Hello everyone.
A little over a year ago, I had to face the unpleasant matter of a suspected rabies infection. An article I read yesterday reminded me of that case — especially its lack of mention of rabies, despite it being a highly prevalent (especially in Russia, Asia, Africa, and America) and very insidious virus. Unfortunately, the risks associated with it are often not given the due consideration.
So, what exactly is rabies? It is an incurable viral disease that is transmitted through the saliva or blood of infected animals and humans. In the overwhelming majority of cases, transmission occurs through the bite of an animal that is a carrier of the virus.
What can the average Russian quickly say about rabies? Well, there is such a disease. It's most often associated with rabid dogs. The older generation will likely add that if bitten by such a dog, you will have to get 40 shots in the stomach and forget about alcohol for several months. That's probably about it.
Surprisingly, not everyone knows that rabies is a 100% fatal disease. If the virus somehow enters your body, a "countdown" begins: as it proliferates and spreads, the virus travels along the nerve fibers to the spinal cord and brain. Its "journey" can last anywhere from a few days or weeks to several months — the closer the bite is to the head, the less time you have. All this time, you will feel completely normal, but if the virus reaches its target — you are doomed. When this happens, you still won't feel any symptoms of the disease, but you will already be a carrier: the virus will appear in your bodily secretions. After that, rabies can only be detected through tests, but treating it at that stage is already too late. As the virus multiplies in the brain, initially harmless first symptoms start to appear, which within a few days escalate into rapidly progressing brain inflammation and paralysis. The outcome is always the same — death.
Rabies treatment is literally a race against death. The disease will not develop if you can administer the rabies vaccine before the virus penetrates the brain and give it time to take effect. This vaccine contains an inactivated (dead) rabies virus, which is introduced into the body to 'train' the immune system to fight the active virus. Unfortunately, this 'training' requires time to produce antibodies, while the virus continues to work its way to your brain. It is believed that the vaccine can still be administered within 14 days after a bite - but it is better to do this as soon as possible, preferably within the first day. If you seek help in a timely manner and receive the vaccine, your body will formulate an immune response and destroy the virus 'on the march'. However, if you procrastinate and the virus manages to reach the brain before the immune response is formed, you may as well pick your grave. Further progression of the disease will be unstoppable.
As you can see, this disease is extremely serious - and it seems even stranger that myths about it persist in Russia.
Myth number 1: only dogs carry rabies. Sometimes cats and (more rarely) foxes are also named as possible carriers.
The sad reality is that, besides the mentioned animals, many other creatures (more specifically, mammals and some birds) can also transmit rabies - such as raccoons, cattle, rats, bats, roosters, jackals, and even squirrels or hedgehogs.
Myth number 2: a rabid animal can be easily identified by its inadequate behavior (the animal moves oddly, it is drooling, it attacks people).
Unfortunately, this is far from always true. The incubation period for rabies is quite lengthy, and the saliva of the infected carrier becomes contagious 3-5 days before the first symptoms appear. Moreover, rabies can manifest in a 'silent' form, during which the animal often loses its fear and approaches people, outwardly showing no threatening symptoms. Therefore, if bitten by any wild or unknown animal (even if it appeared healthy), the only correct action is to seek medical help as soon as possible, preferably within the first day, to receive the rabies vaccine.
Myth number 3: if the wound from the bite is small, it is enough just to wash it with soap and disinfect it.
Perhaps the most dangerous misconception. The rabies virus indeed does not survive contact with alkaline solutions — but to penetrate the tissues of the body, it is sufficient for any damage to the skin. There is no way to know whether it has done so before the wound is washed.
Myth number 4: the doctor will definitely prescribe you 40 painful injections in the stomach, and you will have to go for these injections every day.
This was indeed the case, but in the last century. Current rabies vaccines require 4 to 6 injections in the shoulder at intervals of several days, plus optionally one more injection at the site of the bite.
In addition, the doctor (infectious disease specialist or rabies expert) may decide that vaccination is not necessary based on the circumstances of the bite and the local epidemiological situation (assessing what kind of animal it was, whether it was domestic or wild, where and how it all happened, whether there have been cases of rabies in that area, etc.).
Myth number 5: the rabies vaccine has many side effects and you can even die from it.
This type of vaccine does have side effects — this is the main reason why people are often vaccinated against rabies only when at risk of infection, rather than for preventive reasons. These 'side effects' can be quite unpleasant, but are usually not very long-lasting, and enduring them is not such a high price to pay to stay alive. You cannot die from the vaccinations themselves, but if they are not done or if repeat vaccinations are missed after a bite from a suspicious animal, it is indeed possible to die from rabies.
Myth number 6: if you catch or kill the animal that bit you, then you don't need vaccinations, because doctors will be able to test it and determine if it was rabid.
This is only half true. If the animal is caught and shows no signs of rabies, it can be quarantined, but this does not exempt you from vaccination. Doctors can only decide to stop vaccination if the animal does not become ill or die within 10 days — but there is the risk of atypical rabies, where a sick animal lives. significantly For more than 10 days — during which time the animal can be a virus carrier without showing any external symptoms of the disease. Comments are unnecessary. However, it should be noted that atypical rabies occurs extremely rarely according to statistics — but it is still better to complete the vaccination course than to end up in that statistic and try to prove in the afterlife that it was a tragic coincidence.
In cases where the animal is killed on site or captured and euthanized — such an analysis can be done through examination of the brain tissue slices, but how long it will take (and whether it will be done) greatly depends on where it all happened and where you sought help. In most cases, it is safer to immediately start the vaccination course and discontinue it if rabies is not confirmed by laboratory testing.
If the animal that bit you has fled — this is a clear indication for vaccination, and only a doctor should assess the level of risk here. Of course, undergoing the vaccination course may well turn out to be precautionary — you have no way of knowing for sure if the animal was infected with rabies. But if you don’t get vaccinated, and the animal was indeed a virus carrier — then you are guaranteed a painful death in a few weeks or months.
Myth number 7: if you are bitten by an animal that has been vaccinated against rabies, vaccination is not required.
This is true, but not always. The vaccination must be, firstly, documented (noted in the vaccination certificate), and secondly — it should not be expired or administered less than a month before the incident. Additionally, even if everything is in order on paper, if the animal behaves inappropriately — you should consult a doctor and follow their recommendations.
Myth number 8: rabies can be contracted if you touch a sick animal, or if it scratches or licks you.
This is not entirely accurate. The rabies virus cannot exist in the external environment, so it cannot be present on the skin or fur of an animal, or on claws (for example, cat claws). However, it thrives in saliva—but it cannot penetrate intact skin. In the latter case, it is advisable to immediately wash the saliva-exposed area of skin with soap and disinfect it, after which one should still consult a doctor to determine the need for further action.
Myth number 9: during and after vaccination against rabies, it is forbidden to consume alcohol; otherwise, it will neutralize the vaccine's effectiveness.
There is no scientific basis for claims that alcohol inhibits antibody production during anti-rabies vaccination. This scare is prevalent only in the countries of the former USSR. Notably, outside the former socialist bloc, doctors have not heard of such prohibitions, and the instructions for anti-rabies vaccines do not contain any contraindications related to alcohol.
The roots of this scare go back to the last century when vaccines of the previous generation were used, which indeed required injections in the abdomen for 30-40 consecutive days. Missing a scheduled injection, just like back then, jeopardizes the effectiveness of vaccination, and alcohol abuse is one of the common reasons for failing to see a doctor.
Myth number 10: Rabies is curable. Americans cured a sick girl using the Milwaukee protocol even after symptoms of the disease appeared.
This is highly debatable. Indeed, such an extremely complex and expensive (around $800,000) method of treating rabies at the stage of symptom manifestation exists, but worldwide, only a few cases have confirmed its successful application. Moreover, science still cannot explain how those cases differ from the much larger number of instances where treatment following this protocol yielded no results. Therefore, it is not advisable to rely on the Milwaukee protocol—the success rate hovers around 5%. The only officially recognized and effective way to avoid rabies in cases of potential infection continues to be timely vaccination.
In conclusion, I would like to share a cautionary tale. I live in Germany, and, like in many neighboring countries, we have long eradicated local rabies in animals (and consequently cases of human infection) thanks to the efforts of the government and health organizations. However, imported cases occasionally occur. The last case was about 8 years ago: a man was admitted to the hospital with complaints of high fever, swallowing spasms, and coordination problems. During the medical history gathering, he mentioned that three months before the onset of his illness, he returned from a trip to Africa. He was immediately tested for rabies – and the result turned out to be positive. The patient then went on to explain that he had been bitten by a dog during his trip, but he didn’t think much of it and did not seek help. This man soon died in an isolation room. By that time, all local epidemiological services, including the Ministry of Health, were in a state of alarm — understandably, it was the first case of rabies in the country in who knows how many years… They undertook a titanic effort, locating and vaccinating everyone the deceased had come into contact with after returning from that unfortunate trip within three days.
Do not underestimate animal bites, even from pets, if they are not vaccinated — especially in countries where rabies is widespread. Only a doctor can make an informed decision about the necessity of vaccination in each specific case. Neglecting this puts your life and the lives of your loved ones at risk.
Source: habr.com
