Health Tips

Rabies is a zoonotic infection caused by a virus that is typically found in the saliva of infected animals, such as stray dogs. In the wild, rabies commonly infects bats, raccoons, skunks and foxes. It can spread to people and pets when they are bitten or scratched by an animal infected with rabies. The rabies virus can attack the brain. Without treatment, rabies almost always causes death. What’s worse is that many of the victims of rabies are children who are younger than 15 years old.

In conjunction with World Rabies Day, we would like to raise awareness of this deadly infection and the importance of vaccinating your pets.

Symptoms of rabies

Typically, it takes 2–3 months for a person with rabies to show symptoms, but the duration may vary from 1 week to 1 year, depending upon factors such as the location of virus entry and viral load. Initial symptoms of rabies include:

• Fever 

• Pain and unusual or unexplained tingling, pricking, or burning sensation (paraesthesia) at the wound site

As the virus spreads to the central nervous system (brain and/or spinal cord), progressive and fatal inflammation of the brain and spinal cord develops, which further result in more serious symptoms and even death.

There are two forms of the disease:

• Furious rabies results in 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 paralysed, 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.

Photo by Daniele Franchi on Unsplash

Dog bites management at the hospitals

If you’re bitten by an animal that might have rabies, you should see a medical professional even if you don’t have any symptoms. There are two agents which are used in treating dog bites at the hospitals:

1. Post-exposure vaccine (PEP). Brand name: Verorab. PEP is used to prevent the infection by stimulating our own body to produce the antibodies. The number of doses required is determined by the previous immunization status and medical conditions of the individuals (e.g. whether the person is immunocompromised). 

2. Rabies immunoglobulin (RIG). RIG is not a vaccine but an antibody injection for treating the infection itself. Due to global shortage, the decision to use RIG cannot be made lightly. As you can see below, not all dog bite circumstances require a RIG treatment.

The doctor would evaluate the risk of rabies in the dog-bitten individuals and decide on the appropriate treatment.

Source: Ministry of Health, Malaysia - INTERIM GUIDELINE FOR PREVENTION AND CONTROL OF RABIES IN MALAYSIA

RIG should be given with the first dose of vaccine to promote clearance of infection by neutralizes the virus before invasion of the brain and spinal cord.  Also, RIG should not be administered in the same syringe as the vaccine. Because RIG might partially suppress active production of antibodies induced by the vaccine. If RIG is not available, it can be delayed up to 7 days after the 1st vaccine given. Beyond the seventh day, RIG is not recommended since an antibody response to the vaccine is presumed to have occurred.

Vaccinating your furry friend

In up to 99% of rabies cases, domestic dogs are responsible for rabies virus transmission to humans. Vaccinating dogs is the most cost-effective strategy for preventing rabies in people. Dog vaccination reduces deaths caused by rabies and the need for PEP as a part of dog bite patient care in hospitals.

If you have a furry friend at home, it is encouraged that you get it vaccinated against rabies annually. The Sarawak State Government actually mandated dog owners to vaccinate their dogs against rabies or risk a RM2,500 fine. There is even a new strategy of rolling out oral rabies vaccines for stray dogs, as injecting animals can be challenging.

A word from DOC2US

If you have any questions related to rabies, you can consult our professional doctors and healthcare professionals on DOC2US. DOC2US is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.

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Disclaimer: As a service to our users and general public, DOC2US provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Reference

1. WHO - Rabies

2. Ministry of Health - INTERIM GUIDELINE FOR PREVENTION AND CONTROL OF RABIES IN MALAYSIA

Cover image credit: Photo by Daniele Franchi on Unsplash

Written by

Ms Joyce Toh