Rabies is a viral infection of the brain and nervous system. Generally, the virus that causes rabies is transmitted to humans through animal bites. Rabies is classified as a dangerous disease because it has the risk of causing death if not treated quickly.
In Indonesia, rabies or known as "mad dog disease" is still a disease that threatens public health. Based on 2020 data, there are 26 out of 34 provinces in Indonesia that are not yet free from rabies, with more than 100 deaths per year.
Rabies
Causes of Rabies
Rabies is caused by a virus that is generally transmitted from dogs through bites, scratches or saliva. Apart from dogs, animals that can also carry the rabies virus and transmit it to humans include monkeys, cats, civets, and rabbits.
In rare cases, transmission of the rabies virus can also occur from human to human, through organ transplants.
Symptoms of Rabies
Symptoms of rabies usually appear around 30–90 days after the patient is bitten by an infected animal. This can make the diagnosis of rabies a little difficult, because the patient may forget that he has been bitten or scratched by a rabid animal.
Early symptoms that can appear include:
- Fever
- Tingling in the bite wound
- Headache
In addition to the complaints above, there are several further symptoms that can be experienced by people with rabies, such as muscle cramps, shortness of breath, and hallucinations. These advanced symptoms are a sign that the patient's condition is getting worse.
Rabies Treatment
Rabies needs to be treated as soon as exposure occurs, even if symptoms do not appear. Treatment of rabies is by cleaning the wound and giving rabies serum and vaccine. The goal is to help the immune system fight the rabies virus, so infection and inflammation of the brain can be prevented.
However, if the virus has infected the brain, treatment will be difficult because there is no known method that is truly effective for dealing with it.
Causes of Rabies
Rabies is caused by the Lyssavirus from the Rhabdoviridae family. This virus generally enters the human body through scratches or bites of animals infected with the rabies virus. Licking an infected animal to the mouth, eyes or open wound can also be a way of transmitting the rabies virus from animals to humans.
When it enters the body, the rabies virus can enter the brain through nerve cells, then multiply rapidly. This can cause severe inflammation of the brain and spinal cord.
It is important to remember, the rabies virus that has attacked the brain can make the patient's condition worse and die quickly. The spread of the virus to the brain can occur more quickly if the patient experiences a bite or scratch in the neck or head area.
Types of animals that can carry and transmit the rabies virus include:
- Dog
- Cat
- Monkey
- Bat
- Weasel
- Cow
- Goat
- Horse
- Rabbit
- Beaver
- Change
- Raccoon
- Skunk
Rabies Risk Factors
There are several factors that can increase a person's risk of contracting rabies, namely:
- Worked in a laboratory that researched the rabies virus
- Work as a veterinarian
- Living in an environment with lots of wild animals
- Living in areas with poor sanitation or far from vaccination sites
- Engaging in activities where there is a risk of contact with wild animals, such as camping, hiking or exploring caves
- Have open sores on the skin
Symptoms of Rabies Virus Carrier Animals
The rabies virus is most often transmitted through dog bites, and in fact, the population of feral dogs in Indonesia is arguably not small. Therefore, it is important for you to recognize the signs and symptoms of a sick dog infected with the rabies virus, so that rabies can be avoided.
Some of the symptoms that can appear in dogs infected with the rabies virus are:
- Easy to attack people (aggressive)
- Foaming mouth
- Excess saliva
- Overreacting to light and sound
- Likes to be alone in a dark room
- Fever
- No appetite
- Weak
- seizures
- Paralysed
From the symptoms above, it can be seen that rabies does not always cause a dog to be aggressive or like a "mad dog". In some cases, rabies can actually cause dogs to become weaker and more silent.
Symptoms of Rabies
Early symptoms of rabies usually appear 30–90 days after a person is bitten by an animal infected with the rabies virus. However, in certain cases, symptoms may also appear sooner or later.
Early symptoms of rabies can be similar to flu symptoms. Sufferers generally experience fever, headaches, and muscle aches. A very annoying feeling of tingling, pain, and itching in the bite area can also occur. These symptoms are typical symptoms of rabies.
In addition, some of the initial symptoms that sufferers can also experience are:
- Weak
- Lazy to eat
- Headache
- shivers
- Sore throat
- Nausea and vomiting
- Diarrhea
- Anxiety disorder
- Nervous
- Trouble sleeping or insomnia
- Depression
If rabies is not identified and left untreated, the symptoms will become more severe. These advanced symptoms can be classified into two types, namely the aggressive type and the paralytic type. Here is the explanation:
Advanced symptoms of aggressive type of rabies
Most rabies caused by dog bites will produce this symptom. Sufferers will experience episodes of "angry", which are characterized by anxiety, confusion, hyperactive behavior, the desire to hit or bite, and hallucinations. These episodes usually last less than 5 minutes, but may come back.
Sufferers with these symptoms can also experience muscle spasms and cramps. In some cases, symptoms may progress to the paralytic type. Death can occur from cardiac arrest or respiratory failure.
Advanced symptoms of paralytic type rabies
Patients who experience these symptoms will be more "silent". However, the symptoms of fever and headache will be more severe. Sufferers will also experience paralysis that spreads, starting from the bitten limb to the top. Death can occur if paralysis has spread to the breathing muscles.
Apart from the symptoms above, people with rabies can also experience:
- Saliva production increases
- Photophobia or fear of light
- Hydrophobia or fear of water
- Priapism or erection without sexual stimulation
When to see a doctor
Immediately go to the emergency room or the nearest doctor if you are bitten or scratched by an animal that can carry the rabies virus, especially if the bite occurs on the head or neck. Don't wait for the symptoms to appear, because the timing of the appearance of rabies symptoms can be different for each person.
It is important to remember, rabies can be life threatening once the symptoms appear. Therefore, make sure to get the serum or rabies vaccine no later than 2 days after being bitten by an animal. If you experience advanced symptoms of rabies after being bitten by a wild animal within about 1 month, immediately consult a doctor.
Diagnosis of Rabies
There is no test that can diagnose rabies immediately after a person is bitten by an animal suspected of carrying the rabies virus. This disease can only be detected when the symptoms have appeared.
To diagnose rabies, the doctor will ask about the symptoms the patient is experiencing. The doctor will also ask whether the patient has received the rabies vaccine or not.
After that, the doctor will examine bite marks, scratches, or open wounds licked by animals suspected of being infected with rabies. This examination aims to determine the risk of rabies infection in patients, as described below:
- Low risk wound category, if the contact is only in the form of touching or licking the skin that has no open wounds
- Medium risk wound category, if contact is in the form of small bites that are not deep in the skin or in the form of scratches or abrasions that do not cause bleeding
- High-risk wound category, if the contact is in the form of licking or scratching into the eyes, mouth, or open wounds or in the form of bites or scratches that penetrate the skin and cause bleeding
In patients who have shown symptoms, the doctor will carry out further tests, such as:
- Antibody test, to detect antibodies against the rabies virus
- Imaging with a CT scan or MRI, to detect inflammation in the brain due to the rabies virus
- Biopsy, to detect rabies virus protein from tissue samples from animal bites or scratches
- Rabies virus culture or detection of viral genetic material by PCR, usually from saliva or cerebrospinal fluid samples
If possible, the biting animal will be observed for 10 days, to see whether or not there are signs of rabies in the animal. If the animal does not show symptoms of rabies, it is not necessary to administer the rabies vaccine.
However, if the animal shows symptoms of rabies or if observation is not possible, the doctor will give the rabies vaccine, as a safer measure for the patient.
Rabies Treatment
Rabies has a high risk of causing death, especially if the virus has infected the brain. Therefore, treatment must be given quickly, even if possible, before symptoms appear.
Treatment measures that can be performed on patients suspected of being infected with the rabies virus are:
Cleaning Wounds
If you have just been bitten by an animal suspected of being infected with the rabies virus, the first step that must be taken is to clean the bite or scratch marks. It is important to remember that this step must be performed for each category of wound, whether low, medium or high risk.
The way to clean a wound is to wash it using water and soap, for 10-15 minutes. After that, apply 70% alcohol or an antiseptic liquid containing povidone iodine to the scar.
For low-risk wound categories, this method can significantly reduce the risk of rabies infection. However, animal bites still carry the risk of causing damage to nerves and tendons. Therefore, treatment by a doctor must still be done if you experience an animal bite.
Rabies Vaccine
Rabies vaccine contains attenuated rabies virus. This vaccine will stimulate the patient's immune system to produce antibodies that kill the rabies virus. Ideally, the rabies vaccine is given as a prevention, especially to people who are at high risk of being exposed to the rabies virus.
But apart from preventing it, the rabies vaccine can also be given to people who have just been scratched or bitten by an animal that has the potential to carry the rabies virus. This vaccine is called post-exposure prophylaxis (PEP).
Rabies vaccine as PEP is given to patients suspected of being infected with the rabies virus with medium and high risk wound categories. The dose of vaccine for each patient is different, depending on whether the patient has previously received a rabies vaccine or not.
In patients who have never received a rabies vaccine, the doctor will give 4 doses of the vaccine, with the following details:
- First dose: given immediately after the patient is bitten, followed by an injection of anti-rabies serum, to help the immune system fight the infection
- Second dose: given on the 3rd day after being bitten
- Third dose: given on the 7th day after being bitten
- Fourth dose: given between day 14 to day 28 after being bitten
Meanwhile, for patients who have received a rabies vaccine before, the doctor will only give 2 doses of the vaccine, with details:
- First dose: given as soon as the bite occurs, without injecting anti-rabies serum
- Second dose: given 3 days after the bite
Antirabies Serum
Anti-rabies serum or human rabies immune globulin (HRIG) is blood plasma from someone who has rabies antibodies in large quantities. Anti-rabies serum is only given to patients who have never received a rabies vaccine and have high-risk wounds.
In addition, anti-rabies serum is also prioritized in patients with the following conditions:
- Have more than one bite
- Bitten in areas that have a lot of nerves, such as the head, neck and hands
- Have a weakened immune system, for example as a result of suffering from HIV or taking anticancer drugs, such as rutiximab
- Bitten by an animal confirmed to have rabies
Anti-rabies serum is given together with the first dose of rabies vaccine. The goal is to protect the patient before antibodies from the rabies vaccine are formed.
Rabies Vaccine
As previously explained, the rabies vaccine should ideally be given as a rabies prevention rather than a treatment. The vaccine used to prevent rabies is called pre-exposure prophylaxis (PrEP).
The PrEP vaccine is specifically for people who have not been bitten by an animal carrying the rabies virus, but are at risk of being exposed to the rabies virus and have never received a rabies vaccine before.
Groups of people who are advised to get the PrEP vaccine include:
- Veterinarian
- animal sitter
- Rabies virus researcher
- Wild adventurer
- Field workers who can be bitten by wild animals are infected
- People who frequently visit rabies-prone areas
- Health workers treating rabies patients
Rabies vaccine as PrEP is given in 3 doses, with details as follows:
- First dose: given before visiting areas where rabies transmission is common, or before carrying out activities that carry a high risk of transmitting the rabies virus
- Second dose: given 7 days after the first dose
- Third dose: given 21–28 days after the first dose
If the recipient of the rabies vaccine remains at high risk of exposure to rabies, the doctor will give an additional dose (booster) every 2 or 3 years.
Please note, the rabies vaccine can cause a number of side effects, such as:
- Fever
- Rash
- Headache
- Pain and swelling at the injection site
- Vomit
- Muscle ache
Rabies Prevention
Rabies complications
- Respiratory failure
- Coma
- cardiac arrest
- Death
- Rabies Prevention
- Vaccinating pets, such as dogs or cats
- Keeping pets in their cages and watching them when outside the cage
- Closing holes or cracks in the house that could become nests for wild animals
- Avoid contact with wild animals or animals showing symptoms of rabies
- Report to the wild animal control agency if wild animals appear
- Get a rabies vaccination before visiting areas where rabies transmission is common, and before carrying out activities that can cause you to be infected with the rabies virus