**World Rabies Day: Urgent Call to Prevent a Deadly Yet Preventable Disease**
World Rabies Day, observed annually on September 28, highlights the critical need to control rabies — a deadly yet entirely preventable viral infection.
In Pakistan, government data estimates that between 2,000 to 5,000 rabies-associated deaths occur annually, primarily due to dog bites and delayed or inadequate medical intervention. The actual number is believed to be even higher. Stray dogs, prevalent across both urban and rural areas, play a significant role in this public health challenge.
### Challenges in Rabies Control in Pakistan
Pakistan faces several obstacles in controlling rabies:
– **Large Stray Dog Population:** Numerous stray dogs roam freely, increasing the risk of rabies transmission.
– **Limited Access to Vaccines and Immunoglobulins:** Rabies vaccines and immunoglobulins—life-saving injections administered immediately after exposure—are often unavailable or in short supply in public hospitals, forcing people to seek costly private healthcare.
– **Distance to Medical Facilities:** In rural areas, where dog bites are more frequent, medical centers may be hours away, delaying critical treatment.
– **Socioeconomic Factors:** Poverty, lack of awareness, and limited education contribute to many families being unable to afford or understand the importance of completing the full vaccination course.
– **Underreporting:** Social stigma around animal bites leads some cases to go unreported.
### Understanding Rabies
Rabies is a viral zoonotic disease transmitted primarily through bites or scratches from infected animals. Worldwide, common reservoirs include dogs, bats, foxes, and badgers. A single bite from a rabid animal can be fatal, and saliva-contaminated scratches can also transmit the virus.
Once symptoms appear, rabies is almost always fatal. Early signs in both humans and animals include:
– Fever
– Nausea and vomiting
– Diarrhea
– Runny nose
– Light sensitivity
– Muscle cramps
– Loss of appetite
Additional symptoms include aggression, restlessness, and hydrophobia (fear of water), a classic sign of rabies.
### Immediate Actions After a Dog Bite
Anyone bitten or scratched by a suspect animal should immediately:
– Wash and flush the wound thoroughly with soap and water for at least 15 minutes.
– If available, apply 70% alcohol/ethanol or povidone-iodine.
Healthcare providers should promptly examine and categorize the wound:
– **Category I:** Licking of intact skin — no vaccination required.
– **Category II:** Nibbling or minor scratches without bleeding — vaccination required.
– **Category III:** Transdermal bites, scratches, or exposure of mucous membranes — require both vaccine and immunoglobulin.
The wound should be left open; tight bandaging must be avoided. For large wounds, loose stitches may be applied 3–4 days after injury.
**Important:** Avoid home remedies such as chili powder, acids, or plant juices and steer clear of traditional healers, as these do not prevent or cure rabies.
### Monitoring the Dog
Observe the dog for 10 days after the bite. If the dog remains healthy and alive, it was not infectious at the time of the bite. If the animal dies, becomes sick, or cannot be found, continue and complete post-exposure prophylaxis (PEP) as per medical protocols.
### Rabies Vaccination: Prevention is Key
Rabies is 100% fatal once symptoms appear, but it is also 100% vaccine-preventable. Public health education on the importance of seeking immediate medical care after any potential exposure is critical.
– **Vaccination Schedules:**
– *Intramuscular Vaccine:* 1 ml injections at a single site on days 0, 3, 7, and 14. Immunocompromised patients receive an additional dose on day 28.
– *Intradermal Vaccine:* 0.1 ml at two sites on days 0, 3, 7, and 28.
– For children under two years, vaccines are administered on the anterolateral thigh.
– **Immunoglobulin Administration:**
– Human Rabies Immunoglobulin (HRIG) is given at 20 IU/kg.
– Equine Rabies Immunoglobulin (ERIG), at 40 IU/kg, is a cheaper and equally effective alternative preferred in resource-limited settings.
– Immunoglobulins should be infiltrated into and around the wound, with any remainder given intramuscularly at a different site.
– **Booster Doses:** Patients previously fully vaccinated who suffer a new dog bite should receive booster vaccine doses on days 0 and 3.
– **Incomplete Vaccinations:** Those with incomplete PrEP or PEP must receive full post-exposure prophylaxis.
### Special Precautions
– Pre-exposure prophylaxis (PrEP) is recommended for travelers to rabies-endemic areas and professionals who handle animals. The World Health Organization recommends two 1 mL intramuscular injections on days 0 and 7.
– Dairy product handlers in rural areas should avoid contact with rabid cattle due to the risk from foaming saliva entering wounds.
– Pet dogs must be fully vaccinated, and stray dog control programs—including birth control and vaccination—should be implemented at the community level.
– Immediate reporting of rabid animal sightings to local authorities is vital.
### Innovations and Hope for the Future
Dow University of Health Sciences has locally developed a rabies vaccine molecule imported from China; however, it awaits approval from the Drug Regulatory Authority of Pakistan for commercial use.
### Conclusion
Rabies remains a fatal disease without cure once symptoms develop, but it is entirely preventable through timely wound care, vaccination, and immunoglobulin administration. Responsible interaction with animals, public education, and effective control measures are essential to reduce the burden of this deadly disease.
Priority must be given to prevention and early intervention to save lives and protect communities from rabies.
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*Protect yourself and your loved ones: Avoid contact with stray or wild animals, seek immediate medical care after any bite or scratch, and ensure your pets are vaccinated.*
https://www.thenews.com.pk/tns/detail/1346841-protecting-communities-preventing-deaths