RABIES

ORIGINIALLY ​WRITTEN 9.28.2019

DID YOU KNOW? RABIES IS THE 2ND MOST DEADLY VIRUS IN THE WORLD
In Africa, Asia, and India it is still rampant. 40% or 27,600 children under the age of 15 die every year from rabies. Every year. The World Health Organization (WHO) and others have pulled together to chart a course of action to completely eradicate rabies worldwide by 2030. ​​

IMAGE COURTESY OF UNIVERSITY OF OXFORD

Summary: One of the best ways to put this virus to rest permanently is to educate and vaccinate!  Vaccinate your pets on time. Tell children to never touch sick or dead wildlife, especially raccoons, bats, skunks, fox, mongoose, etc., any mammals. Report any sick animal acting odd.  If scratched or bitten go to the ER.  If travelling to foreign lands look into the viability of getting a rabies vaccination prior to travel. Get vaccinated after exposure in iffy in rural areas.
 
Let's Get Down to the Details:
Rabies is a vicious virus with a legendary history.  There is a scene in the movie “To Kill A Mockingbird” with a rabid dog.  It mirrored one of my grandmother’s childhood memories of a rapid dog walking down Main Street of her small town. What a nightmare!

The virus is on all continents (except Antarctica), according to the World Health Organization, but anyone infected can be saved if a vaccine is administered before symptoms appear. The virus affects the brain, the nervous system and is spread by more means than just a bite.

A death from rabies occurs about every 9 minutes with 40% of the deaths being children.  All but 1% of the deaths are transmitted by dogs although there are a variety of carriers.  It is primarily other carriers in the United States and in the other nations where the concern lies. 

DID YOU KNOW? TRANSMISSION OCCURS PRIMARILY THROUGH BOTH BITES AND SCRATCHES AND TOUCHING DEAD OR SICK ANIMALS IS ANOTHER WAY TO CONTRACT RABIES.  

If a child or adult is scratched by an animal such as a racoon, to go to the emergency room. Interestingly, bat bites occur while campers are sleeping, is also source of concern.  So sleeping under the stars or in a cave and just being outside highlights the summer months are the prime time for bites from animals normally nocturnal, diurnal (day), or crepuscular (twilight)!

In the States, animals other than dogs or cats, spread a majority of reported rabies cases. In domesticated animals, cats are the number one carrier. In one article it was written, “Rabies, though rare... has dramatically dropped in the United States over the past 100 years” (Welsh). It's true but it is the kind of statement that may contribute to a secure feeling about "bottling up" rabies in the U.S. when, maybe, it only lends itself to the notion rabies is a minor concern in the U.S., isolated from the world.

DID YOU KNOW? OVER 60 NATIONS ARE RABIES-FREE. 

“The true burden of the disease is likely to be underestimated due to chronic under-reporting and political neglect in many developing countries,” WHO says.  The downplaying of the world’s #2 virus wherever someone lives,  even where the virus has been eradicated, puts blinders on addressing a killer virus, when the cure is 100% effective if received quickly or prior to exposure.  Vaccinations against viral and bacterial diseases are available and/or required for about 14 diseases. Of these diseases like Mumps, Polio, Measles or Chickenpox (Varicella) there are one to multiple doses required and none of them have the 100% preventative claimer the rabies vaccine has.  Not one. 
 
Rabies in 2019: Can it be eradicated by 2030?  
The World Health Organization and the World Organization for Animal Health (OIE) are working along with others toward eradicating rabies. They plan to end human deaths from rabies by 2030 through the establishment of the global organization, “United Against Rabies,” a collaboration of several world organizations with mutually agreed upon mapped out plan to accomplish “Zero human rabies deaths by 2030”.  
 
Facing Some of the Difficulties
Rabies’ deaths exist in over 100 countries transmitted mostly by dog bites.  The greatest number of human deaths by rabies are found in Africa and Asia but there is a significant number of deaths in India.  Annually over 69,000 human deaths occur worldwide (2017) and most of these deaths are children under 15 years of age.  

In India there were 20,847 known* deaths. 40% of all the deaths were children. Polio was eradicated in India in 2014 and Rabies could be eradicated with the same commitment. There are others who say it will always be in India.  According to WHO there is a worldwide shortage of rabies immunoglobulin.  It costs more than 3 times what the average person makes daily ($2) in India for one dose.

Less expensive choices are available other than the traditional vaccine.   India’s stumbling blocks include cultural issues, animal welfare laws, education, underreporting, livestock vs. domestic animal issues/priorities and simply reaching isolated but infected areas.  It is an ongoing battle. A rabid dog will most certainly die of rabies and a human will usually die if not vaccinated with 10 days. Rabies is spread through the saliva and because dogs lick their nails, a scratch can spread the virus.  The pathos of the disease is horrible.                       
Any mammal can carry and spread rabies.  Domestic animals (cats, dogs and ferrets), livestock (horses and cattle via most probable bites on back legs), bats, exotic pets (hamsters, guinea pigs, rats and mice), wildlife (skunk, fox, raccoon and mongoose) and small rodents (squirrels, etc.) and lagomorphs (rabbits and hares) can carry for rabies. In the wild in the United States raccoons are the most prevalent animal to transmit the infection east of the Mississippi. West of the Mississippi skunks are the most common carriers followed by the fox in the wild. Overall, bats carried 32.2 % (#1) of rabies in 2017 followed by raccoons, skunks and then foxes.
 
Direct Contact
What constitutes ‘direct contact’? Viral transmission occurs by direct contact with a carrier.  Direct contact is when saliva comes in contact via scratch or bite breaking the skin or contact with or soft tissue in the eyes, mouth or nose.  Remember animals lick (saliva) their paws, hence, the danger in scratches.

Another means of uncommon transmission that is not by bite or scratch is by petting an infected animal.  Contact with infectious tissue or fluid blood such as urine, blood or feces in or out of a controlled environment can result in exposure to the virus.  Aerosol exposure for lab workers is possible.  The virus dies when exposed to sunlight.

How Rabies Works 
Rabies does not travel through the bloodstream but through the nerves to the spinal cord and up to the brain.  There it multiplies causing inflammation (swelling, etc.) of the tissues. While this occurs, the virus as it continues to travel to the salivary glands wherein it is spread by saliva during a bite (primarily) or scratch. 

Infection
The incubation period is when there are no symptoms presented and can be weeks to three months. The first symptoms usually appear within 3-5 days of exposure. Symptoms are:

1. Tingling around the infected area
2. Flu like symptoms such as muscle aches, tiredness or loss of appetite.
3. Neurological symptoms develop such as seizures, odd postures with muscle spasms, hallucinations, confusion with unusual or bizarre thoughts, partial paralysis, agitation or aggressiveness. 

A person or animal produces a lot of spittle as if foaming at the mouth.  One of the neurological signs is an unnatural fear of water or choking because of the increase production of saliva with muscle spasms.
 
Turning the Tide
Rabies eradication is possible via vaccinating dogs and vaccinating the ‘at risk’ human population in a pro-active effort. Other than the primary vaccine there are cheaper choices such as using horse immunoglobulin. Kenya created a ‘Zoonotic Disease Unit’ coordinating leaders from the health and agriculture departments of the country to unite and create long term goals and strategy for a rabies free country. Their methods offer affordable possibilities for poorer countries.  The model was proven in Tanzania so it is a real, working model (Serengeti Health Initiative) and inspiration. A country’s political heart has to harken to this call.
 
In 2018 Rabies-Free Nations, Islands, Etc.   (In bold
Albania, Andorra, Anguilla, Antigua, Australia, Austria, Bahamas, Bahrain, Barbados, Belgium, Bermuda, Bosnia, Bulgaria, Caicos Islands, Cayman Islands, Christmas Island, Cocos Island, Cook Islands, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Falkland Islands, Federated States of Micronesia, Fiji, Finland, France, French Polynesia, Futuna, Germany, Greece, Guam, Hawaii, Herzegovina, Hong Kong, Iceland, Ireland (Republic of), Italy,  Jamaica, Japan, Kiribati, Korea, Kuwait, Latvia, Liechtenstein, Maldives, Malta, Marshall Islands, Mauritius, Montenegro, Nauru, Netherlands, New Caledonia, New Zealand, Niue, Norfolk Island, Norway, Nevis, The Grenadines, The Pacific Islands, of American Samoa, Palau, Papua New Guinea, Pitcairn Island, Portugal, Qatar, Saint Kitts, Saint Lucia, Saint Martin (Netherlands Antilles), Saint Pierre et Miquelon, Saint Vincent, Saipan, San Marino, Seychelles, Singapore, Slovakia, Solomon Islands, Spain, Suriname, Sweden, Switzerland, Tonga, Turks Islands, Tuvalu, United Arab Emirates, United Kingdom (England, Scotland, Wales, Northern Ireland), Uruguay, Vanuatu, Wallis, and Western Samoa

What Can You Do?
1.Educate yourself
2. Vaccinate your pets according to your vet's recommendation.  
2. Report any strangely acting and or sickly animal to the local health department or animal shelter (drooling, biting everything, movement impaired).
3. Teach kids not to pet animals in the wild like foxes, raccoons, skunks or bats. Never touch sick or dead animals. If you get scratched by a wild animal such as a raccoon or fox go to the emergency room. 
4. If traveling internationally, a rabies vaccination may be in order. Consider the country and how much time is spent outdoors, handling animals and if the area is rural.  It is difficult to get the vaccine in rural areas as in almost impossible depending on how remote an area you visit.  Stay safe!
 
For more information, check click:
World Rabies Day
 
References:
Contributors, WebMD Editorial. “Rabies in Cats.” WebMD, WebMD, https://pets.webmd.com/cats/rabies-cats#1.

“Is Rabies in Your State?” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 6 Apr. 2020, https://www.cdc.gov/rabies/location/usa/surveillance/index.html#targetText=Wild%20animals%20acco%20%20%20unted%20for%2091,and%20foxes%20(7.0%20percent).

PetTravel. “ Rabies-Free Countries.” PetTravel.com, https://www.pettravel.com/passports_rabies_free_countries.cfm.

“Rabies.” World Health Organization, World Health Organization, https://www.who.int/news-room/fact-sheets/detail/rabies.

Reinfrank, Alkira. “Seven of the Most Deadly Viruses, from Ebola to Rabies.” South China Morning Post, 30 Oct. 2018, https://www.scmp.com/lifestyle/health-wellness/article/2163766/seven-most-deadly-viruses-ebola-rabies-hidden-killers-are.
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Written by Mary-Rose Abraham, Multimedia Journalist. “Why the World Is Not Yet Rabies-Free.” World Economic Forum, https://www.weforum.org/agenda/2015/09/why-the-world-is-not-yet-rabies-free/.