Rabies: The Ultimate Guide on The Mad Dog Disease

Rabies, also known as “The Mad Dog Disease” is probably the most feared disease in our country. Rabies is the reason why a big section of our society is afraid of dogs and other stray animals. And the fear is justified, given the lethal nature of this disease. Rabies has no cure. Once the infection spreads, death is almost certain! However, most cases escalate simply because of lack of information. Timely action and appropriate medical care can save lives. So whether you’re fond of animals, or hate them – you must read this article nevertheless. Someday, it could save a loved one’s life. Here’s everything you must know about Rabies.

Rabies is a viral zoonotic neuroinvasive disease that causes the inflammation of the brain in humans and other mammals. The disease is contracted if an infected animal bites or if their saliva comes in contact with the victim’s blood, or eyes, nose, mouth or sexual organs. Although the disease can be transmitted from any infected mammal-like cats, monkeys, cows, foxes, wolves, squirrels, etc., 99% of all reported cases occur due to dog bites. The reason simply being, well, because we don’t encounter a lot of wolves in urban settings.
 
Rabies is 100% preventable by vaccine. Unvaccinated bite victims are at potent risk. Not all bites result in rabies, but those that do, take up to 59,000 lives worldwide each year. 4 out of 10 deaths are in children. With the highest average rate of Rabies cases in the world, India alone accounts for almost 20,000 deaths each year. Many of these could have been saved if we had proper awareness and information available. The WHO is committed to eradicating dog-transmitted Rabies by the year 2030.
 

History & Legends Associated with Rabies

Rabies has been known to mankind for about 4500 years now. The first written record of this disease is in the Mesopotamian Codex of Eshnunna (1930 BC). It dictates that the owner of a rabid dog should take preventive measure against bites. If the dog bit another person, and the victim later died, the owner was fined heavily and punished.
 
Historical medical journals and ancient folk tales are full of suggested remedies against the Mad Dog Disease. These remedies ranged from outrageous to outright absurd but were almost always ineffective.
 

 
In the 19th century, Rabies was considered a divine curse or scourge inflicted upon the victim for his or her sins. The fear of rabies was almost irrational, given the number of rabid dogs and the absence of an effective treatment. Bite victims would often commit suicide even at the suspicion of being rabid or be killed by the mob out of fear. It wasn’t until 1885 when the paranoia settled after Louis Pasteur successfully tested his nerve-tissue vaccine against Rabies. The vaccine has been progressively improved ever since and provides a 100% effective prevention against the virus today!
 
But even in the modern times, the fear of Rabies has not diminished. The paranoia of the disease fuels fear and hatred against stray animals all over the world. Communities resort to culling stray animals in large numbers such as the 2016 Kerala crusade against stray dogs. Rabies victims are often diagnosed incorrectly and not given correct medical help.
 
An interesting form of mass hysteria is observed in parts of India where people suffer from something called the Puppy Pregnancy Syndrome (PPS). Both men and women suffering from PPS are convinced, that after the dog bite, puppies start growing inside them. Such victims refuse medical help and resort to faith healers and babas for assistance. Incidents like “maata aana” and “deewana hona” are often Rabies cases misinterpreted.
 
The disease and its symptoms, particularly the agitation and aggression have inspired several works of fiction, such as the zombies, vampires or the werewolves. Remember the possessed girl from the Exorcist? Yup, that too!
 

Signs & Symptoms of Rabies

The period between the bite (infection) and when the first symptoms appear, also known as the incubation period is typically 2 – 8 weeks for Rabies. However, incubation periods as short as 4 days and as long as 11 years have been documented. The period majorly depends on Two factors: 1) The location and size of the bite. The smaller and farther away from the bite, the more time it takes for the virus to reach the brain. 2) The concentration of virus in the saliva of the biting dog. Most dogs may not even be infected or may have an extremely low potency of virus in their saliva.
 

 
Just like any viral infection, initial symptoms of Rabies include fever, headache, restlessness, and fatigue. This is what makes the diagnosis of Rabies quite difficult because the symptoms could easily be ignored or mistaken for another viral infection, especially if the signs manifest after a longer incubation period. The onset of Rabies is often characterized by tingling or itching sensation at the site of dog bite and impaired speech. Infected animals are often seen scratching or licking the wound, even several days after the initial wound. The presence of the Rabies virus can be confirmed by a diagnostic method called the Fluorescent Antibody Test (FAT). But as the disease progresses, the symptoms are quite decisive.
 
Rabies victims show fear of water (hydrophobia), fear of sudden movements (kinesiophobia), light (photophobia), sound (phonophobia) and even air (aerophobia). All sensory inputs are heightened and often cause extreme discomfort to the patients. Fear and agony escalate into agitation and aggression, which is often associated with Rabies.
 
Unattended, the infection spreads to the brain and causes inflammation, resulting in partial or complete paralysis, anxiety, agitation, confusion, paranoia, aggression, and hallucinations, that slowly progress to delirium and coma. There is no cure for this condition. Only palliative care can be provided beyond this point; death usually occurs within 2 – 10 days after the first symptoms.
 

Causes & Spread of Rabies

The Rabies virus is a single-stranded RNA genome of the of the Lyssavirus genus, in the family Rhabdoviridae, order Mononegavirales. It is a neurotropic virus that is characterized by raging aggression, excessive drooling, and foaming at the mouth, hydrophobia (fear of water), and general paranoia in victims. The terms Rabies is derived from the Latin “rabere” which means madness, which may, in turn, be derived from “rabhas” which means violence in Sanskrit. The genus Lyssavirus is derived from “Lyssa”, the Greek goddess of mad rage, violence and frenzy.
 

 
Rabies can infect almost any animal, domestic or wild, including but not limited to dogs, cats, cows, goats, monkeys, rabbits, squirrels, raccoons, foxes, wolves, bears, etc. and humans. All hosts are carriers and pose a risk to other animals or humans. Smaller animals like rats, squirrels, rabbits, etc are often killed by the rabid animal and are thus, rarely carriers of Rabies. There are no recorded cases of a rabid human-infecting another, except in few unfortunate organ transplant cases from a rabid donor to a receiver. Birds were also artificially infected in 1884 in a lab experiment; however, the disease is not fatal in their case. In fact, some birds are known to have developed an immunity against Rabies by feeding on the remains and dead-bodies of rabid animals.
 
The virus travels on the saliva of the infected animal and transmits itself to new hosts when the animal bites them, or if such animal licks a wound or scratches on the body of the new host. Rabies can contract to the new host even if the saliva comes in direct contact with the eyes, nose or mouth. In some rare cases, inhaling gases that are emitted from the decomposing bodies of dead rabid animals can also cause Rabies. It’s extremely rare but possible in closed spaces or caves with a high population of bats. The semen or vaginal fluids of a rabid animal is also known to carry traces of the Rabies virus.
 
The Rabies virus is quite fragile and cannot sustain without a host. It gets weak on exposure to air and water. Symptoms like aerophobia (fear of air) and hydrophobia (fear of water), which are commonly manifested in Rabies victims, keeps them away from air and water, hence, protecting the virus. Even saliva from a rabid animal that has been exposed to air and the atmosphere for at least a couple of hours is usually rendered harmless. In fact, the only reason Rabies is not declared as the deadliest virus in the world is because it cannot survive in and spread through the air. If there ever developed a strain of Rabies that could transmit itself through the air, we’re all f**ked!
 
Like all viruses, as soon as the Rabies virus enters the host body, it has two goals – 1) to take control of the host body’s central nervous system; 2) to replicate and spread to other hosts. To accomplish this, the virus usually first infects muscle cells close to the bite area, where they are able to replicate without being noticed by the host’s immune system. Once enough of them have been replicated, they begin to the travel to the nearest nerves and start attacking the nerve cells. This is usually when the symptoms of Rabies start appearing in a host.
 
As soon as the virus is able to penetrate its way into the nerve cell, it begins its journey to the host’s Central Nervous System (CNS), more specifically, to its brain. After the brain is under control, the virus affects motor nerves and then migrates to the salivary glands where it’s ready to be transmitted to other hosts.
 

Stages of Rabies

The following three stages of Rabies have been identified:

• Prodromal Stage – The first stage is a 1-3 day period characterized by sudden behavior change. Even friendly dogs are known to act dejected, confused or even snappy. Generally aggressive dogs, on the other hand, may act surprisingly calm and silent. This is usually the duration when the virus is attacking the nerve cells.
• Excitative Stage or Furious Rabies – The second stage lasts 3-4 days and is characterized by frantic running around, aggression, and hyperactivity. The infected animal has the tendency to bite anything near it, experiences violent convulsions, and displays perceivable “mad behavior”. Foaming at the mouth is noticed at this stage. This is when the virus is infecting the brain and spreading to the salivary glands. Extreme convulsions are experienced while trying to swallow water or anything that’s liquid, including the saliva. Even the thought of water throws the victim in a fit. This is known as hydrophobia.
• Paralytic Stage or Dumb Rabies – The third stage is marked by the paralysis of the limbs due to damage to the motor neurons. The victim feels extreme pain and difficulty swallowing due to the facial and throat muscles being paralyzed. The jaws are often clenched and severe drooling & frothing is noticed at the mouth. The animal would want to hide in closed, dark and quiet spaces, where they go into complete paralysis. Some animals skip the Furious stage and directly escalate to the Dumb stage.

Death is typically caused within a few days by respiratory arrest or pneumonia that’s caused by the saliva entering the lungs.
 

 

Rabies Prevention

Rabies is 100% preventable, provided some basic steps are followed:

1. Avoid conflicts: A lot of dog bites can be avoided by simply avoiding conflicts with animals. Children must be taught to not disturb sleeping or resting animals. If a stray animal looks sick, keep a safe distance from him and inform the nearest animal shelter or the local municipal body.
2. Active Immunization: Vaccination before exposure has been used in both human and nonhuman populations. Laws in several countries mandate domesticated animals like dogs and cats to be vaccinated at recommended intervals. In India, dogs must be given the first set of vaccines between 3 to 6 months of age. Then, a booster shot at first year, and thereafter a booster shot every 3 years is recommended. Over-vaccination is detrimental to your dog’s immune system, hence vaccines must only be administered by a certified vet. Make sure that your vet fixes an appropriate dosage based on the breed and weight of your dog. Individuals working with dogs, or pet-owning families are recommended annual inoculation against Rabies.
   

   SEE ALSO: The Ultimate Vaccination Guide for Pets

3. Stronger Immunity: Pay special care to your dog’s food and nutrition. A balanced & complete diet goes a long way in building a stronger line of defense against any foreign infection that enters the body. A deficiency of essential nutrients may often lead to a weakened immunity, and thus increases the risk of contracting an infection and eventually become a carrier of the virus.
4. Stay vigilant: If your pet or a family member gets bitten or scratched by another dog, DO NOT IGNORE IT! Even a seemingly harmless bite from a vaccinated dog can lead to a Rabies infection. No matter how small the wound or scratch may be, it must always be shown to a doctor after adequate first aid has been given.

First Aid & Treatment of Rabies

What do you do if you or someone around you gets bitten by a dog? First, don’t panic! Luckily for us, Louis Pasteur and Émile Roux developed a vaccine against Rabies in 1885. Their original vaccine involved a course of 14 shots administered in the stomach and was harvested from the nerve tissues of rabid rabbits. The vaccine has been improved several times over since then and is now made by tissue culture in a lab. Modern-day Rabies vaccine comprises of 4 or 5 shots, injected in the arms of the patient.
 
If you ever get bitten by a dog, try and get as far away from the dog as possible but don’t run away just yet. Observe the dog from a safe distance and watch out for signs of disease in the dog. If it’s a pet dog, talk to his owners about his or her vaccination status. The information you collect here can greatly help the doctors in prognosis and recommending a suitable treatment for the bite. It can save your life!
 
The wound must be thoroughly washed under running water with soap, over and over until any possible trace of saliva and thus the virus is washed away. Apply an antiseptic liquid, rubbing alcohol or Iodine tincture solution on the wound to disinfect it. Rush to the emergency care of your nearest hospital. Never cover dog bite wounds with a bandage or a cloth. They must always be exposed to air and washed repeatedly. (Air and water weaken the Rabies virus, remember?!)
 
Based on whether the biting animal was domesticated or stray, his vaccination status, circumstances in which the dog attacked, and the perceived health, behavior or symptoms of the dog, the doctor will advise the treatment. For cases where the bites are not too severe, or if the dog and the bite victim were inoculated for Rabies already (active immunization), a course of 4 or 5 shots is recommended. The first shot is typically administered within the first 24 hours of the bite. The next shots are given on the 3rd, 7th, 14th and 28th day from the bite. The doctor may even skip a shot or two – based on your specific case.
 
For serious bites, or where the dog is suspected to be rabid, a shot of the Human Rabies Immunoglobulin (HRIG) or the Anti-Rabies Serum is recommended as the first course of treatment (passive immunization). This should be subsequated with 4 shots of the active Rabies vaccine. If the treatment begins with little or no delay, it’s 100% effective against the Rabies virus. So if you’re ever dealing with a dog bite, never waste a moment – first aid the patient and rush him to the emergency care immediately.
 

Milwaukee Protocol

On September 12, 2004, Jeanna Giese, a 15-year old girl from Wisconsin was bitten by a rabid bat during a Church mass. On October 14th, she came down with the symptoms of a viral infection. By the time the hospital figured out it was Rabies, she was given 4 hours to live. The physician handling her case, Dr. Rodney Willoughby took a bold decision of combating the virus instead of giving up on Jeanna. He put her in a medically induced coma, isolating the brain and allowing the immune system of the body to deal with the virus. She was gradually revived from the coma, and it was nothing short of a miracle that she survived. Jeanna Giese, thus became the first human ever recorded to have survived Rabies without vaccination. This is known as the Milwaukee Protocol.
 
Jeanna suffered permanent brain damage due to the coma, but she would have been dead had it not been for the Milwaukee Protocol. Dr. Willoughby disclosed in 2009, that out of the 25 patients he treated with this protocol after Jeanna, only 2 survived – giving the Milwaukee Protocol an 8% success rate against a disease that was initially 100% lethal. As of last year, only 14 people have been documented to have ever survived Rabies after the symptoms manifested.

While Rabies may be a mighty disease, mankind’s determination to survive is mightier. The WHO has pledged to eradicate Rabies from the planet by 2030. Global Alliance for Rabies Control, a US non-profit coordinates an international campaign for Rabies awareness. World Rabies Day is a United Nations Observance that falls on 28th September every year, that also marks the death anniversary of Louis Pasteur. The campaign aims to raise awareness about the impact of Rabies on humans and animals, provide information and advice on how to prevent the disease in at-risk communities, and support advocacy for increased efforts in rabies control.