WHAT IS RABIES?
Rabies is a deadly virus that affects the nerves and brain. It is usually spread through the bite of infected animals, but it can also be spread through contact with saliva and nervous tissue through a wound, eyes or nasal aerosols.
Any warm-blooded animal can catch and spread rabies. According to the World Health Organization, an average of 60,000 people worldwide die from rabies and 99 percent of them were bitten by a dog. Once the symptoms appear, the disease is practically always fatal. There are only a tiny number of known cases worldwide where someone has survived once the virus reaches the brain.
WHAT HAPPENS TO A PERSON INFECTED WITH RABIES?
They die. In humans, the first symptoms of rabies may be very similar to the flu. Later symptoms include: violent movements, uncontrolled excitement, fear of water, an inability to move parts of the body, confusion, and loss of consciousness then death.
It can take between a few days to many months before the symptoms start showing. The time depends on how far the virus has to travel to reach the brain. So for example, a person bitten on the face will show symptoms sooner than someone bitten on the leg.
HOW IS RABIES SPREAD?
Rabies is usually transmitted via the saliva of an infected animal, in most cases through a bite. The virus travels along the nerves towards the brain. When it reaches the brain, death happens in only a few days. The rabies virus does not travel through the blood stream, which is why rabies cannot be detected with a blood test.
DOG MEAT AND RABIES
Dog meat is eaten in Cambodia and rabies can be transmitted through the preparation of dog meat. A dog meat seller who is exposed to the saliva and nervous tissue, brain or spinal cord of an infected dog is at high risk of contracting rabies. Rabies cannot be contracted by eating dog meat but it can be contracted by eating incompletely cooked nervous tissue by itself or with the dog meat. Because eating dog meat is a highly risky practice, and the results of being exposed to rabies while killing, preparing and eating dog result in death, we strongly advise against it.
RABIES IN CAMBODIA
It is estimated that the Cambodian population suffers 600,000 severe dog bites each year, with the total number of bites likely to be around one million. *
Nearly 60% of severe bites occur in children under 17. *
Fewer than 5% of people who are bitten (about 40,000 people) seek life saving Post Exposure Prophylactic vaccinations (PEP). * Many people do not know about rabies or that PEP is available so 95% of bite victims do not receive PEP.
Rabies in Cambodia is mainly transmitted by dogs. According to a number of studies carried out by the Epidemiology and Public Health Unit at the Institute Pasteur in Cambodia (IPC), rural communities have on average one dog for every three people – the highest reported figure in the world. This means Cambodia has five million dogs, most of which are not vaccinated. The majority of these dogs have owners, with very few being strays.*
In a 2007 survey, it was estimated that rabies kills 800 people annually in Cambodia. Based on data from other countries with a rabies problem, the number of dogs in Cambodia, the number of bites per year and the lack of a reporting system, it is estimated this number is very much higher.
PROTECTION FROM RABIES
The best way to protect you, your family and your pets from rabies is pre-exposure vaccination. The common approach of, “I’ll get post exposure treatment if I get bitten,” is risky as you can be unknowingly exposed to the rabies virus.
For humans this is a course of four 0.1ml injections, usually at day 0, 7, 21 and 28. If you are bitten, you only need to receive two boosters at day 0 and 3 to be protected.
It is important for children to receive pre-exposure vaccination, because they are more likely to be bitten than adults.
Pre-exposure vaccines are also cheaper and more widely available than post-exposure treatment.
If you are unvaccinated for rabies, you can still protect yourself from infection and death by immediate treatment with Rabies Immunoglobulin (RIG) which is used to provide immediate readymade antibodies until the patient’s own immune system responds to immunization. The RIG is administered around the bite site if possible at a dosage according to body weight.
The disadvantage of relying on RIG treatment is these are in short supply globally, are more expensive and the anti-rabies vaccine will also need to be administered on days 0, 3, 7, 14 and 28.*
In a rabies endemic country like Cambodia with 600,000 – 1 million dog bites occurring annually, pre-exposure protection is a cheaper and safer way to protect you and your family from a 100% fatal disease.
*Source: World Health Organisation FAQ Fact Sheet
DOG BITES - WHAT TO DO
IF A PERSON IS BITTEN BY AN ANIMAL:
Wounds should be washed and flushed immediately with soap and water for 10–15 minutes. If soap is not available, flush with water alone. This is the most effective first-aid treatment against rabies.
2. Wounds should be cleaned thoroughly with 70% alcohol/ethanol or povidone-iodine, if available.
3. As soon as possible, take the person to a healthcare facility for further treatment.
4. Keep the biting dog/cat under 10 days of observation. If the animal remains healthy during the observation period then post-exposure prophylaxis (PEP) can be converted into pre-exposure regimen, i.e. the vaccine taken will be to prevent rabies if bitten in the future.
1. Apply irritants to the wound such as chilli powder, plant juices, acids or alkalis.
2. Cover the wound with dressings or bandages.
Most people know about the aggressive, or furious, type of rabies. In aggressive rabies, the animal shows extreme changes in behaviour, including attacking.
But there is another type: paralytic or "dumb" rabies, where the animal appears depressed, lethargic and uncoordinated. Gradually they become completely paralysed. The paralytic phase usually develops within 2 to 4 days after the first signs are noted.
Your dog could get rabies through an open wound or by chewing on the carcass of an infected animal. If your dog has been in a fight or has been scratched by another animal that you suspect has rabies, you must take your dog to a veterinarian for preventive care immediately.
Biting without any provocation
Eating abnormal items such as sticks, nails, faeces, etc.
Running for no apparent reason
A change in sound e.g. hoarse barking and growling or inability to make a sound
Excessive salivation or foaming at the angles of the mouth – but not hydrophobia (fear of water).
The incubation period ranges from a few days to several months, whereas the duration of illness – until death – varies from 1 to 7 days.
pain, tingling or itching at the site of the bite wound (in 80% of cases)
fever, malaise, headache lasting for 2–4 days.
hydrophobia (fear of water)
intolerance to noise, bright light or air
fear of impending death
anger, irritability and depression
at a later stage the mere sight of water may provoke spasms in the neck and throat
the duration of illness is usually 2–3 days, but might stretch to 5–6 days or more when receiving intensive care support.
There is no specific treatment once rabies develops. There is almost nothing that can be done apart from keeping the patient comfortable, and free from physical pain and emotional upset.
SIGNS & SYMPTOMS OF RABIES
HOW TO PROTECT YOUR DOG FROM GETTING RABIES AND INFECTING OTHERS
THE BEST PROTECTION FROM RABIES FOR YOUR PETS AND YOURSELF IS PRE-EXPOSURE VACCINATION:
If your pet is bitten by a potentially rabid animal, get them a booster vaccination immediately, and isolate and monitor them for 10 days for signs of rabies.
WHEN TO VACCINATE:
If the mother is vaccinated against rabies, the puppies get maternal antibodies against rabies for 3 months and therefore it is recommended to vaccinate at 3 months of age, then at 9 months of age and revaccinate annually. Puppies and dogs must be given anthelmintic drugs regularly before vaccination.
If the puppies adopted are street dogs, the first vaccination should be given as the same protocol (at 3 months of age, 9 months, and yearly boosters).
Alternately, first vaccination can be given as early as 2 months of age. Precautions should be taken in first 3 months of age.
If adult street dogs are adopted, then the first vaccination should be given as soon as possible, and a veterinarian should be consulted.
Source: World Health Organisation FAQ Fact Sheet
CAN YOU HELP US TO ERADICATE RABIES IN CAMBODIA?
It is through a collaboration of like-purposed, passionate people with a variety of skills that
we will be able to eradicate rabies.
Would you like to join us?
Are you able to donate your time and expertise? If you are a vaccinated veterinary technician or veterinarian, please contact us here
Are you able to help us financially? Please donate through this link (to be inserted)
Are you able to help us with resources, media or marketing? Please contact us here
THANK YOU SO MUCH
MORE INFORMATION & LINKS
Institut Pasteur du Cambodge
Vaccination and treatment services, research and information on rabies in Cambodia.
Rabies in Cambodia: https://www.pasteur.fr/en/research-journal/news/rabies-cambodia
Global Alliance for Rabies Control
The leading international rabies non-profit organization. GARC has worked with international stakeholders and many other partners to raise awareness about rabies, encourage collaboration, and build the evidence needed to increase political commitment and funding to end rabies in every country.
GARC Rabies FAQs answering many questions people have about rabies, vaccinations, and prevention: https://rabiesalliance.org/resources/search?type=905
World Health Organisation
Working through offices in more than 150 countries, WHO staff work side by side with governments and other partners to ensure the highest attainable level of health for all people. WHO have been foremost in working with countries to eliminate rabies, and play a role in the SE Asia region to assist.
WHO Rabies site. For more information on rabies and global action against it: http://www.who.int/rabies/human/en/