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What is Rabies?

Rabies is a zoonotic disease (a disease that is transmitted to humans from animals) that is caused by a virus called rhabdovirus that causes acute encephalitis (inflammation of the brain) in endotherms. Rabies virus, a rhabdovirus present in infected animal’s saliva is inoculated into the bite wound. This disease infects domestic and wild animals, and is spread to people through close contact with infected saliva via bites or scratches. For a human, rabies is almost invariably fatal if post exposure prophylaxis is not administered prior to the onset of severe symptoms. The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. Once the rabies virus reaches the central nervous system and symptoms begin to show, the infection is effectively untreatable and usually fatal within days. Once symptoms of the disease develop, rabies is nearly always fatal.

Who are at a high risk of Rabies?

Dog rabies potentially threatens over 3.3 billion people in Asia and Africa. People most at risk live in rural areas where human vaccines and immunoglobulin are not readily available or accessible. Poor people are at a higher risk.

What is the presence of Rabies?

Rabies occurs in more than 150 countries and territories. Worldwide, more than 55 000 people die of rabies every year. More than 95% of human deaths occur in Asia and Africa. Once symptoms of the disease develop, rabies is nearly always fatal. 40% of people who are bitten by suspect rabid animals are children under 15 years of age. Dogs are the source of 99% of human rabies deaths.

Wound cleansing and immunization within a few hours after contact with a suspect rabid animal can prevent the onset of rabies and death. Every year, more than 15 million people worldwide receive a post-exposure preventive regimen to avert the disease – this is estimated to prevent 327 000 rabies deaths annually. Rabies is present on all most all continents, but more than 95% of human deaths occur in Asia and Africa. More than 99% of all human deaths from rabies occur in the developing world. Once symptoms of the disease develop, rabies is nearly always fatal.

What are the symptoms of Rabies?

The incubation period for rabies is typically 1-3 months. This however could vary from 1 week to a year. Initial symptoms of rabies are usually nonspecific and suggest presence of fever and often pain or unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site. As the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops. Two forms of the disease can follow:

Furious rabies, during which people infected by the virus exhibit signs of hyperactivity, excited behavior, hydrophobia and sometimes aerophobia. After a few days, death occurs by cardio-respiratory arrest. Paralytic rabies accounts for about 30% of the total number of human cases. This form of rabies runs a less dramatic and usually longer course than the furious form. The muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the underreporting of the disease.

What is the First aid for Rabies?

Removing the rabies virus at the site of the infection by chemical or physical means is an effective means of protection. Therefore, prompt local treatment of all bite wounds and scratches that may be contaminated with rabies virus is important.

Recommended first-aid procedures include immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.

What is ARS and how is it used in treatment of Rabies?

There is a Vaccine and also Anti Rabies Serum (ARS) for the Rabies disease. But, Anti Rabies Vaccine alone may not save lives. W.H.O recommends ARS (Anti Rabies Serum) with ARV (Anti Rabies Vaccine) in all category III & immune-compromised category II patients. Anti Rabies Serum is a prepared from Human origin and Equine origin.

Equine Rabies Immunoglobulin (ERIG) is obtained from the blood plasma of healthy equines that have been immunized against rabies by vaccination.

Benefits of ERIG:

  • Cheaper and safe (purified pepsin digested horse serum) equine immunoglobulin (ERIG) is availablePurification techniques can be used to reduce the risk of sensitization to ERIG.
  • The objective is to maximize the specific activity and to minimize the allergenic substances in the product.

*Effective treatment of Rabies is critically dependent on the availability of good-quality antisera-W.H.O-2007

What needs to be done?

Like snakebite, dog bite is also a tropically neglected condition which requires more attention to improve the needful things. The solution to the lack of effective and safe antivenoms on a global basis demands the financial support of governments, non-governmental organizations and other international agencies. Without adequate financial support it will not be possible to pursue the objectives described in this plan of action. A concerted international effort, led by W.H.O will guarantee full international exposure of this problem thereby attracting the attention of agencies devoted to solutions for health problems in the developing world. Such a concerted international effort, involving producers, regulators, researchers, national and regional health authorities, international agencies and the community organizations, under the coordination of W.H.O can be expected to result in:Increased availability of safe and effective animal-derived antisera;

  • Enhanced technical capacity of regulatory agencies and manufacturers;
  • Guaranteed production of safe and effective antisera
  • Improved clinical management of rabid bites and envenomingsOptimal clinical use of antisera
  • Improved health programmes in the affected countries.