Rabies, Once and for All.....

Submitted by cur on 3/26/02. ( wildart@prodigy.net ) 64.196.209.246

Here is another Cur book. This time about rabies. This is in response to the emails and the inquiries about the disease, its epidemiology, indications and pathology.

If ya'll cut and paste this and save it as a .doc file or other data base file, you will have the answers the next time someone asks you about it.The data was gleaned from the CDC, NY State CDC, Wadsworth data bank and the World Health Organization...This isn't my personal diagnosis, but the considered opinions of the World Medical Profession: I hope it helps.

Following statement from the New York State CDC data bank:

RABIES...THEN AND NOW
1925-1944
Animal rabies is not a new phenomenon in New York State. During the 20-year period from 1925 to 1944, positive diagnoses ranged from 20 to 600 per year. The majority of the cases occurred in domestic dogs, with 20 to 200 rabid dogs annually. There were 10 human cases of rabies during this period; the number of human postexposure treatments is unknown.
1945-1959
Over the next 15 years, mandatory dog vaccination and stray dog control was instrumental in controlling rabies among dogs, so that the number of rabid dogs was much lower, ranging from 20 to 50 per year. Concurrently, there was a shift in the epizootiological pattern, with red foxes emerging as the primary vector. Rabies among red foxes rose dramatically to a range of 50 to 500 cases per year from a range during the previous 20 years of 0 to 1 foxes annually. Thus, total animal rabies cases remained high, from 300 to 1,200 per year. Associated with this rise were increased reports of rabies in cattle ranging from 100 to 400 cases per year from a previous low level of 0 to 10 cows per year. With improved human postexposure treatment and a reduced risk of exposure from dogs, human rabies mortality was lowered to only two human cases during this 15-year period.
1960-1989
Trends over the ensuing three decades are a testament to successful rabies control through mandatory dog vaccination and stray dog control. These practices led to elimination of the canine strain of rabies, reducing rabies in dogs to historical lows of 0 to 11 dogs per year. Rabies among red foxes, primarily in northern counties, waxed and waned in approximately five-year cycles with cases ranging from 2 to 150 per year. During this time, rabies in bats was differentiated from terrestrial animal rabies strains and remained at an enzootic level of 15 to 85 annual cases. There were no human rabies deaths in New York State during these three decades.
1990-1995
Since the incursion of the mid-Atlantic/northeastern U.S. racoon rabies epizootic into New York State in 1990, the total number of animal rabies cases each year (domestic and wild species) has surpassed all previous years. Annual numbers of rabies cases in racoons have ranged between 600 and 2,400 per year, with a cumulative total of over 6,000. There has been no sign of abatement in geographical spread or intensity at the epizootic front. At present, all New York State counties are either enzootic, epizootic or threatened by racoon rabies.
Following is an abstract from the Wadsworth Library, New York State Rabies Data Bank

HOW DO PEOPLE BECOME EXPOSED TO RABIES?
People usually get exposed to the rabies virus when an infected animal bites them. Exposure may also occur if saliva enters a scratch, open cut or mucous membrane (eyes, nose, mouth).
WHAT SHOULD YOU DO IF YOU ARE EXPOSED TO RABIES?
Wash the wound thoroughly with soap and water and seek medical attention immediately. Contact your doctor and your county health authority immediately. Try to capture the animal without damaging its head or risking further exposure.
If an apparently healthy domestic dog, cat, ferret or other domestic animal bites a person, it must be captured, confined, and observed daily for ten days following the bite. If it remains healthy during this period, the animal did not transmit rabies at the time of the bite. All wild animals must be tested for rabies if human exposures have occurred. Report all animal bites to the county health authority.
If a rabies-suspect biting animal cannot be observed or tested, or it tests positive for rabies, treatment should begin immediately. Human treatment consists of a dose of rabies immune globulin administered as soon as possible after exposure. If there is a wound, the full dose of immune globulin should go into the wound, if possible. The first of five doses of rabies vaccine is given at the same time, with the remaining injections given one each on days 3, 7, 14, and 28 following the initial injection.
People in high-risk occupations such as veterinarians, wildlife biologists, wildlife rehabilitators, animal control officers and taxidermists should consider obtaining rabies pre-exposure vaccination which consists of three injections of rabies vaccine in the arm, the first two a week apart, and the third 14 to 21 days later. A blood sample should be checked every two years to determine the need for an additional injection of vaccine (booster) if the risk of contact continues. A person already vaccinated and later exposed to rabies must receive two booster injections three days apart immediately after exposure.


Following is an Abstract from the World Health Organization Data Bank, Geneva, Switzerland:
RABIES
Rabies is a zoonotic viral disease which infects domestic and wild animals. It is transmitted to other animals and humans through close contacts with saliva from infected animals (ie. bites, scratches, licks on broken skin and mucous membranes). Once symptoms of the disease develop, rabies is fatal to both animals and humans.
The first symptoms of rabies are usually non-specific and suggest involvement of the respiratory, gastrointestinal and/or central nervous systems. In the acute stage, signs of hyperactivity (furious rabies) or paralysis (dumb rabies) predominate. In both furious and dumb rabies, paralysis eventually progresses to complete paralysis followed by coma and death in all cases, usually due to respiratory failure. Death occurs during the first seven days of illness without intensive care.
Incidence
Reliable data on rabies are scarce in many areas of the globe, making it difficult to assess its full impact on human and animal health. The annual number of deaths worldwide caused by rabies is estimated to be between 40 000 and as high as 70 000 if higher case estimates are used for densely populated countries in Africa and Asia where rabies is endemic. An estimated 10 million people receive post-exposure treatments each year after being exposed to rabies suspect animals.
Since 1990 rabies in wildlife has been eliminated in some Western European countries that have conducted oral vaccination campaigns. With the help of this technique rabies could eventually be totally eliminated from its terrestrial reservoirs in Western Europe. Oral vaccination programs for dogs have been or are in the process of being evaluated in a few developing countries where canine rabies is endemic. Dramatic decreases in human cases of rabies have also been reported during recent years in China, Thailand, Sri Lanka and Latin America following implementation of programmes for improved post-exposure treatment of humans and the vaccination of dogs.
Transmission
In developed countries rabies is present mainly in wild animal hosts, from which the disease spills over to domestic animals and humans. Recently bat rabies has emerged as an important epidemiologiic reservoir in some parts of the world (i.e. the Americas and Australia). In North America, most documented human rabies deaths occurred as a result of infection from the silver haired bat rabies virus variant and in Australia at least 2 human deaths have occurred from exposure to a previously unrecognized rabies virus. In contrast, in most countries of Africa, Asia and Latin America, dogs continue to be the main hosts and are responsible for most of the human rabies deaths that occur worldwide.
The most frequent way that humans become infected with rabies is through the bite of infected dogs and cats, wild carnivorous species like foxes, raccoons, skunks, jackals and wolves, and insectivorous and vampire bats. Cattle, horses, deer and other herbivores can become infected with rabies and although they could transmit the virus to other animals and man, this rarely occurs.
Post-Exposure Treatment
The most effective mechanism of protection against rabies is to wash and flush a wound or point of contact with soap and water, detergent or plain water, followed by the application of ethanol, tincture or aqueous solution of iodine. Anti-rabies vaccine should be given for Category II1 and III2 exposures as soon as possible according to WHO recognized regimens. Anti-rabies immunoglobulin should be applied for all Category III exposures and for Category II exposures in immunosuppressed patients. Suturing should be postponed, but if it is necessary immunoglobulin must first be applied. Where indicated, anti-tetanus treatment, antimicrobials and drugs should be administered to control infections other than rabies.
The use of highly purified horse immunoglobulins can provide at least a partial solution to the current problems of insufficient quantities and high cost of human immunoglobulin. Further details on pre- and post-exposure can be found in the reports of WHO consultations held in 1996 and 2000 respectively and available at www.who.int/emc-documents/rabies/whoemczoo966c.htm </emc-documents/rabies/whoemczoo966c.htm> and www.who.int/emc-documents/rabies/whocdscsraph2005c.html </emc-documents/rabies/whocdscsraph2005c.html>. A slide set on WHO recommendations on pre and post exposure treatment can also be accessed and downloaded at: www.who.int/emc/diseases/zoo/slides </emc/diseases/zoo/slides>.
In case of human exposure to animals that are suspected of having rabies, immediate attempts should be made to identify, capture or kill the animal involved. In case of a Category III exposure, post-exposure treatment should be started immediately and can be stopped if the animal is a dog or cat and remains healthy after 10 days. Tissue samples should be taken from dead animals and sent to competent laboratories for diagnosis. The responsible veterinary services should be notified and information obtained on the epidemiological situation in the area.
Vaccines and Immunization
Neural tissue rabies vaccines, still widely used in developing countries, require daily injections over a period of 14 days, followed by booster shots. Highly purified and potent modern cell culture and embryonating egg vaccines were developed over three decades ago. Reduced vaccination schedules and routes for vaccine administration (particularly the intradermal route) have been successfully used in developing countries where the cost of the five dose intramuscular schedule is prohibitively expensive. In addition to the five-dose Essen regimen given on days 0, 3, 7, 14 and 28 in the deltoid muscles, the following reduced intradermal treatment regimens also fulfill WHO requirements:
The Red Cross 2-site ("2-2-2-0-1-1") and the "8-0-4-0-1-1" intradermal schedules have been evaluated and used extensively in some developing countries to replace nerve tissue vaccines where expensive intramuscular vaccination regimes are not an alternative. For more details please consult our web sites: www.who.int/emc-documents/rabies/whoemczoo966c.htm </emc-documents/rabies/whoemczoo966c.htm> .Intradermal injections should be administered by staff well trained in this technique.
Rabies immunoglobulin
Rabies immunoglobulins is expensive and may be either in short supply or non-existent in most developing countries where canine rabies is endemic. However, rabies immunoglobulins should be administered in all Category III exposures and in Category II exposures that occur in immunosuppressed persons. Both purified equine rabies immunoglobulin and human immunoglobulin are used in developing countries. The full dose of rabies immunoglobulin, or as much as is anatomically feasible, should be administered into and around the wound site. Any remainder should be injected intramuscularly at a site distant from the vaccine administrative site.
If the dose of rabies immune globulin is too small to infiltrate all wounds, (as might be the case in a severely bitten child) the correct dosage of rabies immune globulin can be diluted in physiological buffered saline to insure more wound coverage.
Vaccination in immunosuppressed persons
Severely immunosuppressed patients may not develop an immunologic response after rabies vaccination. Therefore, prompt and appropriate wound care after an exposure is an essential step in preventing death. In addition, rabies immune globulin should be administered in all immunosuppressed patients experiencing Category II and Category III wounds.
Rabies in Children
Where data are available, there is consistent evidence that between 30 - 60% of human cases of rabies occur in children under 15 years of age. The majority of these children are not treated because their exposures go unreported to parents or health officials. In order to reduce the mortality rate in children the following activities should be strengthened or initiated in countries where successful canine rabies vaccination or control programs have not been put in place: 1) Promote proper and immediate care of dog bite wounds; 2) Increase access to modern cell culture vaccines in vulnerable populations including pre-exposure vaccination in children living in regions where canine rabies is highly endemic; 3) Promote proper application of effective and economical rabies post-exposure treatment; 4) Prevent dog rabies through dog vaccination.
Conclusions
Prevention of human rabies must be a community effort involving both veterinary and public health officials. Rabies elimination programmes focused mainly on mass vaccination of dogs are largely justified by the future savings of discontinuing prevention programmes. However, until canine rabies is eliminated or at least well controlled, safer and more economical post-exposure treatments for humans are a desirable alternative to the use of nerve tissue vaccines, Pre-exposure vaccination has been widely and successfully used to prevent rabies in at risk populations in industrialized countries and should be promoted in children living in regions where canine rabies is highly endemic. If rabies is not eliminated, expenses related to prevention of the disease in both humans and animals are likely to increase dramatically in developing countries.

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with all this said and documented...

This response submitted by Bill Yox on 3/26/02. ( ) 64.12.96.106

New York state still has no documented case of saliva transferal of rabies. Hell, Im living proof!


also

This response submitted by Bill Yox on 3/26/02. ( ) 64.12.96.106

But please dont let that give anyone any false sense of security, use your head and avoid ANY form of contact.


also

This response submitted by Bill Yox on 3/26/02. ( ) 64.12.96.106

But please dont let that give anyone any false sense of security, use your head and avoid ANY form of contact.


Bill

This response submitted by Cur on 3/27/02. ( wildart@prodigy.net ) 64.196.210.139

That should arouse caution, not relax folks if they read it..Saliva is what transfers the toxin when an animal bites another or a human. Ask a virologist. The statistics you were quoted may indicate that no one was bitten, that is all. Saliva contact transmission is dependent on broken skin, a cut or an abrasion.

I like the idea of the innoculations. Would seem prudent to me if I lived and worked in a high risk area. Better safe than sorry. I was just trying to give the forum folks some data from which to draw their own conclusions. I didn't select the NY data base to prove a point, it was more said with fewer words than my data bases at medscape and medlife........the reader's digest version.


same with me too, BillG

This response submitted by Bill Yox on 3/27/02. ( ) 152.163.189.200

My reply wasnt meant to imply anything other then the saliva transfer thing. I am not upstaging or lessening the info you were good enough to offer all of us. Just throwing more interesting facts, no more. I enjoy what you offer, and respect your background and experience, Bill.


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