Rabies

By Tedler D. Depaynos, MD

Although I never heard of any rabies mortality for several decades already, it is still a welcome news that prevention of the disease is still being emphasized as we read the posters making us aware of Rabies. Rabies causes 100% mortality and the only treatment is awareness and prevention.
Rabies is due to a virus which is usually transmitted thru the bite of an infected animal. The virus is contained in the saliva of the rabid animal and is deposited into the site of bite. It may multiply in the muscles and if uncontrolled it would invade the peripheral nerves and may travel towards the brain causing inflammation or encephalitis. Once it occurs, prayers are the only treatment.
It may be transmitted by different animals like cats, rodents and bats especially in other countries but in our locality, it is usually thru our pet dogs. The incubation period is said to be around 30 to 90 days but if the site of bite is on the upper body like the head and neck, it may be as short as 10 days or less.
Tying or confining the biting animal for observation is usually the first step and if nothing happens after 10 days, the animal is not rabid. Rabid dogs usually die within 10 days. They may become aggressive and keep on salivating continuously and it is said that they even bite their masters. Some suddenly become sickly. If this is noticed during observation, treatment should immediately be commenced and waiting for the animal to die is stupid.
In some cases, the animal is suddenly killed and the brain is sent to the laboratory for signs of rabies. I could remember sometime ago, a friend who used to breed expensive pet dogs suddenly found one of them biting the arm of his young daughter and even refused to release it. He had no recourse but to shoot the dog and brought the head somewhere in Metro Manila for examination. Luckily, rabies was negative.
There are those who feast on canine brains because of the belief that it would make them brainy especially when they appear in court in front of strict and inquisitive judges. I just hope that they are boiled well and any viruses present are incapacitated.
It may sound impossible but suppose one of these people or lawyers suddenly become a carrier of the virus?
In other cases if the biting animal like a rat or a bat and even a snake cannot be observed, treatment is started. Although in our locality transmission of rabies thru these animals is rare or even unheard of. But the treatment is sometimes started to remove the anxiety not only of the patient but also of the treating medical personnel. The concern is understandable and cannot easily be removed knowing that rabies mortality is 100%. All the risk details however are always explained not only to the patients but also to their relatives.
Rabies prevention is now the main thrust so that anti- rabies vaccination of our pet animals is now an aggressive program of our Veterinarians. Not only the animals are encouraged to be vaccinated but the animal lovers and zoo caretakers or those exposed to or have higher risks of incurring the disease like post men or meter readers as they visit individual homes.
Once again treatment for rabies is prevention. Before vaccination, manually cleaning the wound is initially done to remove the deposited virus. This is supposed to be the rational why letting the wound bleed is done before dressing is applied.
I could remember during our elementary days when a neighbor who was bitten by a dog was given a painful daily vaccine injection alternately in his buttocks for 21 days at our local Health Center. The motherly injecting nurse even reported and waited for us on Sundays for the vaccination. Nowadays the different types of vaccine are injected on day 0 (first day), 3, 7, 14 and 28. The more expensive human immunoglobulin vaccines may be available in some hospitals but it is supposed to be a single shot. In special cases they are infiltrated around the wound when rabies suspicion is very high. **