By: Sally Plomley, Health Coordinator
nurse@isb.ac.th
Rabies is a fatal disease which is preventable with appropriate vaccination and treatment after a bite or scratch from an infected animal. It is estimated that 30-40% of street dogs are infected with rabies and so far there have been at least 8 confirmed deaths from rabies in Thailand this year (and the death rate may be higher as it is often undiagnosed or unreported).
Rabies is caused by a virus which affects the nervous system.
There are about 55 000 rabies-related deaths worldwide each year. Bites from unvaccinated dogs cause most of these cases.
Once rabies is diagnosed survival is rare (only 2 reported cases of survival in people with no pre/post rabies exposure care). There is no specific treatment for rabies.
Rabies is spread by contact with the saliva of an animal infected by rabies. This could be due to a bite or even just a scratch from an infected animal. Once infected the onset of symptoms is usually 1-3 months but may be less than a week to more than a year.
Animals with rabies may be infectious for several weeks before symptoms appear and remain infectious until after they have died.
Symptoms:
- Initially “flu-like” symptoms: general weakness, fever or headache which may last for days
- Pain or an unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site
- “Furious” form (70-80% cases) will have hyperactivity, excited behaviour, confusion, fear of water and fresh air. Death occurs within a few days
- “Paralytic” form (20-30% cases) will have gradual paralysis starting at the site of the bite/scratch and gradually spreading to involve the whole body, coma and death
Diagnosis:
There are no easy diagnostic tests for rabies and it is usually diagnosed on symptoms and after death.
Treatment:
There is no effective treatment currently available for people who have developed signs and symptoms of rabies. Survival is very unlikely even with advanced medical care.
Prevention:
- Pre-Exposure:
- Do not attempt to handle wild/unknown animals
- Vaccination:
- Pre-exposure vaccination is advised for travellers to many parts of the world especially if at risk of exposure to animals (such as travelling in rural areas). Parents should consider vaccinating their children as they are more likely to handle such animals and may not tell their parents if they get a scratch. It is also advised for people who will be living in an area where there is rabies (such as Thailand).
- The schedule is 3 doses of the vaccine given on Day 0, Day 7 and Day 21-28
- Side effects include redness and swelling at vaccine site, low grade fever, headache and lethargy.
- Post-Exposure:
- Wash the wound well with soap and water for at least 5 minutes
- Apply an antiseptic solution such as povidone-iodine or alcohol
- Seek immediate medical attention
- If given soon enough after exposure (as soon as possible), rabies immunoglobulin (a solution containing human antibodies specific for rabies that is made from blood products) and rabies vaccine (4 doses on Day 0, Day 3, Day 7 and Day 14) can prevent development of infection. However, once symptoms develop, these infections are almost always fatal.
- Booster rabies vaccination is also required post exposure with 2 doses of vaccine (at Day 0 and Day 3) in people who have had pre-exposure vaccine. No rabies immunoglobulin is required.
- In some remote areas rabies immunoglobulin may not be available and thus individuals who have not had pre-exposure vaccination will be at increased risk of developing rabies.
Resources:
https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rabies.html
https://wwwnc.cdc.gov/travel/destinations/traveler/none/thailand
ISB is committed to your child’s overall development, both educationally and health related. Should you have any questions or concerns, please contact your healthcare provider or the ISB Health Clinic (nurse@isb.ac.th).