World Rabies Day: Why prevention is better – there is no cure
Rabies has made its way onto front-page news in 2024 – this time, aggressive Cape fur seals have been attacking people in the ocean as well as other seals along the Western Cape coast. On 7 June 2024, it was confirmed that the cause of some of these aggressive attacks was rabies. Surfers, swimmers, divers and other water sports enthusiasts – from Blouberg in Cape Town all the way to Mossel Bay in the Garden Route and Plettenberg Bay in the Eastern Cape – have been urged to take care in the water, and people have been warned to not approach seals on land.
This outbreak of rabies in wild animals whose habitats we may frequent, re-emphasises the importance of rabies awareness, and to take cognisance of how serious rabies still is. In this article, we’ll go back to basics and look at what rabies is, what and who is at risk of rabies infection, what to do if you suspect your pet has rabies, and what to do if you suspect you’ve been bitten by a rabid animal.
What is rabies?
Rabies is the deadly disease caused by the Rabies lyssavirus, a viral pathogen that attacks the nervous system and causes brain inflammation in mammals. In South Africa, mammalian hosts of the rabies virus can include dogs, cats, badgers, bat-eared foxes, mongooses, bats, monkeys and seals. Humans are unlikely to be infected with rabies from a bite from a mouse, rat, hamster or other small rodent; because when these small mammals are bitten by larger rabid animals, they are typically killed.
Rabies is a zoonotic disease, which means it can be passed from animals to humans. It has the highest mortality rate of any infectious disease in humans – only a handful of people have survived symptomatic rabies, and not without side effects. Every year, globally, almost 60 000 people die from rabies. The majority of these infections occur in Asia and Africa, and about 24 000 victims are children, aged 15 and under.
Dog bites are the main cause of rabies in developing countries, while in North and South America, rabies is most commonly transmitted by bat bites. There are post-exposure prophylaxis (PEP) protocols that bite victims can get to avoid the rabies virus from establishing itself, but once rabies symptoms start to show, it’s too late and the disease will be fatal.
How is rabies transmitted?
The rabies virus can be found in the nerve cells and saliva of its host – which would typically be a mammal showing uncharacteristic behaviour as the rabies symptoms set in. If a person is bitten by an animal with rabies, the virus is transmitted from the animal’s saliva into the person’s bloodstream through the bite. Even if the animal does not bite, the virus can be transferred in infected saliva via a lick or smear on broken skin, through mucous membranes or an unhealed cut or sore.
The infected animal may foam at the mouth – a result of the over-production of saliva – and become highly aggressive, attempting to bite anything and everything in close range. The host also becomes hydrophobic – or deathly afraid of water; its throat muscles spasming painfully if it attempts to quench its thirst. This aversion to potable liquids is to prevent the host from drinking anything and potentially washing away or diluting the viral load in its saliva. Rabies is classed as a ‘behaviour-altering parasite’: meaning the virus is responsible for changing the host’s behaviour in order to boost its transmission to other hosts.
What are the symptoms of rabies?
Rabies attacks the central nervous system and causes brain inflammation, so there are usually behavioural symptoms that demonstrate this neurological effect:
- sudden and unexplained changes in behaviour (a sociable animal becomes unsociable, or vice versa)
- wild animals lose their fear of humans
- excitability
- aggression
- confusion/lack of coordination
- twitching
- seizures
- fever
- vomiting & diarrhoea
- excess salivation
- inability to swallow
Not all animals develop the aggressive, salivating, biting behaviour that is so often attributed to ‘furious rabies’. The rabies virus can also cause ‘dumb rabies’, where the following symptoms are noted:
- seeking solitude
- paralysis of jaw muscles – lower jaw droops down
- paralysis of the throat – unable to swallow
- progression of paralysis to the rest of the body
Which animals are at risk of contracting rabies?
Any domestic pets that come into contact with a wild animal known for hosting rabies are at risk of getting the disease. Pet dogs may be curious about a bat-eared fox or other wild rabies vector (host) that suddenly appears in their yard, and get bitten when they approach it. If the pet’s rabies vaccinations are not up to date, they are at risk of contracting the disease. Pets with complete rabies vet cards (their shots are up to date) may be exposed to the rabies virus, but their immune system will react with the right antibodies to fight it. However, even if your pet gets bitten by an apparently rabid animal, you must still seek veterinary treatment for them.
For unvaccinated pets or pets whose shots are not up to date, it may take three weeks (and up to 12 weeks) on average for symptoms of the rabies disease to start showing. Some cases have taken a lot less or a lot more time to manifest their symptoms; however, as soon as the clinical symptoms of rabies are evident, the disease will be fatal and the animal will either die or need to be euthanised.
The pets that are most at risk of contracting rabies are those in communities where vaccination rates are low, or vaccination facilities are not easy to access. Following the 1999 rabies outbreak in South Africa, it became mandatory for all pets to be vaccinated against rabies, and the State rolled out vaccination checks and vaccine administration to ensure their mandate could be met. Despite the obstacles to ensuring all pets received their vaccinations and boosters regularly, and the shortage of resources available to achieve their mandate, there is a commitment to ending human deaths by canine rabies in South Africa by 2030.
Stray, unvaccinated dogs pose a huge risk for the rabies virus to spread, which puts vulnerable children in harm’s way. The easiest way to prevent the spread of rabies is to ensure that all dogs that can be vaccinated, are.
What to do if you think your pet has been bitten by a rabid animal
There are no blood tests available that can test for rabies while the (suspected) infected animal is still alive. The only way to confirm a rabies case is to examine post-mortem brain matter. In the meantime, if you think your pet has been bitten by a rabid animal, alert the vet immediately. They will isolate your pet and wait to see if the clinical symptoms of rabies develop. Vaccinated dogs and cats may receive a booster, but unvaccinated pets in South Africa are not recommended to receive post-exposure prophylaxis (injections). If rabies symptoms develop, the only option for your dog or cat is to be humanely euthanised.
If the symptoms of rabies do not appear, the vet will examine your pet, offer symptomatic treatment if necessary, and provide the all-clear before they can go home.
How can pet owners prevent rabies infection?
Vaccination
It’s every pet owner’s responsibility to ensure their pets are vaccinated against rabies. The rabies vaccine schedule is as follows:
- puppies and kittens’ first vaccine: three months of age
- puppies and kittens’ second vaccine: 12 months of age
- dogs and cats’ booster vaccines: every 12 months or every 36 months, depending on the manufacturer’s label
These vaccines not only protect your pets against rabies infection, but they also protect the humans around them. Vaccinating your pets against rabies is the easiest way to prevent rabies infection. And, it will take a dedicated communal effort by all pet owners to achieve the government’s 2030 goal of no human deaths by rabies.
Keep your pets in your yard
Stray dogs are very common in urban and rural areas, and wild animals are still present in rural and farm environments. If your dog or cat is a wanderer, you have no control over which potential rabid animals they may be exposed to. If you keep your pet within the confines of your yard, and protect them by keeping them on a leash when you are out in public, you minimise their chances of having an altercation with other unknown animals and potentially exposing them and you to rabies.
Report stray animals
It can be dangerous to stop and pick up every stray animal that crosses your path, but it can also be dangerous to every stray animal if everyone turned a blind eye on them. If you are able to collect a stray and take them to your nearest vet, SPCA or welfare organisation, that could be one less rabies risk on the street (the stray could get rabies from a wild animal or another stray; and bites from unfamiliar dogs are one of the biggest threats to the child victims of rabies). If you are unable to collect the stray animal, please phone your nearest animal welfare organisation to come out and pick up the animal while you keep an eye on them or confirm their exact location.
What to do if you’ve been bitten by an animal that might have rabies
Veterinarians, vet nurses, and veterinary staff; pet rescuers; wildlife rehabilitation staff; animal inspectors and others who are on the front lines of animal care are all encouraged to get pre-exposure prophylactic injections (or vaccines) in case they are exposed to the rabies virus.
If any human is bitten by an animal suspected of having rabies, their healthcare provider needs to do a risk assessment and decide if they will need post-exposure prophylaxis (PEP). The best way to determine this is to get a confirmation (based on lab results) that the animal that bit them had rabies, which can only be done post-mortem. In the absence of lab results confirming or refuting the presence of rabies, the risk assessment is based on the abnormal behaviour of the animal that bit them, the geographical location of the bite incident, and whether the bite broke the skin – the likelihood of transmission.
Wound care and PEP include:
- thoroughly cleaning and washing the bite wound (for 15 minutes under running water, then with soap, an antiseptic, an iodine-based disinfectant, or 70% alcohol – all of which can inactivate the rabies virus)
- administration of human-rabies immunoglobin (HRIG) – ONLY for those who have not received pre-exposure vaccination
- rabies vaccine in four doses – on days 0, 3, 7 and 14 after potential/exposure to rabies
If wound care and PEP treatments are not provided, the symptoms of rabies can appear a few days after exposure to the virus. When symptoms present, it is too late for treatment and the disease will be fatal. Sometimes the virus can remain dormant for up to 12 months, but it’s always critical to get emergency medical treatment as soon as possible following a bite from a potentially rabid animal.
Conclusion
The devastating consequences of the rabies disease on animals and humans should be motivation enough to take all the necessary precautions against exposure to the virus. Getting our pets vaccinated once a year or once every three years really is the least we can do for the most effective outcome: no rabies infections, and long and healthy lives for our pets, families and communities.
