Rabies
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Rabies

Rabies is a dangerous illness as it is fatal but can be prevented by vaccination. Rabies is caused by the rabies virus. It is an acute viral disease of the central nervous system. All rabies cases in Malta are imported.



Incubation period
Variable, usually 2 - 8 weeks, rarely as short as 5 days to as long as 7 years.


Reservoir
It is primarily a disease of animals, particularly wild and domestic canine species, cats, skunks, raccoons, mongooses, monkeys, bats and other biting mammals. Persons who travel abroad, especially where rabies is present and have been scratched or bitten by animals should seek health advice immediately. Rabies is not transmitted from person to person ( except through corneal transplant - this does not apply for Malta). People who have been exposed closely to the secretions of a patient with rabies are offered the vacciantion purely as a precaution.


Signs and Symptoms
  • Anorexia
  • Anxiety
  • Encephalitis
  • Fever
  • Headache
  • Malaise
  • Nausea
  • Spasms of the swallowing muscles
  • Respiratory failure (late stages)
  • Vomiting


Diagnosis

  • Detection by direct fluorescent antibody of virus by staining brain tissue
  • Isolation in cell culture of virus from saliva, CSF or CNS tissues.
  • Identification of rabies-neutralising antibody titre>1:5 in serum or CSF of unvaccianted persons.


Treatment
Checklist for treatment of animal bites:

  • Clean and flush the would immediately (first aid).
  • Thorough wound cleansing under medical supervision
  • Rabies immune globulin and/or vaccine as indicated
  • Tetanus prophylaxis and antibacterial treatment when required
  • No sutures or wound closure advised unless unavoidable

Patient should be isolated during the illness since be be infective from respiratory secretion and saliva. While taking care of patient one has to take contact precautions including gloves, gown and mask. 

Intensive supportive therapy will be required.

Control and Prevention

  • Travellers should not ignore animal bites especially in endemic countries. Wounds should be immediately washed and cleaned with soap or detergent and water. If possible, the wound should not be sutured. Seek expert medical advice.
  • Followign a bite or scratch, people who have an open wound or mucous membranes that have been contaminated with saliva or other potentially infectious matieral (brain tissue) from a rabid animal, rabies immunoglobulin and vaccine should be given
  • Prophylactic vaccination is offered to high risk groups.Domestic dogs and cats of endemic areas should be vaccinated.

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