Rabies is a viral illness that can be transmitted from animals to humans. The infection spreads when a rabid animal bites or scratches a person. It can also spread if infected animals lick a person’s wounds. In India, most cases of infection are related to bites from an infected dog. This disease is fatal if not treated on time. Implementing effective preventive measures is crucial to avoid contracting rabies. These measures include thorough cleaning of wounds with soapy water, and administering anti-rabies vaccines and anti-rabies serum in accordance with national guidelines.
The primary goal of these measures is to prevent the virus from entering the nervous system. Without proper care, the virus can infiltrate the central nervous system upon exposure, ultimately affecting the brain and leading to death. “The vaccine can only provide protection if administered before the virus enters the nerves. In rare cases, the virus enters the nerves immediately after a bite. Bites to the hands and face are particularly serious because these areas have a higher concentration of nerves. The disease becomes evident when the virus reaches the brain. It travels through the nerves, starting from the bite site, then through the spinal cord before reaching the brain. Once the virus enters the brain, the infected person can potentially transmit it to others through contact with their eye drops or saliva,” said Dr Sheeja Sugunan, a paediatric intensivist and associate professor of Sree Avittom Thirunal Hospital for Women and Children, Thiruvananthapuram.
It’s essential to wash the wound with soap under running water for at least 15 minutes. This helps destroy three-quarters of the viral load. The wound should then be disinfected with alcohol or iodine solution and, if possible, and administer the first dose of the anti-rabies vaccine the same day.
If the wound falls under category 3 (a wound with blood), anti-rabies serum should be applied directly to the wound. It’s critical that the serum is administered within seven days of the bite, as it takes 14 days for the vaccine to produce antibodies. The serum offers immediate protection until the body can produce immunity from the vaccine. However, complications can arise if there are multiple bites or if the bites occur in areas with a high nerve concentration, and they may even go unnoticed.
For this reason, health experts recommend pre-exposure prophylaxis for individuals who have pets or frequently interact with animals.” The goal is to build sufficient antibodies against the virus before potential exposure. Three doses of the vaccine prior to exposure are usually adequate. So, if exposure does occur, the person would only need two vaccine doses and could forego the use of serum,” Dr. Sheeja adds.
A dog is considered immune if it meets specific criteria: it must be over one year old, have received the first vaccine dose at more than three months of age, have taken two doses six months apart, received annual vaccinations and has been vaccinated with a high-quality vaccine. However, for practical purposes, even if bitten by a vaccinated pet, it is advisable to seek vaccination.
Categories of bites and treatment
Category 1: Touching or feeding animals, animal licks on intact skin (no exposure) - Washing of exposed skin surface, No vaccine
Category 2: Nibbling of uncovered skin, minor scratches or abrasions without bleeding (exposure) - Wound washing and immediate vaccination
Category 3: Single or multiple transdermal bites or scratches, contamination of mucous membrane or broken skin with saliva from animal licks, exposure due to direct contact with bats (severe exposure) - Wound washing, immediate vaccination and administration of anti-rabies serum
Pre-exposure prophylaxis