A Burden of Rabies: A Neglected Zoonotic Tropical Disease

Rabies is a viral zoonotic disease; zoonotic refers to the fact that it can be transmitted by animal to humans. It manifests into two clinical forms, furious and paralytic form. Incubation period is 1 to 3 months though symptoms may appear earlier than this as it may go up to one year to show symptoms. It causes invariably fatal encephalitis and myelomenengoencephalitis once an infected person develops clinical signs of one of its forms.

99% of all zoonotic rabies is due to infected dogs (Rabid dogs) and rabies is still present in over 150 countries.  59000 deaths are recorded annually from rabies and 95% of all cases are from Africa and Asia (WHO, 2019). Cats and bats are reservoirs of viral rabies and may be also transmit rabies to humans.

How Rabies virus is transmitted to humans?

Almost all cases of rabies are transmitted to humans through animal bite. In rare cases, rabies may result from non-bite exposure (e.g., saliva contact with an open skin or mucous membrane).

Clinical presentations and diagnosis

Rabies diagnosis requires a thorough patient history and a higher suspicion index. Infected person may present with hydrophobia, aerophobia, fever, malaise, hyperactivity to paralysis and it is mandatory to ask history about the exposure to either suspected or known rabid dogs or cats and contact with bats. 

By Laboratory means, rabies can be detected intra-vitam (while the infected person is still alive) or in postmortem (in a dead body). Samples such as saliva, skin and brain tissues can be tested for whole rabies virus and/or viral antigens. Imaging modalities are of less value in Rabies diagnosis.


How Rabies can be prevented?

Rabies can be prevented in two ways: Pre-exposure prophylaxis (1) and Post-exposure prophylaxis (2). Pre-exposure prophylaxis requires a traveler to endemic zones (mostly in Africa and Asia) to take 2 shots of anti-rabies vaccine prior to travel; one shot on day 0 and the other on day 7. In post-exposure context: An exposed subject should wash the wound, scratches with clean water and soap or with povidone iodine and administration of vaccines and anti-rabies immune globulin. 





Written by Dr Felix MUSABIREMA, MD, IManHR

Masters Student at University of Liege and Université Libre de Bruxelles

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