RABIES

Rabies is an infectious and fatal viral disease of dogs and other mammals that causes madness and
convulsions, transmissible through the saliva to humans and other animals. It causes encephalitis in humans
and other mammals. Historically referred to as hydrophobia ("fear of water") due to the symptom of panic
when presented with water to drink.

Etiology
Rabies is caused by a large, bullet-shaped RNA lyssavirus (family Rhabdoviridae). Its outer envelope makes
it sensitive to heat, light, detergents and disinfectants, and unable to survive for long outside its mammalian
hosts.

Epizootiology
Rabies is the oldest known canine disease and, being until recently almost invariably fatal in infected
humans, it is also one which has been intensely investigated. Rabies occurs worldwide except in Australia,
Antarctica and some islands and peninsular areas. Areas currently rabies free include the United Kingdom
and Ireland, Iceland, Japan, Taiwan, Norway and Sweden, and Spain and Portugal. All mammals can be
infected but susceptibility varies. Wild canidae are highly susceptible, domestic dogs moderately so. Rabies
is perpetuated by wildlife reservoirs in all parts of the world, e.g. foxes in the northern hemisphere, skunks
and raccoons in North America, bats in Central and South America. In Asia, Africa and Central and South
America, feral and stray dogs are an additional reservoir.

Transmission is almost always via bite wound. Respiratory infection occurs occasionally in bat caves where
dark damp conditions allow the virus to survive in aerosols of infected saliva. Most human cases result from
infected dog bites although in areas where canine vaccination is widespread, infected cats may be as much, if
not more, of a problem than dogs. Even in areas with a wildlife reservoir, the domestic pet usually forms the
link between man and wildlife.

Pathogenesis
Virus is inoculated into the tissues by a bite, replicates locally in muscle, then enters nerve axons at
neuromuscular junctions or neurotendinal spindles and is transported along axons to the CNS. Once in the
CNS, it spreads rapidly along neurons and induces behavioral abnormalities and progressive lower motor
neuron deficits. Subsequent centrifugal spread along nerves from the brain results in localization in salivary
glands and excretion in saliva. The incubation period in dogs is usually 3-9 weeks but can be as short as 10
days or as long as 10 months. The incubation period is affected by the amount of implanted virus, the
richness of local innervation and the distance from the wound to the CNS. Virus excretion can start before
the onset of clinical signs but not all infected dogs excrete virus in saliva.

Clinical signs
The typical rabid dog shows an initial 2-3 day prodromal phase of altered temperament and behavior:
friendly dogs become shy and nervous, reserved animals suddenly affectionate. They are often pyrexic and
may chew at the wound site. During the 1-7 day furious phase, the dog reacts excessively to most stimuli,
may wander for long distances, and is spontaneously aggressive, attacking almost anything encountered.
Early lower motor neuron signs are obvious as hind limb ataxia or paresis and partia1paralysis of the lower
jaw. Furious rabies is often absent or shortlived and, ultimately, dumb or paralytic rabies supervenes for
the last 2-4 days. There is progressive paralysis: the lower jaw hangs open drooling saliva, swallowing is
difficult, and the voice alters due to laryngeal paralysis; paraparesis progresses to paraplegia, quadriplegia,
recumbency and terminal coma.
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Death results from respiratory paralysis, usually within a week (occasionally 10-14 days) of initia1 signs.

Diagnosis
Rapid laboratory confirmation of animal rabies is essential so that exposed humans can receive proper
prophylaxis as early as possible. Definitive diagnosis requires laboratory testing of postmortem tissues.
Antemortem tests for rabies are too unreliable to be recommended; thus, always evaluate postmortem tissue
specimens for diagnosis, especially the brain. For laboratory analysis of brain and salivary tissue for the
presence of rabies virus or antigen, submit the animal’s head chilled on wet ice in a leak-proof container,
along with appropriate information and biohazard labeling. Specimens can be stored by refrigeration but not
freezing, because thawing will ruin the specimen for subsequent virus detection.

Direct Fluorescent Antibody Test

This is the test of choice used by most laboratories for rapid, reliable confirmation of rabies antigen in
tissues. Brain tissue is most often used for routine testing, but salivary glands can also be evaluated. The
direct fluorescent antibody (DFA) procedure has also been sued for ante-mortem detection of rabies antigen
in skin biopsies; however, a high percentage of false-negative results limits the usefulness of the skin test.

Histopathology
This older, less sensitive test identifies intracytoplasmic neuronal inclusions called Negri bodies, which are
found in 75% of rabid dogs but rarely in cats.

Mouse Inoculation Test

This is a backup confirmatory test in which DFA positive brain suspensions are inoculated intracerebraly
into mice; the mice then are sacrificed and their brains are examined by DFA testing 5 to 6 days post-
inoculation.

Tissue Culture inoculation test

This test is similar to the mouse inoculation test except that cell cultures are inoculated and then examined by
DFA testing 24 to 72 hours later. Other methods of diagnosis include monoclonal antibody techniques and
molecular techniques (e.g. PCR).

Treatment
Rabies is almost always fatal in domestic animals. Because of the extreme public health danger, quarantine
or euthanize all animals suspected of rabies, and notify relevant veterinary/public health authorities.

Prevention in Dogs and Cats

Rabies prevention requires vaccination and preventing pets from having contact with wild animals.

Vaccination
Vaccinate as early as 3 months of age and 1 year later, then booster every 3 years in accordance with the
product recommendations. Maternal antibodies from vaccinated females will protect neonates until 3 months
of age. Immunity is not fully developed until 28 days after the initial rabies vaccination.

Post-exposure Management
Report all human and animal exposures to relevant authorities. Recommendations for dogs and cats exposed
to rabies (bitten by a known rabid animal or a wild animal that is unavailable for testing) are as follows:
 In a previously vaccinated dog or cat that has been exposed, revaccinate immediately and keep under
the owner’s control for 45 days to observe for illness suggestive of rabies.
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  In unvaccinated dog or cat that has been exposed, recommend immediate euthanasia for examination
of tissues. If euthanasia is not allowed by the owner, strict isolation is required for 6 months with
vaccination either at entry or 1 month before release. If illness suggestive of rabies develops during
isolation, immediate euthanasia and testing for rabies is required.

Prevention in humans
Once signs develop in a human, rabies is almost always fatal; thus prevention is indispensable!

Pre-Exposure prevention
For pre-exposure prevention in humans in high-risk situations (e.g. veterinarians and their employees),
immunization with human diploid cell vaccine (HDCV) or another vaccine approved by respective
authorities is used.

Animal bites to humans

In most countries it is required to immediately notify local public health authorities when an animal bite to a
human has occurred or whenever there is a possibility of contact with a rabid animal.
 When a healthy pet dog or cat has bitten a human, the owners must confine and observe the animal
for 10 days. During confinement the animal must be isolated from contact with other animals and
confined in escape-proof enclosure or building. Any signs of illness in the confined animal must be
reported to local public health/veterinary authorities.

 When a wild animal or a feral or stray dog or cat with unknown vaccination status has bitten a
human, regard the animal as potentially rabid and sacrifice it immediately for laboratory examination
of tissues under the guidance of local public health officials.

What to do for bitten humans

 Vigorously cleanse the wounds of an exposed human with copious amounts of soap and water to
reduce virus in the wound. Ethanol (70%) and benzalkonium chloride (1-4%) are acceptable rabicidal
disinfectants. Depending on the circumstances, public health authorities will decide immediately
whether postexposure prophylaxis is indicated. Previously immunized humans generally receive two
doses of vaccine (on days 0 and 3) whereas non-immunized humans are given five doses of vaccine
(on days 0, 3, 7, 14, and 28) and rabies immunoglobulins.