|
Rabies Infection
Rabies is nearly a uniformly fatal disease and is the most serious complication of an animal bite. The disease is caused by the transmission of a virus found in the saliva of the infected animal. The disease exists primarily in wildlife, but can be contracted in rarer circumstances from the bite of a domesticated animal. In the U.S., the rabies virus is most prevalent in the middle central states (Arkansas, Louisiana, Oklahoma, and Texas), the southern Atlantic states (New York to Florida), and the midwest (Dakotas, Minnesota, Iowa, Missouri, and Kansas). Skunks are the most commonly infected animal in the midwest, while raccoons are commonly infected in the Atlantic states. Commonly infected animals are:
1. SKUNKS
2. BATS
3. RACCOONS
4. COWS
5. DOGS
6. FOXES
7. CATS
* Rodents, squirrels, chipmunks, rats, mice, rabbits, and hares have never been implicated as carriers and their bites are not considered at risk for infection. Nationally, there were approximately 2,400 cases of ANIMAL rabies reported in 1989 with 10 cases of human rabies reported in the U.S. in the 1980's. Four out of the ten cases were from rabid dogs, with the other six cases having no obvious source of infection. Incubation period (time from bite to onset of symptoms) for rabies is 35 to 64 days on average. Initial symptoms include: fever, malaise, headache, loss of appetite, nausea, sore throat, cough, and pain, or tingling sensation at the bite site. Later symptoms include: restlessness and agitation, altered mental status, painful muscle spasms, and muscle weakness. A hypersensitivity to sensory stimuli (light, noise, and touch) is common and, also, fear of water (hydrophobia). Death usually occurs in 4-7 days. Treatment of late rabies is difficult and largely supportive.
Postexposure (after the bite) prophylaxis consists of an IMMEDIATE injection with rabies immune globulin (RIG). This will be followed by a series of 6 vaccinations with human diploid cell vaccine (HDCV) with the first dose on the day of the bite, followed by days 3, 7, 14, 28, and 90. Preexposure (before the bite) prophylaxis is indicated for those individuals at high risk for animal bite (trainers, vets, etc.). This would include HDCV in 3 injections: days 1, 8, and day 21. ALL bites from wild animals (see above) will REQUIRE rabies postexposure prophylaxis, particularly if the animal is not captured for analysis. If captured, animal sacrifice will determine the vaccinations needed to continue the full course. All bites from dogs or cats require postexposure prophylaxis, if the animal is NOT caught and the area has been reported to have had rabies (physician decision). If the animal is captured, it may be observed for "normal" behavior for 10 days and then released, if normal. If the animal can be safely released, rabies prophylaxis will not be necessary for the bite victim.
|
