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Prevention and control of human Rabies

Dr M Salim Uzzaman
In order to create awareness against a neglected and fatal but preventable disease — Rabies, World Rabies Day was observed all over the world on September 28. Every year 50-60 thousand people die of rabies all over the world. Within Asia, 80 percent of cases occur in India, Pakistan, Bangladesh, China, Philippines and Thailand. People usually get rabies from the bite of a rabid animal like dog, cat, bat, fox etc.
Rabies infects the central nervous system, causing encephalopathy (brain disease, damage, or malfunction) and ultimately death. Early symptoms of rabies in humans are nonspecific, consisting of fever, headache, and general malaise and feels pins, numbness or itching and at the bite site. As the disease progresses, neurological symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation, difficulty swallowing, hydrophobia (fear of water) and aerophobia (fear of air). Death usually occurs within days of the onset of symptoms, although fatal, rabies is almost 100 percent preventable disease with timely proper intervention.
There is no treatment for rabies after symptoms of the disease appear. However, scientists developed an extremely effective new rabies modern tissue culture vaccine regimen that pro-
vides immunity to rabies when administered after an exposure (post-exposure prophylaxis) or for protection before an exposure occur (pre-exposure prophylaxis).
Pre-exposure vaccination is recommended for persons in high-risk groups, such as veterinarians, animal handlers and certain laboratory workers. In addition, international travellers, UN peacekeeping forces working in areas of enzootic animal rabies countries and other persons whose activities bring them into frequent contact with rabies virus or potentially rabid animals should be specially taken care of.
Post-exposure prophylaxis (PEP) is indicated for persons with possible exposures include animal bites, or scratches, abrasions, open wounds, or mucous membranes contaminated with saliva or other potentially infectious material or tissue. PEP should begin as soon as possible after an exposure. Measures after a possible exposure
•Do vigorous washing of the wound thoroughly with soap and plenty of water for 10-15 minutes, and seek medical attention immediately. Then, apply any antiseptic or povidone iodine and ensure tetanus Prophylaxis.
•Use of appropriate antibiotic (if necessary) to prevent wound sepsis.
•Avoid suturing, the wound(s) should not be dressed or bandaged unless
necessary.
•Active immunisation with Anti-Rabies vaccine as per doctor's advice.
Measures to prevent the spread of rabies
Though it is the responsibility of the local municipal cooperation/health department to control the number of stray animals in the areas, but as a good citizen we have some responsibilities.
•Teach children never to handle unfamiliar animals, wild or domestic, even if they appear friendly.
•Enjoy wild animals (mongoose, raccoons, skunks, foxes etc.) from afar. Do not handle, feed or unintentionally attract wild animals with open garbage cans or litter.
•Never adopt wild animals or bring them into your home.
•Do not try to nurse sick animals to health. Call animal control or an animal rescue agency for assistance.
There is an urgent need to plan a comprehensive national programme for rabies control based on basic elements like ensuring compulsory vaccination and licensing of the pets, elimination of stray dogs and cats population and strict implementation of quarantine regulations. We have to ensure that people affected by rabies get immediate treatment form skill physicians, not from the traditional-healer.