Rabies is a viral infection that causes about 55,000 deaths worldwide every year.1 Once onset of clinical rabies develops in an individual, death is inevitable. Cats, dogs and cattle account for nearly 90% of rabies cases in domestic animals while horses, mules, sheep, goats and ferrets constitute the remaining cases. Dogs are the major vector, especially in developing countries.2 Among wild animals, rabies is most often reported following bites of skunks, raccoons, bats, monkeys, rodents and foxes.
The rabies virus, which is present in the saliva of an infected animal, usually spread through a bite, scratch or licks on broken skin and mucous membranes. The incubation period averages from 30 to 90 days.2 Once infected, the virus spreads from the affected person’s muscle, peripheral nerves, spinal cord and to the brain. The initial symptoms are usually vague and include pain, itchiness and numbness at the bite site, fatigue, muscle aches, irritability, agitation, insomnia, headache, nausea, vomiting and abdominal pain. Later the individual can have hallucinations, seizures, severe pharyngeal spasms, fear of water (hydrophobia), difficulty in swallowing and excessive thirst, thus causing the excessive salivation and drooling.
Rabies vaccinations may be recommended when traveling in rural areas of countries, where rabies is a risk.3 For persons exposed or potentially exposed to rabies virus, prophylaxis must be instituted as soon as possible following the exposure. Post-exposure prophylaxis consists of a regimen of one dose of immune globulin and five doses of rabies vaccine on days 0, 3, 7, 14 and 28. Local wound management is an essential part of post-exposure rabies prophylaxis
The following are the recommended first aid when an individual is bitten, scratched or licked on mucous membranes or an open wound:
1.Paulke-Korinek M, Kollaritsch H. Rabies, a neglected threat. Med Monatsschr Pharm. 2008; 31(2): 53–58 (Article in German).
2.Leung AK, Davies HD, Hon KL. Rabies: Epidemiology, pathogenesis, and prophylaxis. Adv Ther. 2007; 24(6): 1340–1347.
3.Di Quinzio M, McCarthy A. Rabies risk among travellers. CMAJ. 2008; 178(5): 567.
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