Is your dog or cat your best friend? Does your pet nibble, lick you in gratitude? According to a World Health Organisation (WHO) report, every year, 300,000 Indians die due to rabies while in the USA there are only three such deaths reported. If you think it cannot happen as your pet is immunised, think again. There are so many myths about rabies that many fail to understand how rabies actually spreads. Neurologist Dr N Balamurugan from Salem helped demystify rabies in an interview to Media Voice.

By Deepa Kandaswamy

Question : Does rabies spread through animal bites?

N. Balamurugan: It spreads through the saliva of animals. The bite only helps break the skin and the licking helps in injecting the virus into the human body. If your skin is already broken due a previous injury or cut, then just licking by your pet is enough to inject the virus into your body, if your pet has contracted rabies or hasn't been immunised against rabies.

Question: Is rabies restricted to dogs?

N.Balamurugan No. Cats, foxes, rats, skunks, raccoons, rabbits, hares, squirrels, hamsters, guinea pigs, other large rodents, other mammals, livestock and bats can cause rabies too. They can also spread the rabies virus to other animals.

Question :Do only stray dogs and cats get rabies? Not pets or domesticated animals?

N.Balamurugan : It can happen to your pet too. Many people think that their pets are automatically immune from contracting rabies because of breed or because they let it out only at night, especially dogs used for guarding the house. No one monitors the behaviour of the pet at night, when it might interact with rabid animals. Transmission of rabies from stray to pet animal is high.

Question :If a pet has been immunised, are both, the pet and the family that owns the pet, safe from rabies?

N.Balamurugan : The pet has to be immunised every year, year on year. The vaccine is effective for only 11 months. After the 11-month period, it becomes ineffective and the pet has to be vaccinated again.

Question : What is the difference between the two types of rabies - furious and dumb rabies?

N.Balamurugan : In 'furious' rabies (or irritable) , the animal or infected human is agitated and bites without provocation. In 'dumb' rabies, the infected animal or infected human is paralyzed and cannot swallow.

Question : Even if the pet is immunised, and if it plays with an animal which has not been immunised, will it contract the virus?

N.Balamurugan : Circumstances of the biting incident and vaccination status of the exposing animal (both the bitten and biting animal) are two factors that need to be taken into account. An unprovoked attack by an animal might be more likely (than a provoked attack) to indicate that the animal is rabid. Bites inflicted on a person attempting to feed or handle an apparently healthy animal should generally be regarded as provoked.

Other factors to consider, when evaluating a potential rabies exposure, include the epidemiology of rabies in the area, the biting animal's history and health status (e.g. abnormal behavior and signs of illness), and the potential for the animal to be exposed to rabies (e.g. presence of an unexplained wound or history of exposure to a rabid animal). A dog, cat, or ferret with a history of continuously current vaccination (i.e., no substantial gaps in vaccination coverage) is unlikely to become infected with rabies. Even after an initial rabies vaccination, young animals remain at risk because of the potential exposures preceding vaccination or before adequate induction of immunity during the 28 days, after primary vaccination.

Transmission :

Rabies virus can be transmitted from

1. Animal to Human – licks or bites by rabid animals. This is the most common form of transmission and is true in 99% of the reported rabies cases.

2. Human to human - pretty rare and caused due to organ or tissue transplants.

Signs to watch out for in Rabies:
Incubation period of the rabies virus in an affected person can vary from 2 weeks to 6 years.

Stage 1 - Healed wounds that are painful and irritable, numbness in tissues, depression and anxiety in the affected person.

Stage 2 – Irritable, hypersensitive, difficulty in breathing and swallowing, feeling of strangulation and terror, extreme thirst followed by hydrophobia when water is given.

Stage 3 – Vomiting, fever and coughing, followed by seizures or respiratory/cardiac failure and death.

Pre -exposure : Pre-exposure vaccines should be administered to people in areas or occupations where risk of exposure to rabies is considered high -- people close to wildlife areas or forests or places which have bats, foxes, rats, skunks, etc. and jobs in places like rabies-testing or research labs, veterinarians, animal handlers, wildlife officers, or if one is visiting a high-risk environment.

WHO recommends periodic booster injections for those who work with live rabies virus or in testing, research and diagnostic labs where chances of exposure to the virus are high.

Children less than 15 years of age are the most frequently exposed, according to the WHO report, and represent approximately 50% of all human rabies cases, especially high due to canine-infected rabies.

* One full dose of vaccine is administered in three stages - day 0, 7 and either 21 or 28.

* Vaccination is administered through injection into the upper arm of adults

* In the antero-lateral thigh region in children.

The vaccine should not be administered in the buttocks region (gluteus region) as its absorption in that region is unpredictable. If the immune system of the person is questionable because of some other disease, then the effectiveness of the vaccine has to be determined after the complete three dose of the vaccine is administered.

Post-exposure : All people exposed to rabies should promptly clean their wound(s) and apply antiseptics, and get to the nearest hospital. They should be medically assessed and should receive the entire series of post-exposure rabies vaccine.