Are We Losing The Battle Against Rabies?

rabies

Last week, a young, handsome boy of about five years died of rabies at the Komfo Anokye Teaching Hospital (KATH). This young boy, following his natural developmental playful instinct, went to a neighbour's house to play.

He was unprovokedly bitten on the hand by the neighbour's dog. He quickly ran home to inform his auntie who approached the owner of the dog to send the child to hospital.
 
This dog owner sent the boy to a drug store where an injection was given and some oral medication added.
 
Three weeks after the bite, the auntie of the boy realised his behaviour was unusual and when she attempted to bathe him in the morning, the boy started screaming and running away at the sight of water.

He started having spasms (shaking) at the sight of the water and refused to drink. She, therefore, sent the child to a nearby hospital from where this child was referred to KATH and diagnosed as having rabies.
 
The child died 12 hours after admission. To make matters worse, it was alleged that the owner sold the dog after the incident.

On the May 24 edition of The Mirror, a veterinary officer was reported to have been held responsible for the death of a five -year-old boy (similar age as that in the KATH case) after allegedly injecting him with anti-rabies drugs.

When did veterinary officers become clinicians? Did he mistake the boy for a five- year-old dog?
 
These two instances may be the tip of the iceberg. The number of unreported cases and deaths may stand taller than expected.

Rabies is caused by a virus which affects mainly the central nervous system. It is caused by the saliva of rabid animals, not only dogs but also cats, bats, etc.
 
Children are at greater risk because of their short stature, fearlessness of animals and also their inability to protect themselves.

The time between a bite from rabid animals and development of rabies may be as short as nine days or as long as seven years. On the average it is normally between 30 to 60 days.

Before the specific sign of rabies sets in, the patient may have pain, itchiness and numbness at the site of the bite. Symptoms may be unspecific initially such as fever, malaise, headache, anorexia and vomiting. As the disease progresses the child becomes anxious, agitated and depressed.

The specific clinical presentation can be described as either furious or paralytic variety. The patient will not want to see water (hydrophobia) or feels very uncomfortable with current of air (aerophobia).
 

Other signs may include: disorientation, hyperactivity, hoarseness of voice, convulsions, and the child may die of cardio-respiratory arrest or go into coma.

Let us note that human beings with rabies are also infectious and can transmit rabies a week before the onset of symptoms and continue to be infectious up to five weeks afterwards.
 
When anyone gets a bite from a rabid animal (dog or cat), immediately irrigate the area with water (preferably flowing tap water) and soap for about 10 minutes.
 
If povidine-iodine is available, all the better because it can kill viruses. Thereafter ask yourself if the animal was provoked or unprovoked.

Obviously when you irritate a dog which has just delivered, then you can be sure it will bite you. Then report to the hospital for definitive management such as Post Exposure Prophylaxis (PEP).
 
 The PEP may include passive antibodies which are normally infiltrated around the wound and active immunisation which is normally given at day zero, three, seven, 14 and 28. Day zero is the day of the bite.
 
 If the victim has had previous vaccination, then two immunisations can be given at three days interval.

Rabies prevention is everybody's responsibility. We need to create awareness about the danger of rabies.

Veterinary officers are major partners in rabies prevention.

Dogs and cats should be regularly vaccinated. Not only should dogs be vaccinated but there should be identification tags and certification to confirm it.
 
It was alleged that a dog owner vaccinated his dog and took a certificate of vaccination. This owner later acquired more dogs but anytime the Vet officers came around, he produced the same certificate for the first dog as evidence of vaccination for the newly acquired dog.

This was possible because the dogs were not tagged. It has also been reported that the vaccines are ineffective.
 
This may be possible if the cold chain was not maintained or the drugs were expired. Sometimes too, the unavailability of the vaccines also poses a great challenge to the Vet officer.

Just as the National Immunisation Programme goes out to fish for children and immunise them, the Vet officers should be equipped to carry out mass immunisation of pets on community basis.

Owners of pets including dogs should immediately report a change in the behaviour of their pets to the Vet officer, whether the pet is vaccinated or not.
 
They should also make sure every pet in the house is vaccinated against rabies.

Any pet that bites a human being should be reported immediately to the Vet officer for it to be guarantined.
 
The human victim should also be sent to a clinic or hospital for proper assessment by a competent health worker. Death from rabies can be avoided if appropriate measures are taken.

Children should be taught how to avoid wild animals, stray dogs and animals with unusual behaviour.
 
If a child complains of dog bite or scratch he or she should be taken seriously because they are at greater risk than adults.

The community should get rid of stray dogs, especially those who attack when they have not been provoked and exhibit other abnormal behaviours.
 
When this is suspected in the community, the veterinary office in the district should be informed for mass immunisation of other dogs and cats.

Dogs and cats have and will remain a faithful companion of man. Transmitting rabies to their close allies is a natural adverse effect of their faithfulness to their masters. We therefore need to keep them safe from rabies for our own good.

Asks Dr Anthony Enimil