Rabies infection around the world by Ray Sahelian, M.D.
February 10 2016

 

Rabies is a disease of the central nervous system caused by a virus. It is one of the oldest and most feared diseases reported in medical literature. Incidence of rabies is widespread throughout the world. Human rabies cases have been documented on all continents except Australia and the Antarctic. Many cases are unreported in third world countries. Since control of canine rabies in the 1940s and 1950s, human rabies in the United States has become quite rare.

 

Rabies, an acute progressive, fatal encephalomyelitis, transmitted most commonly through the bite of a rabid animal, is responsible for an estimated 61,000 human deaths worldwide.

 

Prevention
Rabies is a dangerous disease that can be transmitted to animals and people alike via the bite of an infected animal. To help prevent spreading the disease:
Make sure pets are under your control. If possible, keep dogs, cats, ferrets and other pets indoors.
If you spot a stray animal in your neighborhood, call animal control.
Spay or neuter your pet to help reduce the unwanted pet population.

 

Treatment and risk
After someone is exposed to rabies, they have to be treated quickly with anti-rabies serum, or immune globulin - a scarce commodity. Anti-rabies immune globulin is derived from the blood of horses or people who have been infected with the rabies virus, producing antibodies that can be used to neutralize rabies in newly infected people. Experiments in hamsters show that a combination of two monoclonal antibodies or MAbs, which can be produced consistently and in relatively large quantities, may be as effective and safe as anti-rabies immune globulin for post-exposure prevention.

 

J Pediatr Hematol Oncol. 2015. A Case of Immune Thrombocytopenic Purpura After Rabies Vaccination. We describe a case of immune thrombocytopenic purpura (ITP) occurring 15 days after the first dose of a 4-dose rabies vaccination series. ITP is thought to be an immune-mediated process triggered by an infection or toxin. There is little evidence in the literature beyond case reports of an association of ITP with vaccines other than with the measles, mumps, and rubella vaccine. This is the third reported case of ITP associated with rabies vaccination. Because of the rare occurrence of this adverse event relative to the severity of rabies infection, the benefits of rabies vaccination, when indicated, outweigh the low and possible risk of ITP.

 

Rabies in China
China's booming southern province of Guangdong has reported more than 300 deaths from rabies in 2005, the highest number in a decade, as its increasingly affluent population buys more dogs. Pet dogs were shunned in the days of Mao Zedong as a symbol of bourgeois decadence and dog is still a popular restaurant dish. But pets have become increasingly popular in the last decade with improved living standards. Last year, 330,000 people sought treatment for rabies in Guangdong, which borders Hong Kong, and 500,000 were vaccinated. There were 1.5 million reported dog bites or scratches. Some 2,660 people died of rabies in China in 2004, according to Ministry of Health figures.

 

Rabies in India

India reports at least 20,500 deaths from rabies every year out of 50,000 fatalities globally, WHO data shows. But experts say many deaths go unreported. Poor people cannot afford to buy rabies vaccines, which cost around 1,500 rupees ($32) for a full course from private hospitals and chemists.

 

Rabies in the United States
Although there has been a reduction of rabies in pets and domestic animals during recent decades in the United States, rabies remains enzootic among bats and several species of terrestrial wildlife. Spillover transmission of wildlife rabies to domestic animals therefore remains a public health threat  While the majority of reported potential rabies exposures are associated with dog and cat incidents, most rabies exposures derive from rabid wildlife. Stray cats are frequently rabid among domestic animals.

 

Emails and questions
Q.
Back in March, 2015 my father was bitten by a wild dog and had to have the rabies vaccines. Each time it was given he had a reaction and by the third round, he was in the hospital. His whole body shook/seizure like activity and was unable to walk. In less than a weeksí time he had coded twice and the doctors ran every test known to try and figure it out. We ended up in Houston Methodist Hospital where he was admitted into the neuro icu. The neurologist said that he was not having epileptic seizures and we were eventually sent home with no answers. He is currently seeing a local neurologist and also my naturalist doctor. Heís receiving chelation treatments from the naturalist dr and the neurologist is treating him for Parkinsonís and the meds arenít working. He had no symptoms of Parkinsonís before the rabies vaccine. Have you ever heard of this happening before?
   A. I am not an expert on this topic but here is some info I found.

 

Med Pregl. 2004. Fatal outcome after postexposure rabies vaccination in a patient with Parkinson's disease. n Serbia and Montenegro postexposure rabies vaccination is performed using five doses of rabies vaccine with a potency of 2.5 I.U. It is given on 0, 3rd, 7th, 14th and 28th day, combined with human rabies immunoglobulin with the first dose. Modern rabies vaccines produced in cell cultures rarely cause neurologic complications, among which Guillain-Barre syndrome and parkinsonism. The authors report a case of a 78-year-old woman with a documented five-year history of Parkinson's disease, who was bitten by a rabid cat. Twelve hours later, when the rabies infection of the cat was confirmed by an immunofluorescence test, the patient received the first dose of rabies vaccine Verorab (Aventis), a cell culture vaccine, together with the human rabies immunoglobulin produced in Belgrade. After the third dose of rabies vaccine, the symptoms of Parkinson's disease progressed and vaccination was interrupted. However, one month later, the patient died with predominantly neurological symptoms. As the patient died at the time when incubation of rabies might have been expected, autopsy and rabies diagnostics were performed. The autopsy and pathohistologic findings from the specimens treated with routine hematoxylin and eosin staining, together with immunofluorescence test, excluded rabies as a cause of death and revealed neurodegenerative changes typical for Parkinson's disease. Using two different fluorescent rabies antibodies, we performed a direct immunofluorescence antibody tests, but no rabies antigens were detected. However, in histologic slides of the brain stem, large intracytoplasmic inclusions were found in some neurons, identified as Lewy bodies characteristic for Parkinson's disease. Parkinson's disease, with its complications, was the cause of death of the patient bitten by a rabid cat. Furthermore, the coincidence of the progression of Parkinson's disease symptoms, at the time of postexposure rabies vaccination, points to the vaccine as a possible contributing factor to aggravation of the disease and lethal outcome.