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Prevention is better than Cure: World Rabies Day, 2017

Photo : Purabi Deshpande / Research Matters

 

On a warm summer day, a few centuries ago in a tiny hamlet in France, tragedy struck. A young boy was severely mauled by a dog. To make matters worse, that dog was rabid. The boy's fate seemed sealed. However, his parents refused to watch their son die. They carried him to a famous scientist and begged him to use his knowledge of science to save their son.

Though the scientist had no idea where to begin, he did not shy away from the challenge. He decided that he would create a lifesaving injection: a vaccine. Through several gruesome steps involving the spinal cords of unfortunate rabbits, he succeeded. He developed a vaccine that had to be administered in thirteen separate sights round the boy's navel. This is the story of how the first vaccine against rabies came to be and more importantly, the story of how rabies became conquerable. The world owes this to that one scientist: Louis Pasteur.

Rabies is a disease that is most commonly seen in dogs and humans. There are also tales of it existing in vampire bats. Rabies has been portrayed in the Stephen King’s novel ‘Cujo’, where the protagonist, a huge Saint Bernard Cujo, becomes rabid, vicious and dangerous. While most fictions are exaggerations of the truth, this book was surprisingly accurate. The disease is caused by a type of virus called the Lyssa virus. It enters the body usually through the saliva of an infected animal through a bite . It is also possible to acquire the disease through licks from diseased animals over open skin. Once inside the body, it travels up to the brain where it causes the typical signs of rage, aggression, hydrophobia and altered voice.

There are several scientists who have played a part in understanding rabies. As the first cases of the disease were recorded in ancient Egypt, history is awash with the men who studied the disease. These were the heroes of yesteryears. The heroes of today are doctors, veterinarians and the public. It is the job of doctors and vets to ensure that the patients they are brought do not contract the disease despite being bitten by a rabid animal, by the use of timely post-bite ARVs (anti-rabies vaccines). It is the additional duty of the veterinarian to see that rabies is contained, rather than spread, and that it is ultimately eradicated.

According to public health specialist and vet Dr. V Ajay Kumar, “Although vets have to contribute to the control of the disease by immunising pets and educating pet owners, the most important responsibility is assisting the local bodies in dog population control and pet animal registration. What we have to understand is that all the dogs, even if they are pets and not used for breeding, shall be neutered. Why I feel this is necessary is that most of the stray dogs we see now were earlier pet dogs or born to some pets which were abandoned earlier.”

Rabid dogs get infected by other dogs and bite unsuspecting humans, livestock and also dogs, thus perpetuating the cycle. This results in 15 million cases of suspected rabies per annum. Upto 300,000 people have died of rabies since 1985 in India alone. This is depressing but expected  because rabies is fatal. Once the signs start, there is no vaccine, no antibody and no cure.

The bright side of this situation is that rabies is preventable, easily. There are several vaccines available that can be taken for prophylaxis and they have come a long way from the initial crude Pasteurian vaccine. While these are not mandatory and are not even recommended except in high risk situations, post-exposure vaccinating is a must. This means that if an individual, human or animal, is bitten by a rabid animal or by an animal that could be rabid, they must compulsorily get anti-rabies vaccines. This is not a one-shot relief; it’s a 5 shot relief. The first of these must absolutely be on the day of the bite itself. Doctors may also recommend the use of anti-rabies antibodies based on the severity of the wounds.

When explained, it all seems absurdly simple. If bitten, get vaccinated. The doctors will take care of when, where and how much. This is the importance of celebrating World Rabies Day. Every 28th of September, the death anniversary of the great Pasteur, is a day designated to educate people and create an awareness amongst them about rabies, it’s transmission and most importantly; it’s prevention. “I didn’t know any better” should not be considered a valid excuse for not taking precautionary measures. It is the responsibility of doctors and veterinarians to try to eradicate the disease and treat any patient diagnosed with and at risk of rabies. But it the duty of every individual to help control it.

Rabies is one of those diseases that can infect practically any warm blooded animal and, yes, there may always be a rabid wild animal. This makes me question whether it can ever be fully eradicated, but it can (and should) be very easily prevented.