You have to be living a very isolated life to have missed the latest headlines that Bali currently has a rabies outbreak. Until this recent occurrence we had (apparently) been rabies free for over 10 years. Dog lovers like myself shudder at the mass slaughter of cats and dogs that could ensue, however rabies is not a disease that can be taken lightly. Our current outbreak seems to be isolated to the area of Ungusan, on the Jimbaran peninsula, but unless measures are taken to prevent its spread are taken, we could have a very serious situation on our hands. We already have four cases of suspected human deaths due to the disease, two of them children.
So why does rabies cause such a commotion among health authorities?
Key facts
- Rabies is widely distributed across the globe. More than 55 000 people die of rabies each year. About 95% of human deaths occur in Asia and Africa.
- Most human deaths follow a bite from an infected dog. Between 30% to 60% of the victims of dog bites are children under the age of 15.
- Once the signs and symptoms of rabies start to appear, there is no treatment and the disease is almost always fatal. Never wait for symptoms to occur after being bitten before seeking treatment.
- The most cost-effective strategy for preventing rabies in people is by eliminating rabies in dogs through animal vaccinations.
Rabies is a disease that is transmitted to humans from animals that is caused by a virus. Rabies infects domestic and wild animals, and is spread to people through close contact with infected saliva (via bites or scratches). The disease is present on nearly every continent of the world and once symptoms of the disease develop, rabies is fatal.
Symptoms
The first symptoms of rabies are flu-like, including fever, headache and fatigue, and then progress to involve the respiratory, gastrointestinal and/or central nervous systems. In the critical stage, signs of hyperactivity (furious rabies) or paralysis (dumb rabies) dominate. In both furious and dumb rabies, some paralysis eventually progresses to complete paralysis, followed by coma and death in all cases, usually due to breathing failure. Without intensive care, death occurs during the first seven days of illness.
Transmission
Dogs continue to be the main carrier of rabies in Africa and Asia and are responsible for most of the human rabies deaths worldwide, although any mammal can transmit the rabies virus including bats and rats. Humans most often become infected with rabies through the bite or scratch of an infected dog or cat. In developed countries rabies continues mainly in wild animals. The disease is transmitted to domestic animals and humans through exposure to infected saliva. In the past few years, bat rabies has emerged as a public health problem in the Americas and Europe. For the first time in 2003, more people in South America died from rabies following exposure to wildlife, particularly bats, than from dogs.
Treatment after suspected exposure
Wound cleansing and immunizations, done as soon as possible after suspect contact with an animal and following WHO recommendations, can prevent the onset of rabies in virtually 100% of exposures. Recommended treatment to prevent rabies depends on the category of the contact:
- Category I: touching or feeding suspect animals, but skin is intact
- Category II: minor scratches without bleeding from contact, or licks on broken skin
- Category III: one or more bites, scratches, licks on broken skin, or other contact that breaks the skin; or exposure to bats
Post-exposure care to prevent rabies includes cleaning and disinfecting a wound, or point of contact, and then administering anti-rabies immunizations as soon as possible. Anti-rabies vaccine is given for Category II and III exposures. Anti-rabies immunoglobin, or antibody, should be given for Category III contact, or to people with weaker immune systems.
Prevention
Safe and effective vaccines are available to prevent rabies in animals and in humans before and after suspected exposures. Vaccination of domestic animals (mostly dogs) has led to reduced disease in several developed and some countries. The most cost-effective strategy for preventing rabies in people is by eliminating rabies in dogs through animal vaccinations.
Kim Patra is a qualified registered nurse and midwife who has been living and working in Bali for almost 20 years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com or Hp. 081 2366 0000.
