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WHAT IS THE RABIES VIRUS

Rabies is an infectious viral disease that occurs in many countries globally and is an issue that Bali has been dealing with for more than a decade. There are only nine rabies-free provinces in Indonesia, and unfortunately, Bali isn’t one of them. Rabies is transmitted through saliva – when an infected animal bites (or scratches) another, they can also become infected. Monkeys, dogs, bats or, in rare cases, cats can all be Rabies carriers. In Indonesia, 98% of rabies cases occur from a rabid dog bite, the rest from a monkey or cat.2 If there’s no intervention of treatment, rabies is almost always fatal.1,3

INFECTION & SYMPTOMS

Rabies is a virus that attacks the central nervous system, making progressive and fatal inflammation of the brain and spinal cord. The incubation period is typically 2–3 months, but may vary from one week to one year, dependent upon factors such as the location of virus entry and the viral load (the amount of virus in the transmission fluid). The closer the bite to the head (e.g. neck, upper arm), the quicker the infection can get into the central nervous system (the brain). Initial symptoms of rabies include a fever with pain and unusual or unexplained tingling, pricking, or burning sensation (paraesthesia) at the wound site.1-4

PREVENTION & MANAGEMENT

The good news is rabies is a vaccine-preventable disease. Human rabies vaccines exist for pre-exposure immunisation. People working in certain high-risk occupations such as laboratory workers handling live rabies and rabies-related viruses should always have this vaccine. A pre-exposure vaccine is also recommended for travellers to rabies-affected, remote areas who plan to spend a lot of time outdoors involved in activities such as caving or mountain-climbing.1,5 In Bali, many animal rescue organisations also require their volunteers to have this.

Now the important part: if you’ve been in contact with any wildlife or unfamiliar animals, particularly if you’ve been bitten or scratched, you should talk with a doctor to determine your risk for rabies or other illnesses. As soon as you get bitten/scratched immediately wash the wound thoroughly with soap and water for at least 10 to 15 minutes. Applying iodine solution to the wound at this stage is also recommended; this first aid wound care is crucial and can save lives.1-5 The next step is to visit your nearby healthcare professional to determine if you need a post-exposure prophylaxis (PEP) vaccine or not.

THREE CATEGORIES OF EXPOSURE

(as per the WHO classifies)

Category I

Touching or feeding animals, licks on intact skin

Category II

Nibbling of uncovered skin, minor scratches or abrasions without bleeding

Category III

Single or multiple transdermal bites or scratches, contamination of mucous membrane or broken skin with saliva from animal licks, exposures due to direct contact with bats.

Individuals with WHO category II or III exposures should receive PEP without delay. The PEP rabies vaccine will need to be given several times, so it is important to talk to your healthcare professional to plan a regimen that suits you. For severe category III exposures, Rabies Immunoglobulin (RIG) should also be administered alongside the PEP. Adverse reactions to rabies vaccine and immunoglobulin are not common, and newer vaccines in use today cause fewer adverse reactions than previously available vaccines.1,7

Unless an individual is sick with rabies, it is not transferable from person to person. PEP will protect you from developing rabies, ensuring you cannot expose other people to the virus. So if you feel like you have been exposed, and are managing it through the correct course of precautions as recommended by the WHO, you can continue to participate in your usual activities.7

References

1.Chow CM, Leung AK, Hon KL. Acute gastroenteritis: from guidelines to real life. Clin Exp
Gastroenterol. 2010 Jul 15;3:97–112.
2.Publishing HH. Gastroenteritis In Adults [Internet]. Harvard Health. [cited 2019 May 2].
Available from: https://www.health.harvard.edu/a_to_z/gastroenteritis-in-adults-a-to-z
3. Barr W, Smith A. Acute Diarrhea in Adults. Am Fam Physician. 2014;89(3):180–9.

4. Longo DL, editor. Harrison’s principles of internal medicine. 18th ed. New York: McGraw-Hill; 2012. 2 p.
5. CDC. Foodborne Illnesses and Germs [Internet]. Centers for Disease Control and
Prevention. 2018 [cited 2019 May 2]. Available from: https://www.cdc.gov/foodsafety/foodborne-germs.html
6. CDC. Signs and Symptoms of Food Poisoning [Internet]. Centers for Disease Control and Prevention. 2019 [cited 2019 May 2]. Available from: https://www.cdc.gov/foodsafety/symptoms.html

7. McFarland LV, Goh S. Are probiotics and prebiotics effective in the prevention of travellers’ diarrhea: A systematic review and meta-analysis. Travel Medicine and Infectious Disease. 2019 Jan;27:11–9.
8. Islam SU. Clinical Uses of Probiotics. Medicine. 2016 Feb;95(5):e2658.
9. Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clinical Infectious Diseases. 2017 Nov 29;65(12):e45–80.

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