Rabies

Written by Dr Charlie Easmon, specialist adviser in travel medicine

What can you do to avoid infection?
In developing countries, avoid stray dogs. In general, you should not pick sick animals up. At home, it can be tempting for a child to pick up a poor little bat, flapping about wildly on the ground.

If an animal bites you, don't despair. Administer normal first aid. It is vital to wash the wound thoroughly with copious amounts of water, and, if at all possible, use a 20 per cent dilution of soap.

If the animal may be infected with rabies, the wound must be treated by a doctor, even if you have been vaccinated. You should also see a doctor for cuts and scratches

You should also think about whether you are adequately protected against tetanus.

Vaccination
The vaccine is administered as an injection of killed rabies virus. It is now much improved and no longer consists of painful injections into the stomach!

A total of three injections are needed: the first two with an interval of one week and the last one three weeks later. The injection can be given into the skin (intradermal) at a tenth of the dose of the intramuscular injection. The vaccination provides protection for three years.

The vaccination is recommended for people who live in areas where there is a steady incidence of rabies virus. In particular, if you intend to spend time in areas where there is no immediate access to preventive treatment, you should be vaccinated.

Should you be bitten, you will need the rabies vaccine regardless of whether you had a pre-travel rabies vaccination. However, if you have received the pre-travel vaccine you will not need to have the rabies immunoglobulin injection as well.

How is the disease diagnosed?
In developing countries, the disease is often diagnosed on the basis of what the patient's family can relate and the characteristic disease picture.

In developed countries, the doctor will confirm the diagnosis by sending tissue samples to a laboratory, where the virus can be detected. In animals, the diagnosis is made by detecting the virus in samples of brain tissue from the dead animal.

How is rabies treated?
As soon as a bite has been sustained, immediate first aid is vital.

The likelihood of infection is determined by the extent of rabies in the area, the species of the attacking animal and whether the attack was unprovoked.

The closer a bite is to the face, the greater the risk, since the virus has a shorter distance to travel to the brain.

Preventive treatment after exposure to infection is the only way to stop the fatal disease developing. Treatment is both by giving specific immunoglobulin (passive immunisation) and by administration of a normal vaccination (active immunisation).

The disease usually takes long enough to develop in humans to allow the body's immune response to be stimulated by the vaccination, before the symptoms of rabies manifest themselves.

Preventive treatment with immunoglobulin
It is possible to administer specific antibodies (immunoglobulins) against the rabies virus as a type of antidote. It is the same principle as the antidote to snake bite.

The immunoglobulins act by binding themselves to their target, in this case the rabies virus, and preventing the virus from penetrating into the cells, so that the immune system has time to react and destroy them.

The immunoglobulins are broken down in the body after a while and, as a result, this type of vaccination does not provide lasting protection, because the immune system itself has not learnt to recognise the virus. The latter is achieved by active immunisation with rabies vaccine.

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