Review of Rabies Preventions and Control
Review of Rabies Preventions and Control
Review of Rabies Preventions and Control
Corresponding Author:
Nejash Abdela,
Jimma University, College of Agriculture and Veterinary Medicine,
School of Veterinary Medicine,
Jimma, Ethiopia.
Email: nejash.abdela@gmail.com
1. INTRODUCTION
Rabies is a viral disease that affects the central nervous system of warm-blooded animals, including
humans [1],[2] and it is a zoonotic viral disease that produces almost invariably fatal encephalitis in humans
and most other mammals [3]. The disease is characterized by the development of severe nervous symptoms
that lead to paralysis and death [4]. Once symptoms of the disease develop, it is invariably fatal and deadly
viral disease that can only be prevented but not cured [5]. Dogs remain the primary reservoir in developing
countries, whereas wildlife species serve as hosts in developed nations [6].
Rabies is widely distributed throughout the world with the exception of Australia, New Zealand,
Japan, a number of European countries and some Caribbean Islands. Wild animals serve as a large and
mainly uncontrollable reservoir of sylvatic rabies, which is an increasing threat to the human population and
to domestic animals in many countries [1]. Rabies is an acute viral infection of the central nervous system,
caused by a lyssavirus in the family Rhabdoviridae [4],[7].
The name Rhabdo comes from the Greek and identifies the characteristic bullet or rod-shape of the
viruses [1]. It affects all mammals, including humans, cats, dogs, wild life and farm animals. In animals,
three forms are classically described; prodromal, excitement (furious) and paralytic (dumb). The virus is
present in the saliva of affected animals, and the most frequent method of transmission to humans is by bites,
scratches or licks to broken skin or mucous membranes [8]. The virus is spread through infected saliva in
bites, scratches and through licks from infected animals in open wounds or on mucosal membranes
[7],[9],[10].
Rabies infection in humans is still a major public health Problem all over the world [11]. Rabies
kills an estimated 35,000 per year, mostly in Africa, Asia and Latin America [6]. The World Health
Organization (WHO) considers rabies to be a neglected disease and declare it to be primarily a problem in
areas troubled with poverty and with a lack of economic resources [12]. With over 55 000 human deaths a
year [7] and signs of it re-emerging [9]. The domestic dog is the most important vector of human exposure
[13]. It is possible to prevent a person exposed to the virus from getting ill to rabies by neutralizing virus with
antibodies before the virus invades the nervous tissue. This is done through vaccination and/or use of
immunoglobulins, so called post-exposure prophylaxis (PEP) [7],[14]. Public awareness and an increase of
knowledge about rabies disease, first aid measures after dog bites, increased knowledge about dog behavior
and how to avoid getting bitten by dogs are suggested methods to prevent rabies in humans [7],[9]. Therefore
the main objective of this paper is to review the current information available for prevention and control of
rabies.
2. LITERATURE REVIEW
2.1. Etiology
The causative agent of rabies is a member of the Lyssavirus genus of the Rhabdoviridae family of
bullet-shaped viruses, which have a single-stranded RNA genome [1],[7]. The genus includes the classical
rabies virus (genotype 1) and six so-called rabies-related viruses, Lagos bat virus (genotype 2), Mokola virus
(genotype 3), Duvenhage virus (genotype 4), European bat lyssaviruses 1 and 2 (genotypes 5 and 6), and the
recently discovered Australian bat genotype 7 [15]. The genus Lyssa virus comprises rabies virus and closely
related viruses, including Mokola virus, Lagos bat virus and Duvenhage virus from Africa, European bat
virus 1 and 2 and Australian bat Lyssavirus. Each of these viruses is considered capable of causing rabies like
disease in animals and humans [1]. Rabies virus can be inactivated by sodium hypochlorite, 45-75% ethanol,
iodine preparations, quaternary ammonium compounds, formaldehyde, phenol, ether, trypsin, β-
propiolactone, and some other detergents. It is also inactivated by a very low pH (below 3) or very high pH
(greater than 11). This virus is susceptible to ultraviolet radiation. It is rapidly inactivated by sunlight and
drying, and (in dried blood and secretions) it does not survive for long periods in the environment [16].
2.2. Epidemiology
2.2.1. geographic distribution
With some exceptions (particularly islands), rabies virus is found worldwide. Some countries such
as the United Kingdom, Ireland, Sweden, Norway, Iceland, Japan, Australia, New Zealand, Singapore, most
of Malaysia, Papua New Guinea, the Pacific Islands and some Indonesian islands have been free of this
virus for many years [17]. Rabies is a serious disease threat to humans, domestic animals, and wildlife.
Worldwide rabies kills about 50,000 – 100,000 people/year and countless domestic and wild animals [18].
In Europe the red fox is the most important reservoir host and vector of rabies. An increase in incidence of
rabies in foxes result in an increase in incidence of rabies in domestic animals such as cattle, sheep, horse,
cat, dog and others.
Sylvatic and urban rabies cycles occur concurrently in some regions, while the sylvatic cycle
predominates in others. For example, wild animals accounted for more than 90% of the animal rabies cases
reported in the U.S. and Canada in 2010. Rabies can be a serious concern in some rare or endangered
species. In Africa, the Ethiopian wolf (Canis simensis) and African wild dogs (Lycaon pictus) are
threatened by this virus. Although cases of rabies tend to be sporadic, epizootics are possible [16].
2.2.3. Transmission
A rabies exposure is any bite, scratch, or other situation in which saliva, cerebral spinal fluid, tears,
or nervous tissue from a suspect or known rabid animal or person enters an open wound, is transplanted into,
or comes in contact with mucous membranes of another animal or person. On rare occasions human rabies
has been acquired by inhalation of airborne virus in laboratories working with live rabies virus and in caves
with millions of bats. The common mode of transmission of rabies in man is by bite of a rabid animal or the
contamination of scratch wounds by virus infected saliva [19].
2.3. Pathogenesis
Rabies virus enters the body through wounds or by direct contact with mucosal surfaces. It cannot
cross intact skin. Rabies virus replicates in the bitten muscle (local viral proliferation in non-neural tissue)
and gains access (viral attachment) to motor endplates and motor axons to reach the central nervous system
[20]. Virions are carried in transport vesicles [21] and travel to the central nervous system (CNS) exclusively
by fast retrograde transport along motor axons, with no uptake by sensory or sympathetic endings [22].
Following centrifugal transport along efferent cranial nerves, the salivary glands become infected
and virus particles are shed in the saliva. Infection of the brain commonly leads to behavioural changes that
induce the host to bite other animals, thereby transmitting the virus. The widespread central nervous system
infection almost inevitably leads to death, usually through respiratory paralysis, but also through secondary
circulatory, metabolic or infectious processes [23],[24].
Viruses can also enter motor axons in peripheral nerves directly during a penetrating injury. The
incubation period varies from 5 days to several years (usually 2–3 months; rarely more than 1 year),
depending on the amount of virus in the inoculum, the density of motor endplates at the wound site and the
proximity of virus entry to the central nervous system [25].
The incubation period is less than 50 days if the patient is bitten on the head or neck or if a heavy
inoculum is transferred through multiple bites, deep wounds, or large wounds. A person with a scratch on the
hand may take longer to develop symptoms of rabies than a person who receives a bite to the head. In dogs
and cats, the incubation period is 10 days to 6 months; most cases become apparent between 2 weeks and 3
months. In cattle, an incubation period from 25 days to more than 5 months has been reported in vampire bat-
transmitted rabies. In humans, the incubation period can be a few days to several years. Most cases become
apparent after 1-3 months [17].
2.5. Diagnosis
Laboratory diagnosis of rabies in humans and animals is essential for timely post-exposure
prophylaxis. Rabies diagnosis may be carried out either in vivo or postmortem [27]. Infection with rabies
virus can be difficult to diagnose ante-mortem. Although hydrophobia is highly suggestive, no clinical signs
of disease are pathognomonic for rabies. Historical reliance on the detection of accumulations of Negri-
bodies is no longer regarded as suitable for diagnostic assessment because of low sensitivity and alternative
laboratory-based tests based have been developed to conclusively confirm infection [4].
Most diagnostic tests for rabies virus in animals need brain material for diagnosis and as such are
often only possible post mortem [28]. The diagnosis of rabies in animals can be made by taking any part from
the affected brain. But in order to rule out rabies, the test must include tissues from at least two locations in
brain, from the brain stem and cerebellum. There are many diagnosis methods for detection of rabies in
animals like (Table 1); direct florescent antibody, mouse inoculation technique, tissue culture infection
technique, and polymerase chain reaction [29]. Brain samples are most readily taken by breaching the skull
and sampling directly. Brain smears or touch impressions are used for the meni detection of virus antigen
with the fluorescent antibodytest (FAT) for both human and animal samples. In animals the direct fluorescent
antibody test (dFAT) is the recommended diagnostic test. This test detects the presence of rabies antigens in
brain tissue. Other diagnostic techniques include reverse transcription polymerase chain reaction (RT-PCR),
direct rapid neur immunohistochemistry test (dRIT) and serological tests (Fluorescent antibody neutralization
test, rapid pres fluorescent focus inhibition test). In humans, the rabies recommended test is dFAT on brain
tissue. Other diagnostic tests that have been used are RT-PCR and dRIT [4].
Clinical diagnosis of rabies divided upon three stages in human; prodromal, excitement (furious) and
paralytic (dumb). But all these stages cannot be observed in an individual. The very first clinical symptom is
neuropathic pain at the site of infection or wound due to viral replication. Following by the prodromal phase
either or both the excitement or paralytic forms of the disease may be observed in the particular species. It is
also documented that cats are more likely to develop furious rabies than dogs [29]. In some cases, no signs
are observed and rabies virus has been identified as the case of sudden death [30]. Diagnosis can only be
confirmed by laboratory tests preferably conducted post mortem on central nervous system tissue removed
from cranium [31].
Rabies must be considered in the differential diagnosis of any suspected mammalian meningitis/
encephalitis, distemper, infectious canine hepatitis and cerebral cysticercosis (Taenia solium) in dogs,
sporadic bovine encephalomyelitis (Chlamydia psittaci), heartwater in cattle and sheep. Other conditions like
mineral/ pesticide poisoning and Plant poisoning from Pennisetum clandestinum (kikuyu grass) in cattle,
Cynanchum spp (monkey rope) in sheep should be considered [23].
education on the risks of rabies transmission from wild animals is paramount to effective disease prevention.
Immunization of wildlife by widespread distribution of vaccine-impregnated oral baits has shown variable
success toward arresting the propagation of rabies in raccoons and coyotes in other states. The use of oral
rabies vaccines (ORV) for the mass vaccination of free-ranging wildlife should be considered in selected
situations [32].
ACKNOWLEDGEMENTS
Above of all we would like to thanks almighty God for guiding us in every day of our life in every
direction. Next we would like to acknowledge Jimma University College of Agriculture and Veterinary
Medicine, and school of veterinary medicine for their facility support and internet access.
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