The horror of rabies in humans

Last summer 8-year-old Raymond found a sick puppy lying on their frontyard seemingly needing some help.

He decided to bring the puppy inside the house so he could feed the animal. Unexpectedly, the puppy bit his fingers and right hand.

The bites were not very severe but with some bleeding.  He told his parents about the incident, but they waved him off. The puppy died the following day.  The father left the body in a dump nearby.

They forgot all about it until two months later when Raymond developed fever, muscular aching all over his body and intense pain in his right arm.  He was brought to the hospital but by that time he had trouble drinking water.  In fact, he trembled just even seeing anything with water.

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Five days after admission to the hospital, Raymond died.  He was a victim of rabies, a viral infection of the brain to which all mammals, including human beings, are susceptible.  Despite continued attempts at medical interventions, rabies retains the dubious distinction of being the infectious disease with the highest cases of death.

Rabies has a 100-percent case fatality rate, although it is preventable.  In the Philippines rabies remains a serious public health concern, although in Singapore, Japan and other industrialized countries, the disease is already unheard of.

About 200 to 300 Filipinos die of rabies each year, recent reports showed.  This, despite the enactment of Republic Act 9482, otherwise known as the Rabies Act of 2007, which seeks to eradicate rabies in the Philippines by 2020.

Among Filipinos, rabies is a highly misunderstood disease.  Many, especially those in rural areas, still believe that garlic and a few drops of vinegar can cure rabies.  Others believe that quack doctors—called tandok—have the power to eliminate the virus from the body with the use of a stone or by sucking with the use of a carabao horn.

“Rabies is an acute and deadly viral infection of the brain that causes irritation and inflammation of the brain and spinal cord,” The Merck Manual of Medical Information informs.  It is one of the most terrifying diseases known to man.

“Usually, rabies is eventually fatal once the rabies virus reaches the spinal cord and brain, but the virus takes at least 10 days—usually 30 to 50 days—to reach the brain [depending on where the bite is],” the Merck manual notes. “During that interval, measures can be taken to eradicate the virus and help prevent death.”

The virus that causes rabies belongs to the group of viruses with a distinct “bullet” shape. It is usually introduced into humans through the bites of infected animals, but other means of transmission are possible.

Aside from dogs, other animals that can transmit rabies are cats, bats and foxes.  Rabies rarely affects rodents (such as mice and rats), rabbits or hares.  Birds and reptiles do not develop rabies. “The domestic dog is the most important reservoir of the virus,” says Dr. Mary Elizabeth Miranda, leader of the rabies research program of the Research Institute for Tropical Medicine.

According to the health department, rabies is usually transmitted from a dog’s saliva and enters the body through breaks in the skin. It can also enter the body through a person’s eyes and mouth.

Medical books say the incubation period of rabies—from the introduction of the virus to the moment it reaches the spinal column or brain—is variable.  “The nearer the site of the bite to the brain, the faster the movement of the virus,” Dr. Silvius Jude Alon, a veterinarian who used to work with the Mindanao Baptist Rural Life Center, points out.

During the incubation period, no signs of illness are evident.  The virus may be traveling silently through the nerves from the wound to the brain.  Once it reaches the brain, it multiplies rapidly then travels from the brain to the salivary glands and other nerves.

Health experts say rabies develops with three main phases: the early period, followed by the excitation phase and, finally, coma.   During the early period, the symptoms are mild and nonspecific. They include:  a slight fever, chills, uneasiness, headache, loss of appetite, vomiting, sore throat, abnormal reaction to light, and a persistent loose cough.  A specific early symptom is local or radiating pain, burning, or itching, a sensation of cold, and/or tingling at the inoculation bite.

During the excitation phase, patients experience nervousness, anxiety, agitation, marked restlessness, apprehension, irritability, sensitivity to loud noises, fear of water, excessive salivation (one to one-and-a-half liters in 24 hours), secretion of tears and perspiration.  Systemic symptoms are severe, and they include:  heart beating faster than 100 beats per minute, cyclic respirations, urinary retention and a higher temperature.

Death is inevitable once the symptoms appear.  “Though a small number of people have survived rabies, the disease is usually fatal,” the Minnesota-based Mayo Foundation for Medical Education and Research says. It is, therefore, important to seek immediate consultation with a doctor or the nearest animal-bite center for proper management.

In 2007 the government launched the National Rabies Prevention and Control Program (NRPCP), whose component activities include mass vaccination of dogs; establishment of a central database system for registered and vaccinated dogs; impounding, field control and dispositing of unregistered, stray and unvaccinated dogs; and conduct of information and education campaign on the prevention and control of rabies.

The NRPCP is also mandated to do provision on pre-exposure treatment to high-risk personnel and post-exposure treatment to animal-bite victims and provision of free routine immunization or pre-exposure prophylaxis of schoolchildren aged 5 to 14 in areas where there is high incidence of rabies.

The Rabies Act of 2007 also encourages responsible pet ownership. As such, all pet owners are required to have their dogs regularly vaccinated against rabies and maintain a registration card, which shall contain all vaccinations conducted on their dogs, for accurate record purposes; submit their dogs for mandatory registration; and maintain control over their dogs and not allow them to roam the streets or any public place without a leash.

A responsible pet owner is also required to provide his or her dog with proper grooming, adequate food and clean shelter.  He has to report, within 24 hours, any dog-biting incident to the concerned officials for investigation or for any appropriate action and place such dog under observation by a government or private veterinarian. The pet owner should also assist the dog-bite victim immediately and shoulder the medical expenses incurred and other incidental expenses relative to the victim’s injuries.

Image Credits: www.pixabay.com

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