World Rabies Day (28 September) 2018: ‘Rabies. Share the message. Save a Life’

World Rabies Day is celebrated on 28th September each year. This year, the call is to ‘Share the message. Save a life’.

Background Information:

In 2015, the world called for action by setting a goal of zero human dog-mediated rabies deaths by 2030, worldwide. World Rabies Day provides a platform to improve awareness, engage communities and help endemic countries in building successful and sustainable rabies programmes.

It is celebrated annually to raise awareness about rabies prevention and to highlight progress in defeating this neglected disease.

28 September also marks the anniversary of Louis Pasteur’s death, the French chemist and microbiologist, who developed the first rabies vaccine.

Key Messages:

Rabies is a 100% vaccine-preventable viral disease which occurs in more than 150 countries and territories.

Dog-mediated rabies has been eliminated from Western Europe, Canada, the United States of America, Japan and some Latin American countries.

rabies_stills_2018_2text

40% of people bitten by suspect rabid animals are children under 15 years of age.

Infection causes 59 000 deaths every year, with 95% cases in Asia and Africa. India accounts for 59.9% of rabies deaths in Asia and 35% of deaths globally.

rabies-infographic-w2015 transmission

Domestic dogs are the main source of human rabies deaths, contributing up to 99% of all rabies transmissions to humans. Rabies elimination is feasible through vaccination of dogs and prevention of dog bites. Vaccinating dogs is the most cost-effective strategy for preventing rabies in people. Dog vaccination reduces deaths attributable to rabies and the need for PEP as a part of dog bite patient care.

Education on dog behaviour and bite prevention for both children and adults is an essential extension of a rabies vaccination programme and can decrease both the incidence of human rabies and the financial burden of treating dog bites.

dog-language

Transmission

People are usually infected following a deep bite or scratch from an animal with rabies, and transmission to humans by rabid dogs accounts for 99% of cases.

Clinical Features

The incubation period for rabies is typically 2–3 months but may vary from 1 week to 1 year, dependent upon factors such as the location of virus entry and viral load. Initial symptoms of rabies include a fever with pain and unusual or unexplained tingling, pricking, or burning sensation (paraesthesia) at the wound site. As the virus spreads to the central nervous system, progressive and fatal inflammation of the brain and spinal cord develops.

There are two forms of the disease:

People with furious rabies exhibit signs of hyperactivity, excitable behaviour, hydrophobia (fear of water) and sometimes aerophobia (fear of drafts or of fresh air). Death occurs after a few days due to cardio-respiratory arrest.

Paralytic rabies accounts for about 20% of the total number of human cases. This form of rabies runs a less dramatic and usually longer course than the furious form. Muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the under-reporting of the disease.

Prevention: Post Exposure Prophylaxis

Post-exposure prophylaxis (PEP) is the immediate treatment of a bite victim after rabies exposure. This prevents virus entry into the central nervous system, which results in imminent death. PEP consists of:

extensive washing and local treatment of the wound as soon as possible after exposure (includes immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.);
a course of potent and effective rabies vaccine that meets WHO standards; and
the administration of rabies immunoglobulin (RIG), if indicated.

Rabies categories of contact and post exposure prophylaxis

All category II and III exposures assessed as carrying a risk of developing rabies require PEP. This risk is increased if:

the biting mammal is a known rabies reservoir or vector species
the exposure occurs in a geographical area where rabies is still present
the animal looks sick or displays abnormal behaviour
a wound or mucous membrane was contaminated by the animal’s saliva
the bite was unprovoked
the animal has not been vaccinated.

prevention

The cost of Post Exposure Prophylaxis (PEP) is highest in Asia, with estimates up to US$ 1.5 billion per year.

The overall economic cost of dog-mediated rabies is estimated to be US$ 8.6 billion. Major costs associated with dog-mediated rabies vary by region but include losses in productivity due to premature death, cost of PEP and direct costs to the medical sector and bite victims.