Modern medicine: Man bites dog!

Medical condition in the news this year is rabies. Mind you, rabies has been around for a lot longer than this year, but it has been reported that the number of infected cats and dogs has doubled year on year. (How they managed to count them I have no idea, but they probably counted the legs and divided by four!)

However, being serious as this is a serious problem, rabies is a deadly virus spread to people from the saliva of infected animals. The rabies virus is usually transmitted through a bite. Animals most likely to transmit rabies include the most visible animal and that is the dog (and Thailand has a rather large number of soi dogs) but other animals that may carry the virus include cats, bats, coyotes, foxes, raccoons and skunks, most of which we do not have – but soi dogs we do have by the thousands, with the World Health Organization (WHO) stating that dog transmission is around 99 percent of the total, so the moggy can stay and forget about the bat cave.

Some of the oldest texts that are linked to rabies come from 2300 BC where in Eshunna, a Babylonian city, it was known for heavily fining people whose dogs bit others leading to their death. With the asking person dead, I am not sure who got the fine money!

In 400 BC, Aristotle wrote that “dogs suffer from the madness,” but it was the Romans who first described the saliva from rabid dogs as ‘virus’ which is Latin for poison. Many physicians in history have since then described the symptoms of rabies and also came up with “cures” and temporary ailments for the sick.

The first case of rabies reported in the Americas was in Mexico by a priest in 1703, and the disease swept the entire world over the next few centuries.
In 1804 Zinke, a German scientist began conducting experiments using infected saliva on various animals, confirming that the disease is transmitted from other infected animals.

The key turning point in history for rabies comes in the 1880’s when Louis Pasteur, a chemist, and his assistant, scientist, and physician, Emile Roux began research for a cure to rabies. By 1883, the two had created was to be the first vaccine against the disease, but the real test to prove to the public that it works came in 1885 when a nine year old Joseph Meister is begged by a rabid dog and brought to Pasteur who puts his career on the line by testing the new vaccine for the first time. The vaccine was a success and young Joseph Meister became the first person to be successfully treated for the disease. Pasteur was given immediate praise and hailed as a hero. This new vaccine is still used to this day and is still the standard treatment of rabies. The vaccine also works on animals such as dogs, leading to many vaccination campaigns directed toward pet owners to prevent the spread of disease.

Pre-exposure immunization is recommended for travelers to rabies-affected, remote areas who plan to spend a lot of time outdoors. Expats and long-term travelers to areas with a high rabies exposure risk should also be immunized.

In unvaccinated humans, rabies is almost always fatal after neurological symptoms have developed. Vaccination after exposure, PEP (post Exposure Prophylaxis), is however, highly successful in preventing the disease if administered promptly, in general within 6 days of infection. Begun with little or no delay, PEP is 100 percent effective against rabies, and yes, I have been asking and had to go through a course of PEP.

The symptoms in humans include fever, headache, nausea, vomiting, agitation, anxiety, confusion, hyperactivity, difficulty swallowing, excessive salivation, fear of water (hydrophobia) because of the difficulty in swallowing, hallucinations, insomnia, partial paralysis, finally coma and death.

The WHO and the Bill & Melinda Gates Foundation project recently showed that a reduction in human rabies cases is possible through a combination of interventions involving mass dog vaccination, improved access to PEP, increased surveillance and raising public awareness.

So, gentle reader, the rest is up to you, now you are aware as well.

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