RABIES

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The 28th of September marked the 16th world rabies day under the theme; “One Health, Zero Death”. It is therefore fitting that this week’s column focuses on a few aspects regarding rabies.

Rabies is the disease that is commonly referred to as “Molafo”. Rabies is one of the Neglected Tropical Diseases (NTD) that predominantly affects poor and vulnerable populations who live in remote rural locations. Approximately 80% of human cases occur in rural areas.

Dogs are the main source of human rabies deaths, contributing up to 99% of all rabies transmissions to humans. Other animals that can transmit rabies are cats, jackals and bats. The virus is commonly transmitted via saliva that contaminates bites, scratches, and wounds, and via mucosal exposure.

Rabies is fatal once clinical symptoms develop. The goal should therefore be to prevent transmission. The period after exposure and before the appearance of signs and symptoms of the disease varies, but is typically found to be between 20 and 90 days. During this time period there is often no symptoms at all. Some patients may complain of tingling sensation or pain at the wound site. The first symptoms of rabies may be similar to the flu, including weakness or discomfort, fever, or headache. These symptoms may last for days.

Symptoms then progress to cerebral dysfunction, anxiety, confusion, and agitation. As the disease progresses, the person may experience delirium, abnormal behaviour, hallucinations, fear of water and lack of sleep. Once clinical signs of rabies appear, the disease is nearly always fatal, and treatment is typically supportive. Less than 20 cases of human survival from clinical rabies have been documented. Only a few survivors had no history of pre- or postexposure prophylaxis. Diagnosis is often made clinically, however there are special laboratory tests which can be confirmatory.

If one gets bitten by an animal that could potentially have rabies they need to wash the wound with soap and copious amounts of water for 5 to 10 minutes. They also need to present to a health care worker as soon as possible where an assessment will be made to give rabies vaccine and immunoglobulins. It is important to seek help even in the absence of symptoms.

Another important factor in the prevention of rabies is the vaccination of dogs, which is the most cost effective strategy. People who work high risk jobs and are potentially exposed to rabies should also be vaccinated. With these measures it can be possible to achieve zero deaths from rabies.

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