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Rabies Facts
Thanks to public health efforts, few Americans die each year from rabies. However, in some areas of the U.S. this disease is still endemic in wild animals. By Rear Adm. Joyce Johnson, D.O.
In the U.S. in the early 1900s, more than 100 people died each year from rabies. Today, with animal control and vaccination programs as well as effective post-exposure prophylaxis for humans (vaccine and immune globulin), usually only two or three people die from rabies each year in the U.S. The largest threat of rabies in the U.S. today is from wild animals — raccoons, skunks, foxes, and bats. Residents of urban areas also are at risk; recently, a rabid fox was found in the Washington, D.C., metropolitan area.
Worldwide, human rabies is still endemic in some areas. Though estimates are difficult, more than 50,000 people likely die from rabies each year, most from stray dog bites. To reduce animal rabies, an oral vaccine can be placed in traps; stray dogs that eat the bait are vaccinated. A similar approach can be used for some wild animals. Pet dogs and cats should be protected with regular vaccinations (administered every one to three years, depending on the vaccine).
Rabies is transmitted through saliva and found in brain and nervous system tissue. When a person is infected, typically through a bite, the virus infects the nerves and travels to the brain, where it causes encephalitis. The incubation period (from the time of a bite to the appearance of symptoms) is usually a couple of months, but it can vary from a week to a year, depending on the extent of the bite. Once symptoms appear, death follows within a week or two.
Rabies in humans is preventable if bites are treated early. If you or someone you know is bitten, immediately wash the bite area thoroughly, for at least 15 minutes, with soap and water or a diluted povidone-iodine solution to remove as much of the animal’s saliva (and thus the potential viral infection) as possible. Immediately contact your health care provider and describe the type of animal, situation, and extent of the bite. The prevalence of rabies in your geographic area will be a factor in the treatment plan.
If your health care provider — often in consultation with the local health department — determines there is a risk of rabies transmission, post-exposure prophylaxis includes both rabies immune globulin (rabies-specific antibodies) injected in and around the bite and also rabies vaccination. The long series of painful abdominal injections has been replaced with four doses of vaccine injected into a muscle, generally the upper arm, over a two-week period.
A rabies vaccine for use before exposure is recommended for veterinarians and others who regularly are exposed to potentially infected animals. A three-dose series of rabies vaccine sometimes is recommended for those traveling overseas to areas where rabies is endemic. Seek advice from your travel clinic.
MO
— Rear Adm. Joyce Johnson, USPHS (Ret), D.O., M.A., is a health care consultant in Chevy Chase, Md. Find more health and wellness resources at
www.moaa.org/wellness. For submission information, see page 6.
Sept. 28 Is World Rabies Day
When the rabies vaccine is administered shortly after a bite, post-exposure prophylaxis is completely effective in preventing rabies, in both children and adults.
50 MILITARY OFFICER SEPTEMBER 2013
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