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Do you need a rabies vaccine?

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Rabies is an infectious viral disease that is almost always fatal following the onset of clinical symptoms. In up to 99% of cases, domestic dogs are responsible for rabies virus transmission to humans. Yet, rabies can affect both domestic and wild animals. It is spread to people through bites or scratches, usually via saliva – WHO

The Public Health England has issued a warning to UK travellers going abroad to protect themselves against Rabies. This is consequent upon the death of a Briton, who was bitten by a cat infected with rabies in Morocco. 

It is surprising that a disease which is 100% preventable using vaccines could lead to avoidable deaths. Many may therefore wonder if they need a Rabies Vaccines. But first, what exactly is rabies and how is it transmitted?

Related: Bitten in Morocco, died in UK

What is Rabies?

Rabies is a viral infection transmitted from animals to man. It is alamos always fatal when the disease is fully established. Rabies is caused by the rabies virus which attacks the central nervous system.

Rabies is a zoonotic infection – it is a disease primarily of animals that affect humans. Some of the animals commonly affected are dogs, cats, bats, skunks, racoons and foxes. 

Human cases of the disease are not common but when it occurs, it is highly deadly – with mortality as high as 99.9%. Rabies is found only in mammals.

Over 95% of human deaths from Rabies occurs in Asia and Africa regions. Rabies is present on all continents, except Antarctica.

Rabies Key Facts Source: WHO – http://www.who.int/news-room/fact-sheets/detail/rabies

How is rabies virus transmitted?

Rabies virus is transmitted via the saliva of rabid animals (animals infected with rabies) through a breach in the integrity of the skin. It could be through scratches. Rabies virus does not penetrate an intact skin.

When an infected animals passes the saliva through a broken skin, the virus travels to the brain where it replicates further. With further replication comes clinical signs and symptoms. Infiltration of a broken skin could be when salivas with rabies virus gets in touch with a wound (scratches) or by direct exposure of skin mucosa to the rabies virus (wounds).

There are two clinical manifestations of rabies – furious (classical or encephalitic) and paralytic. Furious rabies is the most common form of human rabies, accounting for approximately 80% of cases.

The early symptoms of rabies in people are not different from those common many other illnesses, including fever, headache, and general weakness or discomfort.

As the disease progresses, more specific symptoms appear. They may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hyper-salivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of these symptoms.

Rabies can be prevented. However, once fully established, rabies has the highest mortality rate of any disease worldwide, 99.9%. Till date, less than 10 case have been documented of humans who survived clinical rabies.

Rabies is one of the neglected tropical diseases that predominantly affects poor and vulnerable populations who live in remote rural locations. Although effective human vaccines and immunoglobulins exist for rabies, they are not readily available or accessible to those in need. Globally, rabies deaths are rarely reported and children between the ages of 5–14 years are frequent victims. Treating a rabies exposure, where the average cost of rabies post-exposure prophylaxis (PEP) is US$ 40 in Africa, and US$ 49 in Asia, can be a catastrophic financial burden on affected families whose average daily income is around US$ 1–2 per person – WHO

Dog-mediated rabies affect the poor and rural communities especially children,  more than the general population. In about 80% of cases, deaths from rabies are found among the those who are poor and live in rural settings. This is due to limited access to care and post-exposure disease-prevention treatment or care (prophylaxis). 

Do you need a rabies vaccine?

Rabies is 100% preventable through the use of appropriate vaccines called anti-rabies vaccine. Where countries have embarked on deliberate vaccination campaigns, they have been able to reduce incidence of rabies. 

Also, vaccination of dogs/pets against Rabies has also proven effective in controlling the disease. Elimination strategies require targeting mass vaccination of 70% of the dog population in order to break the cycle of transmission of the disease. 

So then, do you need a a rabies vaccine?

There are two clear situations where rabies vaccination is prescribed for people: 

  • Pre-exposure prophylaxis 
  • Post-exposure prophylaxis 

Prophylaxis is the treatment/care given to prevent onset of a particular disease – in this case – rabies.

What is pre-exposure prophylaxis? 

This is the type of vaccination recommended to people at high risk of exposure to rabies, such as laboratory staff working with rabies virus, veterinarians, animal handlers and wildlife officers, and other individuals living in or travelling to countries or areas at risk.

Furthermore, travellers with extensive outdoor exposure in rural areas – such as might occur while running, bicycling, hiking, camping, backpacking, etc. – may be at risk, even if the duration of travel is short.

Similarly, preexposure vaccination is advisable for children living in or visiting countries or areas at risk, where they provide an easy target for rabid animals.

Pre-exposure vaccination is also recommended for individuals travelling to isolated areas or to areas where immediate access to appropriate medical care is limited or to countries where modern rabies vaccines are in short supply and locally available rabies vaccines might be unsafe and/or ineffective.

Please check with your local health authority to ascertain your eligibility for pre-exposure vaccination against rabies.

Post-exposure prophylaxis 

Post-exposure vaccination is recommended to those who have been exposed to the Rabies Virus. In this case, an expert opinion is immediately sought to guide the administration.

Please note that post-exposure prophylaxis depend on the type of contact with the confirmed or suspected rabid animal.  

In all cases, strict adherence to WHO guidelines is advised before proceeding with vaccination.