The Potential Danger of Rabies

Typically found in both domestic and wild animals, rabies is a viral disease that is spread to humans through bites or scratches. In China dogs are the primary source of rabies. Approximately 50,000 people die of rabies each year globally, as the disease is fatal if not treated immediately. In China, the annual death toll averages around 2,000 people, the second highest number of reported cases in the world, but deaths in Beijing in 2012 more than doubled compared to 2011 (13 total fatalities). According to Beijing’s Centers for Diseases Control and Prevention, most people were bitten by pet dogs rather than strays, and in all but one case the victims did not seek treatment or vaccination after being bitten.

Rabies is a disease typically found in poor and vulnerable populations, though it is not uncommon in more affluent or urban areas. In recent years, Chinese health authorities have stepped up rabies awareness campaigns with a goal of eliminating the disease altogether by 2025. Currently it is listed as a category B disease that must be reported to health officials. Every year, upwards of 15 million rabies vaccines are administered to patients, according to Ministry of Health statistics.

Local treatment of the wound

Should you be bitten or scratched by an animal of unknown vaccination status, quickly removing any potential rabies infection is the first important step of effective protection. An immediate and thorough flushing and washing of the wound with soap and water, as well as povidone iodine, is recommended. This action may be able to halt infection should the animal be contagious, but it is still critical to be evaluated by a medical professional as soon as possible.

Post-exposure prophylaxis

Rabies infection can be prevented post-incident through what is known as PEP – post-exposure prophylaxis – the scale of which is determined by the severity of contact with the suspected infected animal. For a small bite or scratch with no bleeding, local treatment of the wound and immediate vaccination are generally all that is needed. For more serious bites or scratches, licks on broken skin, or any contact with bats, the administration of rabies immunoglobulin alongside local treatment and vaccination is required. Both exposures carry an elevated risk of developing rabies especially if any of the following is true:

• The animal is a known rabies reservoir
• The animal displays abnormal or sickly behavior
• The wound is contaminated by the animal’s saliva
• The bite incident was unprovoked
• The animal is not vaccinated against rabies

If the victim has previously been vaccinated for rabies before, post-exposure immunization is generally only two rabies vaccine doses including one on the day of the incident and another three days later. If the patient has never before received rabies vaccination, they will need a four dose regimen spread out over 2-3 weeks.

Preventive immunization

Pre-exposure immunization using safe and effective vaccines is recommended, especially for people traveling to rural areas or spending time outdoors involved in activities such as bicycling, camping, or hiking. For expatriates living in areas of significant exposure, including China, vaccination is also recommended. Because they often play with animals, may not read danger signs or report bites or scratches, children are at higher risk for infection; strongly consider having your child immunized if you live or visit a high risk area, and report any bites to health authorities immediately. Pre-exposure immunization for adults and children above the age of 6 months is a three dose series over 3-4 weeks.

References:

www.cdc.gov/rabies

www.uptodate.com/contents/when-to-use-rabies-prophylaxis

www.wpro.who.int/china/mediacentre/factsheets/rabies/en/index.html