Many people think that rabies is transmitted through only dog. But its not true, rabies is transmitted through not only dog, but also spread through bite or scratch from rabies infected animal like dog, bats, raccons, fox, monkeys etc.. Any open wound exposed saliva of infected animal can be potential source of infection. Many European countries and North America have already eliminated rabies as a public health problem through mandatory vaccination of dog and good access to post exposure prophylaxis for human beings. More than 95% of human death occurs in Asia/ Africa. And 99% of human rabies cases came from dogs. There is a small proportion of human rabies reported due to transmission via wild life (such as fox, wolves, jackels, raccoon, bats). Rabies kills more than 60,000 people each year (that is one death in every 9 minute) over 150 countries.

1. Description of Rabies and its Spread, Clinical finding, Prevention and
Control
Introduction:
Rabies is an acute viral zoonotic disease (a disease that is transmitted to human
from animal) characterized by sign of abnormal behavior, nervous disturbance
ascending paralysis and death. All warm blooded mammals are susceptible to
infection by the rabies virus. The virus is present in the saliva of the infected
animal and is transmitted to the other animal and to human through saliva.
Causative agent:
Rabies is caused by RNA virus belongs to family Rhabdoviridae and genus
lyssavirus. The virus is bullet shape and measure about 180-250 nm in length by
75nm in diameter.
Spread of rabies:
 Rabies is transmitted through direct contact between the virus (e.g. in
contaminated saliva) and mucus membrane or wound.
 Human infection most frequently occurs following a transdermal bite or
scratch from an infected animal.

2.  Very rare, rabies has been contracted by inhalation of virus containing
aerosol (eg. In caves inhabited by bats)
 Human –human transmission has never been confirmed. With the exception
of organ transplant from rabid patient.
 Transmission through the consumption of milk and cooked meat has not
been reported to date but the consumption of milk and meat from rabid
animal is discouraged.
Rabies exist in 2 cycle: urban and sylvatic. In urban cycle, dog are the main
reservoir where as in sylvatic cycle, wild animal are main reservoir.
Many European countries and North America have already eliminated rabies as a
public health problem through mandatory vaccination of dog and good access to
post exposure prophylaxis for human beings.
More than 95% of human death occurs in Asia/ Africa. And 99% of human rabies
cases came from dogs. There is a small proportion of human rabies reported due to
transmission via wild life (such as fox, wolves, jackels, raccoon, bats). Rabies kills
more than 60,000 people each year (that is one death in every 9 minute) over 150

3. countries. Some countries like Australia, Switzerland, Netherland, rabies are
eliminated.
WHO (world health organization)
OIE (world organization for animal health)
FAO (food agricultural organization)
GARC (global alliance for rabies control)
How virus travels:
Rabid dog virus enter through saliva Travel via Peripheral Nervous
System to Central Nervous System.
Many people think that rabies is transmitted through only dog. But its not true,
rabies is transmitted through not only dog, but also spread through bite or scratch
from rabies infected animal like dog, bats, raccons, fox, monkeys etc.. Any open
wound exposed saliva of infected animal can be potential source of infection.
Clinical findings:
In dog:
1. Furious form
This is classic “mad dog syndrome”. There is rarely evidence of paralysis
during this stage. This form can be divided into stage of melancholy and
stage of excitation.
Stage of melancholy: In this stage, dog may show bite inanimate or animate
objects. It may show unusual violence and frenzy behavior. Rabid dog may
Mission
Global Eradication of dog mediated
rabies by 2030. (zero by thirty
project) 0.30

4. move from one village to other a long distance in a circular way and thus
spread the disease over wide areas. The animal may lick water and attempt
to drink but due to obvious paralysis of pharyngeal and laryngeal muscle
does not succeed to drink water. The above period last for 1 to 3 days.
Stage of excitement: in this form dog may become very aggressive. Dog
may hide in dark place due to photophobia. The voice may be change due to
the paralysis of vocal cord. Animal may lick their genital area its show that
the sign of heat. In the fag end, the dog will lose its ability to bark. The
lower jaw will hang, tongue will protrude and head will drop down. The dog
will develop dyspnea, ascending paralysis, coma and death. This period may
last for 1 to 7 days.
2. Dumb form:
This form is also called paralytic form. In this form there is paralysis
of lower jaw, tongue, larynx, and hind quarter. The dog is unable to
close the mouth (open mouth condition). In fair percentage of cases,
the owner is suspicious that a bone or some other object might have
stuck in the neck and owner may try to open the mouth for
examination and thus prone them to the possibility of contracting the
infection. The entire clinical course of the disease up to the death
takes 1 to 7 days.
10 day confinement and observation period:
Clinically course usually less than 7 days animal dead before end of 10 days.
In general if a biting dog does not die within 10 days rabies is unlikely.

5. In human:
Initial symptoms: pain or paraesthesia at the wound site
Later: hyperactivity, hallucination, hydrophobia, paralysis and coma and death
Furious form:
 Hydrophobia, photophobia, aerophobia
 Excitation and confusion
 Excessive sweating/ salivation’
 Dehydration and death in 2 to 5 days
Paralytic form:
 Gradual ascending paralysis
 Hydrophobia is not seen
 Coma, death in 1-2 weeks
Approximately 80% of patient present with classical (furious) rabies and 20%
present with paralytic rabies.
40 to 50% of people who are bitten by suspected rabid animal are children under
15 years age. In Nepal less than 100 people have been died each year due to rabies.
How long will it take to show symptoms in human?
Generally between 1 to 3 month to more than 1 year.. But it may be short as 4 days
or long or may be many years. It depends upon location of bite and how deep the
wound

6. WHO classification of Exposure:
Category of exposure Type of contact
Category:1 Touching or feeding of animal,
animal lick on intact skin
(no exposure)
Category:2 Nibbling of uncovered skin
Minor scratches or abrasion without
bleeding
(exposure)
Category:3 Single or multiple transdermal bites
or scratches
Contamination of mucus membrane
or broken skin with saliva from
animal kicks
(Severe exposure)
Post exposure prophylaxis (PEP):
Category:1 exposure Category:2 exposure Category:3 exposure
NO PEP required Wound washing and
immediate vaccination
Wound washing+
immediate vaccination+
RABIES
IMMUNOGLOBULIN
(RIG) administration
Diagnosis:
Diagnosis can only be confirmed by laboratory test preferably conducted
postmortem on CNS tissue removed from cranium.
Diagnosis technique for rabies:
1. Direct fluorescent antibody test (DFA)
2. Mouse inoculation technique (MIT)
3. Polymer chain reaction (PCR)

7. 4. Tissue culture infection technique (TCIT)
Can we treat after appearance of symptoms?
No treatment of rabies after the appearance of symptoms. Fatal after symptoms
begin.
Prevention and control:
 Rabies in human can be prevented, after exposure by PEP. Proper wound
management combine with PEP is close to 100% effective in preventing
rabies.
 Immunize all dog and cat owned by an individual or by the community
 Immunize any person with proven or probable exposure to rabies and
administer rabies immunoglobulin in case of severe exposure
 Wild animal should not be kept as pets
 Strict quarantine regulation
 Human as high risk (eg. Veterinarian, vet technician, lab person, volunteer,
etc.. ) much received pre exposure immunization.
 Pre exposure prophylaxis : 0,7, 21 or 28 days
 Post exposure prophylaxis:0,3,7, 14, 21 days
 Vaccine should never be administered in Gluteal region.
 Rabies awareness and vaccination program

8. Local wound management:
 Through washing and flushing of the wound for approximately 15 minutes
with soap or detergent and plenty of water is required.
 If local irritant like herbs, oil, chilli or turmetic powder have been applied,
there should be removed by through washing of the wound
 After wound has been washed, local antiseptics like Povidine iodine should
be applied on the wound.
 Whenever necessary, tetanus prophylaxis should be administered.
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