Rising cases of rabies is a global concern , India and Africa carrying most of the burden. It is transmitted by bite , scratch & wound contamination by saliva by dogs (major) , bats etc. It bind to nicotinic acetylcholine receptor at NMJ , spread retrogradely to CNS and later spread to salivary gland. Clinically it present as agitation , hypersalivation , hydrophobia and later progress to paralysis and death. There is almost no cure once symptom appear. But this can be prevented by immediate wound washing ,post exposure prophylaxis which includes vaccines and immunoglobulin based on category of wound :-
- Category 1 -Touching/Linking/Intact skin - Only wound washing
- Category 2 -Nibbling /Minor scratches /Abrasion with no bleed
- Category 3 -Bites/Scratch with bleeding
Both category 2 & 3 requires wound washing and post exposure prophylaxis which include 5dose (Essen) -IM on days 0,3,7,14 &28 or 4dose (Thai red cross) -ID on two sites on days (2-2-2-0-2).
Category 3 requires rabies single dose immunoglobulin too ,which is given into and around wound sites.
Other area which require great deal of attention is stray dog neutering and vaccination. Reporting of rabid animals.
At least 70%vaccination coverage in dogs is must to break the transmission.
MBH/AB