Wilderness Medicine, First Aid, and Outdoor Skills
Rabies Virus, Symptoms, Vaccine, Treatment

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Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary


Table of Contents

Introduction

BatThe history of rabies goes back to 2000 B.C. Aristotle recognized that dogs were able to transmit the infection to other dogs through bites. When a 9-year-old boy was bitten by a rabid dog in 1885, Louis Pasteur treated him with a rabid spinal cord vaccine, becoming the first human being successfully immunized, as the boy did not develop rabies.

Rabies is a virus that ranks 10th in causes of mortality in the world. There are approximately 55,000 deaths annually. The vast majority of these are clearly in Third World countries.

Rabies Virus

The rabies virus contains 5 proteins. The virus is almost always transmitted by the bite of an infected animal, most commonly wild and domestic carnivores. There are some activities, especially cave explorers, who are more likely to come in contact with the virus, actually breathing in the virus in the dark, humid cave environment where a large number of infected bats are found. The virus is able to survive outside the host. Carnivorous animals can acquire rabies by eating infected prey and skunks have been able to transmit rabies to their young transplacentally, and there is one reported human case, where the mother was dying of rabies, and transmitted rabies to her unborn child.

Rabies is primarily a disease of animals. Infected dogs account for less than 5% of all rabies cases. However in other countries where canine rabies has not been controlled, it accounts for 90% or more of cases of rabies. In North America, especially on the east coast, an increasing number of infected raccoons are being seen. In the Midwest, skunks and bats more commonly carry rabies.

Wild animals generally account for about 93% of rabies, raccoons about 40% of that, skunks 30%, and foxes 6%.

It should be noted that the following animals have rarely been found to carry rabies, and almost never require post-exposure prophylaxis injections. These are squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, domesticated rabbits and other small rodents.

Rabies is considered to be uniformly fatal. However, there have been some cases of spontaneous recovery, although very rare.

Rabies Symptoms

When an individual is first bitten by a rabid animal, the symptoms are first seen in the skeletal muscle. It travels along the neuromuscular spindles and on the peripheral nerves to the central nervous system. An average incubation period, from the time of the bite to the time symptoms present, is about 60 days. That is specifically a bite that was obtained on the foot. A bite on the face only takes about 30 days.

It should be noted that approximately half of untreated individuals bitten by rabid dogs are going to develop rabies. This seems to be a combination of a couple factors, the bite location, and the amount of inoculum or saliva that is contaminated. So the incubation period can vary, anywhere from 9 days up to a year, although both 9-days and a year are rare. Again, it depends on the bite site and the amount of inoculum. The vast majority of the cases are being 2 weeks and 3 months.

Symptoms are usually vague and include fatigue, muscle aches, anxiety, irritability, agitation, insomnia, headache, nausea, vomiting and abdominal pain. One of the true early symptoms is pain and itchiness as well as numbness at the bite site, which occurs in about 55-60% of patients. It is not uncommon for humans to have what is called furious rabies, and these individuals have episodes of agitation. They can have seizures, can thrash out and become very aggressive. They may have severe pharyngeal spasms and become very thirsty, the combination is no doubt what causes the excessive salivating and drooling that occurs.

When untreated, a human being only survives approximately 8 days. With supportive care, life can be extended up to a month.

Rabies Vaccine

Pre-exposure Immunization: It is strongly recommended that individuals at high recreational or occupational risk be vaccinated. Individuals in professions of greatest risk are taxidermists, wildlife biologists, and professional or recreational trappers, especially those individuals traveling to Third World countries, where frequently infected domesticated animals are seen. The CDC recommends vaccination if traveling in Third World countries for longer than 30 days. Please check with your healthcare provider regarding countries you may be traveling to, or if your job or recreational activity places you at greater risk.

Rabies Treatment

Post-exposure Prophylaxis: Any wild animal that bites a person should be killed immediately, and the brain sent for diagnostic evaluation. Even though the animal may not appear ill, it should be noted that some of these animals that are infected could shed the virus for up to 2 weeks before they even show that they are ill with the rabies virus. According to Auerbach, unvaccinated dogs and cats that are bitten by a rabid animal should be destroyed immediately. If the owner refuses to have this done, the unvaccinated animal “should be kept in strict isolation for 6 months, and vaccinated one month before being released.”

A good history should be obtained:

  1. Whether the bite was provoked or unprovoked.
  2. Bites to the face and hands carry the highest risk.
  3. A fully vaccinated dog or cat is unlikely to become infected with rabies, although some rare cases have been reported, especially when they only got a single dose and did not have the complete regimen.

The CDC recommends that a healthy dog, cat or ferret that bites a person should be confined and observed for 10 days.

In the United States, post-exposure prophylaxis consists of the following: One dose of HRIG (Human Rabies Immune Globulin), and then 5 doses of the rabies vaccine over a 28-day period. The first dose, the HRIG, should be given as soon as possible after exposure, preferably within 24-hours. It should be important to note that the CDC recommends that as much as possible the full-dose be infiltrated around the wound. HRIG should never be administered in the same syringe or into the same anatomical site as the vaccine. They also recommend that post-exposure prophylaxis be followed exactly how the guidelines are stated. After your initial dose of HRIG, the 5 doses of vaccine should be given on days 0, 3, 7, 14, and 28, and it is 1 ml. dose per vaccine. Again, as stated previously, it should not be given in the same syringe or in the same site where the HRIG was given. They also recommend that it not be given in the gluteal region, since the vaccine might be deposited in fat and poorly absorbed. They recommend the deltoid muscle.

For further information on rabies treatment, Survive Outdoors strongly recommends that you visit www.cdc.gov.

 

References

1. Paul S. Auerbach, Wilderness Medicine
2. Tintinalli, Judith, Kelen, Gabor, Stapczynski, Stephen, J., Emergency Medicine, A Comprehensive Study




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