Rabies

Clinical Considerations and Exposure Evaluations

Pam Wilson, Rodney E. Rohde, Earnest Oriertli, Rodney Willoughby

• Publisher: Elsevier
• Year: 2019
• ISBN:
  9780323639804
• Topic: Medicine
• Subtopic: Internal Medicine & Diagnosis

Written by leaders in medicine and veterinary medicine, this compact volume is a practical, up-to-date resource for information and recommendations on potential and actual rabies cases. Useful for medical, veterinary, and public health personnel, it helps you quickly determine the correct steps to follow regarding a possible rabies exposure, including assessing the situation, determining diagnosis and treatment options, and answering questions from patients and clients about the virus. Clear, concise explanations and illustrations ensure that you have the most up-to-date information available at your fingertips in time-sensitive situations.

• Presents real-life examples of potential rabies exposures that can be readily accessed and implemented.
• Explains how to determine if postexposure prophylaxis (PEP) is warranted, provides patient education and prevention tips, and contains case studies that show how to respond to real-life questions from patients and clients.
• Includes pertinent coverage of common myths and legends of rabies.
• Consolidates today's available information and guidance into a single, convenient resource.

Section 1

Background and Rabies Basics: Factors to Consider In Exposure Evaluations

Outline

Chapter 1. Introduction

Chapter 2. Clinical Signs and Symptoms of Rabies

Chapter 3. Rabies Epidemiology and Associated Animals

Chapter 4. Laboratory Testing

Chapter 5. Common Myths and Legends of Rabies

Chapter 1

Introduction

Pamela J. Wilson, MEd, LVT, MCHES

Abstract

Although rabies has existed since antiquity, many unknowns remain pertaining to its pathogenesis and clinical stages. Rabies is a significant disease and concern for public health worldwide; with few exceptions, this disease is fatal if rabies postexposure prophylaxis (PEP) is not administered properly. Estimations of annual cases in humans are in the tens of thousands with the majority occurring in developing countries. In the United States, there are thousands of cases in animals annually, but rabies is rare in humans, partially because of readily available medical care and PEP biologics, plus progressive animal control programs and rabies vaccination campaigns for domestic animals. This exemplifies the need for rabies awareness so exposed persons know to seek medical attention and health professionals recognize when PEP is warranted and include rabies in differential diagnoses.

Keywords

Animal control; Dogs; Human-animal bond; One Health; PEP; Postexposure prophylaxis; Rabies; Rabies vaccination; Wildlife; World Rabies Day

Perplexities of Rabies

An animal infected with this disease may show any one or all of these signs or none of them.

From Center for Disease Control (now the Centers for Disease Control and Prevention), Public Health Services, Viral Diseases Division, Bureau of Epidemiology. Clinical Rabies in Animals. Video (discontinued). ¹ https://www.cdc.gov/.

This quote is taken from a rabies educational film that has been used in classroom and training settings for decades as the video gives a concise, precise overview of the more common clinical signs of rabies in animals. The message that is relayed embodies the perplexity and elusiveness of rabies that holds true not only for its diverse clinical signs and symptoms but also for its problematic routes of exposure and varying incubation period. It is, indeed, amazing that with all the advances in science and health care, a disease that was noted in legal documents in Mesopotamia as early as 2300 BC in which owners were held responsible for deaths resulting from bites from their “mad” or “vicious” dogs and described as a disease that drives the animal mad by Aristotle in the 4th century BC ^2,3 is still, with a few exceptions, fatal by the time clinical signs and symptoms develop. If rabies postexposure prophylaxis (PEP) is administered before the virus enters the nervous system and prior to the onset of clinical features, the disease can be prevented, ⁴ but this mode of prevention requires that the person exposed to the virus knows to seek medical attention and the attending physician knows to prescribe the proper rabies biologics. Throughout this length of history, Pasteur’s development of an effective rabies vaccine in the 1880s was a landmark advancement in preventing rabies ^3,5 and made rabies one of the frontrunners among vaccine-preventable diseases. ⁶ However, elements of the pathogenesis and core etiology of rabies, as well as a reliably effective cure, remain an enigma after centuries of awareness of this disease and how it manifests (see Fig. 1.1).

Needs of Health Professionals

Pertaining to salve applied to a bite wound of a potentially rabid dog, remove it and feed it to a hen.

If the bird eats it and does not die, the victim was not bitten by a rabid dog.

Oribasius (AD 325–399). ⁷

Antiquated practices such as this might have been limited in the catacombs of history, but PEP recommendations are much more complex. (Note: for up-to-date testing techniques, refer to Chapter 4; don’t use the “feeding salve to a hen” approach.) While dealing with multiple clients on a daily basis or an endless stream of emergencies, most health professionals for both humans and animals do not have time to read extensive history, research descriptions, and experimental designs to locate the basic information they require to effectively evaluate a potential rabies exposure to determine if administration of PEP is warranted. The intent of this book is to aid them in the goal of quickly accessing this information, which includes common modes of transmission, fundamental pathogenesis, clinical signs and symptoms, and modes of prevention. Critical concerns specific to possible exposure to rabid bats and details on potential exposure scenarios are also outlined.

When conducting a literature search on rabies, one can develop an appreciation for the frustration a health professional might experience when trying to find basic information to address a case involving a potential exposure to rabies. On many of the disease topics, such as the incubation period, disease stages, and clinical signs and symptoms, volumes may have to be read on studies with varying, sometimes opposing, outcomes with the potential result of still lacking clarity on the topic or a concrete answer to an issue in question. Such is the elusive nature of this disease as there sometimes are no clear resolves or concrete answers. Thus, these observations should not be construed as criticisms, as that is not the intent, but rather as rabies realities. Even within the confines of this book, research had to be...