The risk of rabies in South Africa is particularly high. It is endemic in our country.
Rabies is the deadliest disease on earth. It’s fatality rate is 99.9%, with more than 95% of deaths occuring in Africa, the Middle East and Asia.
Dogs, and not farm animals as we like to believe, pose the greatest risk of rabies transmission yet there are still pet owners who neglect to vaccinate their pets.
Rabies is found on every continent except Antarctica. It has the highest case-fatality rate of any infectious disease known to man, because there is no proven cure or treatment available once there are signs of an infection. However, if proper medical treatment (post-exposure prophylaxis, PEP) is received immediately after exposure to the bite or scratch of a rabid animal, rabies infection can be halted before symptoms of the disease are present, and the disease can be prevented.
What is rabies?
Rabies is a viral disease that is transmitted through the saliva or nervous system tissues of an infected mammal to another mammal. The rabies virus infects the central nervous system and causes severely distressing neurological symptoms, disease in the brain, and, ultimately, death.
Rabies is a zoonotic disease, which means that it can pass from other animals to humans.
Unfortunately, by the time a patient has clinical symptoms of rabies there is very little that can be done except palliative care. Medical teams can use sedation and tranquilisers to prevent the patient suffering from the distressing symptoms, but no cure exists.
Who is at risk of rabies?
Worldwide, the main reservoir of the rabies virus is the dog. Rabies can also be present in different wildlife species, such as raccoons, skunks, mongooses, jackals, foxes and bats. The animals that can act as reservoirs of rabies infections vary across countries, but because of the less common contact between humans and wildlife, transmission to people is most commonly from dogs.
Cats are not natural reservoirs of the virus, but they can become readily infected by rabies and can transmit the disease. Any mammal can theoretically be infected with rabies and can therefore transmit the disease to humans if exposure occurs.
Small rodents are not reservoirs of rabies so a bite from a squirrel, rat, mouse, guinea pig, hamster, rabbit, chipmunk or gerbil generally does not usually require post exposure prophylaxis.
Bats can be infected with rabies, and bats that are behaving abnormally (e.g. venturing out during the daytime, crawling on the ground, flying aggressively into a human, or trapped in a room) have a high chance of being rabid.
In general, any unprovoked mammal that bites a person could be rabid, and PEP should be considered for the bite victim, based upon medical advice and laboratory test results. When the animal is not available for testing, medical advice should be sought regarding the need for rabies vaccination.
How else am I at risk?
• Bites and or contact with saliva from a person infected with rabies during the symptomatic stage of the disease could theoretically transmit rabies, and people who have been exposed to rabies patients should be offered post- exposure prophylaxis. Documented cases of rabies known to be caused by human-to-human transmission have occurred among recipients of transplanted corneas and other solid organs, when rabies infection in the donor was not suspected.
• Casual contact with a person infected with symptomatic rabies (touching unbroken skin or contact with non-infectious tissues or bodily fluids) cannot transmit the rabies virus to another person.
• Puncture wounds due to needle sticks penetrating neural tissue during the care of a rabies patient does constitute an exposure to rabies and requires treatment. It may be possible to transmit the virus from a symptomatic rabies patient through mouth-to-mouth contact or kissing.
• The virus has been reported to be present in sperm or vaginal secretions, so transmission through sexual intercourse with an infected person may be possible. Oral sex with a person infected with the rabies virus may also carry a risk.
• If you have risky contact with an infectious person 14 days prior to the onset of clinical symptoms, post-exposure prophylaxis is recommended. Risky behaviors include: bites, kisses or other direct contact between saliva and mucous membranes or broken skin, sexual activity, and sharing eating or drinking utensils or cigarettes.
• No case of human rabies resulting from consumption of raw meat from a rabid animal has been documented. Consumption of meat or milk from a rabid animal is strongly discouraged and should be avoided, but is not considered an exposure. However, there have been documented cases of rabies transmission in butchers who were cutting meat from a rabid animal. This occurred when virus entered the body through breaks in the skin whilst butchering. Preparation of meat from domestic animals or wildlife killed by hunters is considered a high risk activity for rabies transmission. In some countries there are guidelines that prohibit the slaughtering of animals that have been known to be exposed to rabies in the recent past.
In general, any mammal that bites you without being provoked should be tested for rabies. Rabies prophylaxis is then offered based upon the laboratory test results.
If testing the animal is not possible, see a doctor or local medical practitioner to discuss whether you need rabies post-exposure prophylaxis.
Symptoms to look out for
Immediately after transmission of the virus (e.g. through a bite), there are no symptoms. The virus then travels through the nervous system, again without causing any symptoms, until it reaches the brain. Once in the brain (usually 1-3 months after the bite) the virus causes a variety of non-specific problems: general malaise, fatigue, headache and general weakness or discomfort. There may also be discomfort or a prickling or itching sensation at the site of bite. As the brain infection progresses, more specific symptoms are apparent and include: insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water). Eventually the patient falls into a coma and dies.
What should I do if my dog is bitten?
If you suspect that your pet has been bitten by an animal that is rabid or potentially rabid, you should take it to a veterinarian immediately. If your pet is up-to-date on his rabies vaccinations, then a booster should be administered immediately and your pet should be observed for a period of time, according to local legal requirements.
Your veterinarian should report the biting incident to the local health department so that the potential rabies case can be monitored. The animal that bit your pet should be identified to the local animal control office, and if it is still at large, animal control can capture and submit it for diagnostic testing. If rabies is not present in the tissues of the biting animal, the exposed pet that is up-to-date with its vaccinations is not at risk for rabies. If there is no way to confirm whether the biting animal was rabid, then veterinary experts usually assume exposure to rabies, and the bitten pet should receive a booster shot and be observed for a period of time.
If the biting animal was rabid, and your pet was not up-to-date with their rabies booster or was not vaccinated at all, then the local public health officer may recommend that the pet be immediately euthanased. Pets, with up to date rabies vaccination that have been exposed to a wild animal should be given a booster shot and observed for a period of time.
If you are bitten by a suspected rabid animal… apply first aid, then immediately seek medical advice.
- Wash the wound thoroughly with soap and water for at least 15 minutes.
- Apply ethanol or a similar antiseptic to prevent secondary infection.
- Seek urgent medical attention. You need to start post-exposure prophylaxis as soon as possible.
If you have already had pre-exposure prophylaxis, you still need further treatment.
Modern vaccines are the only way to prevent the onset of rabies after exposure. Traditional remedies, such as jackfruit gum and chilli powder do not stop the rabies virus.
Please treat any potential exposure to rabies seriously. Once clinical symptoms appear, death is almost inevitable.
Rabies vaccines are inactivated and should be safe to use in both pregnant and nursing dogs, and the risk would be further reduced if they have been previously vaccinated.
How do I know if my dog has rabies?
Often you can’t tell by looking.
An animal with rabies may stagger or stumble and display unprovoked aggressive behaviour or be over-friendly. Animals with advanced rabies may also foam at the mouth. This is because the rabies virus affects the salivary glands causing hyper-salivation. They may also develop hydrophobia (fear of water).
None of these symptoms are definitive signs that an animal has rabies, and rabid animals may or may not exhibit these signs.
If an animal shows any of these signs, you should contain it to prevent possible exposure either to you, your family, or another animal, and contact your veterinarian or animal health department.
To confirm an infection, the animal must be euthanased and a brain tissue sample tested in a reputable laboratory.
Vaccination is your best protection
Pet owners in South Africa are required by law to vaccinate their pets against rabies.
Pet owners should vaccinate their puppies at 12 weeks of age and again at one year, and then according to your veterinarian’s recommendations.
Additionally, spaying or neutering your pet will help to reduce the number of potential strays that are not vaccinated against rabies.
Keeping your pet on a leash when outdoors prevents inadvertent exposure to a rabid wild animal.