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Condition
Rabies
Class
Immune system
Description
Rabies is a serious life-threatening inflammation of the brain caused by an infection with a type of virus called the lyssavirus.

A bite from a dog already infected with the virus is the most common way that people become infected, but a bite or scratch from other rabies infected or rabid animals such as bats, monkeys, foxes, skunks, raccoons, cats or other warm blooded animals may also spread the disease.

Strict quarantine laws on the importation of animals have kept the UK free of rabies. No cases of indigenous (occurring naturally) human rabies from animals, other than bats, have been reported in the UK since 1902. However, in 2002 a man who was a bat handler did die from a bat bite caused by the bat lyssavirus. Since 1946, twenty-four cases of rabies have been reported in the UK, all imported. Only 4 cases have occurred since 2000, the most recent case occurred in December 2008 following a dog bite in South Africa.

Although the UK is officially classed as being rabies-free, the disease is common in most parts of Africa, Asia, South America, North America and some parts of Europe. The World Health Organisation (WHO) estimates that more than 3 billion people are at risk from rabies in over 85 countries, and that up to 55,000 people die each year, mostly in Asia and Africa. An estimated 14 million people each year receive treatment following exposure to rabies.
Causes
The rabies lyssavirus is carried in the saliva of infected animals and is spread from animal to animal, and from animal to humans when the saliva enters the body through a bite, scratch or cut. It can even be spread if saliva enters the eye.

The virus multiplies at the site where it entered the body and then travels through the nerves to the brain and spinal cord. Here, the virus continues to multiply causing severe swelling. The virus continues to spread throughout the body, reaching the saliva from where it will eventually be spread to another animal or person. Inflammation of the brain and spinal cord can lead to extremely aggressive behaviour, causing animals to bite without provocation and so increasing the risk of the spread of the disease.
Symptoms
Once the virus enters the body, it generally takes between 3 weeks and 12 weeks for symptoms to appear, but it has been known to take up to 19 years. In over 93% of people infected, symptoms appear within 1 year. The time taken for symptoms to develop seems to be related to the site where the virus entered the body, the further from the head, the longer symptoms taking to appear.

Early symptoms may include paraesthesia (pins and needles) around the site of the wound, fever, headache, vomiting, loss of appetite and a general feeling of being unwell. As the disease progresses, the person or animal becomes anxious, hyperactive, unable to control movements, confused, delirious and liable to fits. Spasms develop in the throat, making swallowing difficult and eventually leading to such fear of choking that even the sight or sound of water creates extreme panic or fear (hydrophobia). Once visible signs of rabies appear, death inevitably occurs following coma and respiratory paralysis.

Prevention
Vaccination - pre-exposure
Anybody travelling to areas where there is a high risk of rabies, particularly if travelling in remote areas where it is difficult to get medical help, should receive a course of injections to protect against rabies. The course consists of a series of three injections given on days 0, 7 and 28 (or on day 21 if there is insufficient time before travel). Booster doses are recommended for continued protection for those who remain at risk.

Vaccination is also recommended for people whose profession brings them into close contact with animals that may be at risk, for example zoo keepers, veterinary surgeons, customs officers, bat handlers.

Vaccination - post-exposure
After becoming infected, preventative treatment is the only way to stop rabies spreading. As soon as a bite from a suspected infected animal is sustained, immediate first aid is vital. After washing the wound thoroughly using lots of running water and soap for at least five minutes followed by the application of a suitable disinfectant, urgent medical attention is essential even if the person has been vaccinated or has been only cut or scratched.

Under medical attention, the person's risk of developing rabies will be assessed by taking into consideration the site and severity of the wound, the species and behaviour of the animal that attacked, whether the person and the animal have been vaccinated against rabies and how common rabies is in the area the attack took place.

If the risk of getting rabies is considered to be high, human rabies immunoglobulin (HRIG) should be given immediately to provide rapid protection against rabies. At the same time, but at a different site, rabies vaccine should also be administered. HRIG is injected in and around the cleansed wound. It contains antibodies that bind to the lyssavirus and delay it from entering the nervous system while the rabies vaccine becomes effective. If the risk of getting rabies is considered to be low, then just a course of rabies vaccine should be given.

Wound cleansing and immunisations, 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.
When to see your pharmacist
If you are planning a trip abroad, whether on holiday or business, talk to your pharmacist well in advance of your date of departure. Your pharmacist has access to up to date travel advice. After questioning you about the countries you will be visiting, whether you'll be staying in remote areas and the length of your stay, your pharmacist will let you know whether pre-exposure vaccination against rabies is recommended. You will also be told some simple precautions to take to reduce the risk of your catching rabies, and offered advice on vaccination against other diseases and the prevention of malaria.
When to see your doctor
If you are travelling to areas of the world where rabies is common or your work involves direct contact with animals that might carry rabies, you should see your doctor to be vaccinated against rabies.

If you or a member of your family gets bitten or scratched by an animal while abroad, seek urgent medical advice while you are in the country, do not delay and see your doctor on your return. Explain to your doctor what happened and the action you took following the attack. If your doctor thinks that you may be at risk, a course of rabies vaccine will be started immediately.
How to avoid rabies
To keep the UK free of rabies, never bring any animal into the UK without a licence and always have your pets vaccinated against the disease if you take them with you when travelling abroad. Wild animals infected with rabies can transfer the virus to domestic pets which in can turn transfer the virus to humans.



When travelling abroad, particularly to remote areas, always check with your pharmacist to determine if there is a risk of rabies in the area. If there is a risk, make sure that you and all of your members of your family have sufficient time to receive the full course of rabies injections before your leave.



While in a rabies endemic country, it is important to protect yourself, your family and your pets from animal bites and scratches. If you do get bitten or scratched seek urgent medical advice. Most human deaths follow a bite from an infected dog, and between 30% to 60% of the victims of dog bites are children under the age of 15. Warn children therefore not to approach or stroke dogs, no matter how friendly the animal may appear.
Useful Tips
  • Do not touch unknown animals
  • Warn children not to stroke animals or allow animals to lick them
  • Keep your arms and legs covered as much as possible
  • Cover all cuts with a plaster
  • If bitten or scratched, wash the wound thoroughly with soap and water, apply a disinfectant and seek urgent medical advice


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