A Call for Awareness

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Again and again, rabies has been an ongoing outbreak in Sarawak. However, there are still cases reported this year that show a lack of awareness and understanding of this deadly disease. This year, World Rabies Day highlights the importance of preventing rabies and combating this horrifying disease.

Rabies: A fatal yet preventable disease

Sharing information about rabies and its fatalities in conjunction with World Rabies Day, Timberland Medical Centre’s Medical Officer, Dr Everard Ives, emphasised the importance of always expecting the unexpected, particularly concerning this deadly disease.

Celebrated each year worldwide, the World Health Organization (WHO) aims to raise awareness about rabies prevention and to highlight progress in combating this horrifying disease. A serious issue throughout Asia and Africa, rabies is a viral, zoonotic, neglected tropical disease that causes tens of thousands of deaths annually, with 40 per cent of the victims being children under 15.

In Sarawak alone, there have been 71 reported fatalities since the first case in July 2017. An ongoing outbreak, rabies is a highly devastating infectious disease primarily transmitted from rabid animals to humans through bites or scratches.

“Rabies occurs when an infected animal’s saliva, which is rich in the rabies virus — specifically the lyssavirus — penetrates human skin, allowing transmission of the disease to occur. Once the virus enters the body, it begins to spread to peripheral areas through the nerves, eventually reaching the central nervous system, which includes the spinal cord and brain. Once it reaches the brain, the virus replicates in vast amounts,” explained Dr Everard.

He further said that when the viral load is brought back down through the nerves and into the salivary glands, the virus can be found there. Describing the infection as a vicious cycle of dog to dog and dog to human, Dr Everard concluded that once clinically diagnosed, rabies eventually leads to death for both dogs and humans.

Once infected, the medical officer revealed that symptoms are non-specific and vague.

“For example, two to three days post-infection, common cold or flu-like symptoms can appear, such as a sore throat, muscle aches, fatigue, and nausea. However, it is also important to note that a feeling of pins and needles at the wound site is highly suspicious for rabies symptoms, unless proven otherwise.”

When the virus reaches the central nervous system, the major symptoms become more apparent, including altered levels of consciousness, high irritability, intermittent moments of aggression, extreme fear of water, and uncontrolled autonomic dysfunction, such as persistent salivation.

“Towards the end, the brain tissue of the patient becomes severely inflamed. During this time, there will be major seizures, altered levels of consciousness, and the patient will eventually enter a comatose state and succumb to death due to cardio-respiratory collapse.”

Treat immediately

The proximity of the bite site to the central nervous system is also important to note. According to Dr Everard, the closer the bite is, the faster the virus spreads to the brain. Therefore, it is crucial for doctors to recognise the area of the wound. For example, a person bitten on the forearm experiences a shorter transmission time than someone bitten on the leg.

Once bitten, the affected person must thoroughly wash the wound under running tap water for at least 15 minutes to reduce the load of the potential rabies virus, he said.

“After washing, it is important to apply a virucidal solution, such as alcohol or iodine, and then dress the wound simply before seeking medical treatment at healthcare centres.”

When asked about the “golden hour” for seeking treatment, Dr Everard emphasised that it should be done as soon as possible — preferably within the same hour or the same day.

“I don’t think it is wise to delay treatment.”

He added that there are cases where pet owners who were bitten dismissed it as a behavioural problem and later succumbed to rabies.

To diagnose rabies, several tests can be conducted by acquiring samples from the saliva, brain-spinal fluid, or even a skin biopsy from the back of the patient’s neck to determine whether the test is positive.

Important to vaccinate pets

To date, local councils and the government have encouraged the vaccination of pets against the rabies virus. Among the campaigns conducted is a regular vaccination drive for dogs and cats. At Timberland and other medical centres, rabies vaccinations are provided to patients who have been bitten.

To end the cycle of rabies, Dr Everard strongly encourages pet owners to vaccinate their animals to decrease the risk of infection. Nevertheless, the public should not disregard dog or cat bites or scratches, as proper wound care is vital.

“Once it has been clinically diagnosed, it is too late.

“So, what’s the lesson here? Rabies is highly fatal but also highly preventable. We need to start at the point where things do not seem so bad, when everything is still alright. Owners must ensure that their dogs and cats are vaccinated, and when bitten — regardless of whether their pets are vaccinated — it is still important to get proper wound care treatment and vaccinations.”