeking medical advice after an exposure,
it is extremely important to verify the vaccination status of the animal and
the animals’ vaccination records should be produced at the time of seeking care
whenever possible. In the event where there is more than one animal on the
premises, the identity of the animal involved should be verified. This is
important because the course of treatment will also depend on the vaccination
status of the animal.
However, seeking medical advice should not be
unduly delayed if the vaccination status of the animal cannot be readily
verified.
Once post-exposure prophylaxis (PEP) treatment is initiated……
·
PEP treatment is a series of vaccines given at
specific intervals. It is essential to complete the full course of vaccines for
optimal protection. If PEP is started, it is extremely important that all the
subsequent doses are taken on the exact date and that the course of treatment
is completed as prescribed.
·
It is not essential to go to the same hospital
where PEP was initiated for the subsequent doses. You can get them from any PEP
providing hospital in the country on the due date, upon producing the PEP
vaccination card.
When
you are asked to observe an animal following an exposure…..
Whether PEP treatment is initiated or not it is necessary to monitor the animal involved closely for any changes in behaviour or signs of ill health for 14 days of the exposure and immediately report to the hospital if,
- Any changes are observed
- The animal dies or
- Goes missing.
·
Initial signs in the animal may include,
-
Any behavioural change
-
Lethargy
-
Fever
-
Refusal of food and water
-
Difficulty in swallowing
-
Vomiting, diarrhoea
-
Excessive salivation
-
Frequent straining to urinate and/or defecate
-
Changes in sound of the bark
-
Dropped jaw
There are two clinical forms of rabies in
carnivores such as dogs and cats; the furious form and the dumb form.
·
Animals with furious rabies can exhibit signs
such as,
-
Increased aggressiveness and barking
-
Fearfulness
-
Restlessness
-
Aimless wandering
-
Biting anything encountered
-
Convulsions/fits in the body
·
Animals with dumb rabies would show,
-
more confused like clinical signs such as
withdrawal from the society
-
partial or complete paralysis of different parts
of the body including the limbs, resulting in inability to walk.
Both forms eventually end up in death.
·
It is important that this observation is made by
a responsible and competent person.
·
The animal should be monitored daily for the
entire 14-day period, and should report to the hospital immediately if such change
in behaviour or signs of ill health is observed, the animal dies or goes
missing.
·
If the animal is not vaccinated, it should be
vaccinated immediately after the 14-day observation period.
How to send a dead animal/animal head for laboratory confirmation of rabies
In case the animal dies within the observation
period or a dead animal is suspected of having rabies the animal should be
decapitated and the head sent to the Medical Research Institute (MRI) Colombo,
Karapitiya Teaching Hospital or Peradeniya veterinary faculty immediately to
test for rabies. In the case of small
animals such as squirrels, the whole animal should be sent.
·
Animal heads should be sent within 8 hours of
death. If it takes more than 8 hours the sample could be sent in ice within 24
hours.
·
You should seek advice from your area medical
officer of health (MOH) or the public health inspector (PHI) on this procedure.
· If the animal brain is tested positive for rabies, immediately inform:
- - The area MOH/PHI
- The institution where PEP treatment was sought
- Any other persons exposed to the same animal (in order to seek PEP treatment)
- Owners of other animals exposed to the rabid animal
·
If other animals have been exposed to the rabid
animal they should be kept in isolation without having any physical contact with them.
·
The exposed animal must be placed in strict
isolation and closely monitored for any development of signs of rabies. If an
exposed animal is currently vaccinated, it should be revaccinated immediately
and closely observed for 45 days.
Advice on further cause of action should be sought from the area MOH / PHI.
·
If an animal is bitten or exposed by a
wild/stray or a suspected rabid animal it should also be regarded as an
exposure to rabies.
How
to prevent Rabies?
Apart from dogs a variety of other animals such
as cats, cattle, giant squirrels (rock squirrels), bandicoots, jackals,
polecats, wildcats, mongoose, civet cats, monkeys, and squirrels, can transmit
rabies to humans. In Sri Lanka, as human rabies is mostly dog-mediated
prevention of dog rabies is the key to preventing human rabies.
·
Dog vaccination is the most effective way of
preventing rabies. All dogs should be vaccinated annually. Pups should be
vaccinated within 4- 6 weeks of birth with a second dose given in three months
of the 1st dose followed by annual booster doses.
·
Vaccination records should be maintained for all
pets including cats.
·
In Sri Lanka there is a large population of
“semi-owned” dogs known as community dogs that live in schools, temples,
hospital premises, bazaars and other public premises.
·
It is the responsibility of the persons who feed
and maintain them to make sure these dogs are vaccinated annually. The
area MOH office conducts annual dog vaccination programmes to vaccinate
domestic as well as community/stray dogs.
·
Domestic/community dogs can also be vaccinated
at a government or private veterinary clinic.
·
It is the responsibility of the pet owner to
produce the vaccination records in case of a bite.
·
When obtaining pups make sure their mother is
properly vaccinated.
·
Avoid feeding / caring for / handing / bringing
home stray pups and dogs.
·
Responsible pet ownership is an important
strategy of preventing rabies.
Legal Provisions on rabies prevention;
·
Under several ordinances and acts such as the
Rabies ordinance and the Nuisance ordinance, pet owners are legally bound to
ensure that their pets pose no health threat or nuisance to the public.
· Any person who knowingly provides resort to a dog shall be regarded as the owner of the dog. Any such owner would be civilly and criminally liable for violating any clause of these ordinances.
Leaflets
What should be done in the case of an animal bite
When you are asked to observe an animal following an exposure