How is rabies treated
Rabies is a viral infection of the central nervous system. Other names for the disease are anger disease, Lyssa (Greek), Rabies (Latin / English) and Rage (French). The causative agents of the disease are lyssaviruses. The incubation period - i.e. the time from infection to the onset of the disease - is generally three to eight weeks, but in rare cases it can be less than nine days. Once the disease has broken out, it is almost always fatal. Immediately after infection, however, immunization can still prevent the onset of the disease.
Transmission through saliva
Rabies is almost always transmitted by infected animals. If an animal has been infected with the virus, they first multiply in the central nervous system and then spread. Among other things, the viruses are excreted en masse in saliva. It is usually transmitted to humans through the bite of an infected animal. However, infection is also possible through skin injuries or if infectious material such as saliva comes into direct contact with the mucous membrane.
Wild animals that have become infected with rabies often lose their fear of humans (for example foxes). If a wild animal behaves in an unusual way, you should therefore be particularly careful and keep your distance. Even if you find a bat lying on the ground and want to help it, you should at least wear leather gloves. Anyone who is bitten anyway must see a doctor immediately!
Germany is considered rabies-free
Germany has been considered free from classic wild rabies since 2008. This was achieved by immunizing wild animals with feed bait, especially foxes. In addition, pets were regularly vaccinated against rabies. The last case of rabies in a wild animal - a fox - was recorded in February 2006. Many other European countries such as Switzerland, France, Belgium, Luxembourg, the Scandinavian countries, the Czech Republic, Spain and Portugal, Great Britain and Ireland are officially "rabies-free".
The last reservoir of the pathogen in this country are bats. They carry a different form of lyssavirus than foxes, which are closely related to the fox pathogen. Doctors assume that bat rabies is just as dangerous for humans as classic wild rabies.
Last cases of rabies in people in Germany
In 2005, organs were removed for transplant from a woman who had previously contracted rabies in India. Of the total of six organ recipients, three fell ill and died as a result of rabies. The recipients of the two corneas did not become ill, as did the recipient of the liver, who had previously been vaccinated against rabies.
Rabies was most recently found in Germany in 2007 in a man who was infected by a dog bite while abroad in Morocco.
For people living in Germany today, there is only an increased risk of infection when traveling to countries where rabies still occurs. Transmission of the disease by bats cannot be ruled out in Germany.
Rabies: symptoms and course of the disease
The rabies incubation period (time from infection to onset of the disease) is three to eight weeks in most cases. In some cases, however, it can also last for several years. The incubation period is rarely shorter than nine days. The closer the portal of entry of the rabies virus is to the brain, the shorter the incubation period. This is because the viruses move from the point of entry along the nerves towards the brain. Once you get there, the disease breaks out. It is then fatal.
Three stages of rabies
Rabies has three stages in humans:
Prodromal stage: In the first stage of rabies, unspecific symptoms such as headache, nausea, vomiting, abdominal pain, diarrhea, usually also fever and possibly coughing occur. The bite site tingles and itches. As the disease progresses, it becomes irritable and sensitive to light, noise and drafts. The fever rises continuously.
Acute neurological phase (excitation stage): The so-called encephalitic form of rabies infection manifests itself primarily in the brain. The sick develop a pronounced fear of water (hydrophobicity). When swallowing, the throat muscles contract so that patients are afraid of swallowing. The sick even avoid swallowing their own saliva so that it flows out of their mouths. Just the sight of water or drops and rushing can trigger restlessness and cramps. The mood of the patient fluctuates between aggression and depression.
The rarer paralytic form of rabies mainly affects the nerves of the spinal cord and the peripheral nerves. Even at this stage, increasing paralysis occurs.
Coma (stage of paralysis): In the last stage of rabies, the patient suffers from progressive symptoms of paralysis. The patient eventually falls into a coma and usually dies of respiratory paralysis. Once rabies has broken out, it is fatal.
Rabies: causes and risk factors
The causative agent of rabies is the rabies virus (Lyssavirus). In industrialized countries, the virus is mainly found in forest animals; these transmit the rabies pathogen to pets and humans. In Africa, Asia and Latin America, however, dogs are the main vectors and thus responsible for most deaths from rabies worldwide.
The most common way of transmission of rabies to humans is bites or scratches from infected dogs, cats, foxes, raccoons, skunks, jackals and wolves, as well as from insectivores (e.g. hedgehogs) and vampire bats. Cattle, horses, small game and other herbivores can become infected, but they only rarely transmit rabies to humans.
Even simple contact, for example when petting infected animals, can be infected - but the risk of infection is very low. Most viruses are found in saliva. Especially if it comes into contact with mucous membranes or wounds, there is a very high risk of rabies infection.
Rabies is considered to be eradicated in Germany. It still occurs, which is a problem in bats. Since native species are not vampire bats, but mainly feed on insects, they do not fall on humans. The only risk of becoming infected is direct contact with the bats - or when traveling to countries where there are still many animals suffering from rabies.
Rabies: examinations and diagnosis
The suspicion of rabies in humans is always given whenever there is contact with a possibly infected animal - especially in the case of bite and scratch wounds. A stronger suspicion arises when corresponding clinical symptoms already appear.
For an accurate diagnosis, the genetic material - the RNA - of the rabies pathogen (Lyssavirus) is detected in saliva, in the cornea of the eye or in the cerebral fluid. However, it is not always possible to diagnose a rabies infection in this way. A reliable, unambiguous diagnosis of rabies is often only possible after the person concerned has died.
A rabies vaccination must be carried out if contact with a rabid animal is suspected. In the event of an infection, it is the only chance of rescue.
After an animal bite or other contact with a possibly infected animal, you must rinse and clean the bite or the contact points as quickly as possible with water, soap or detergent solution. Also, you should disinfect them with alcohol or iodine solutions.
Subsequently, after an animal bite, you must always consult a doctor who will administer an appropriate vaccination. Even if you have slight scratches or after a conspicuous or wild animal has licked your skin, the rabies vaccination must be given as soon as possible.
The doctor gives ready-made antibodies (immunoglobulins) that fight the rabies virus in the body (passive immunization). In addition, the patient receives an active vaccination that contains killed virus components and instigates the body's own protection against the viruses, i.e. it stimulates the formation of specific antibodies against the virus.
If the first symptoms of rabies appear, vaccination or administration of the antiserum is no longer effective. Therapy for rabies then consists exclusively of relieving symptoms such as cramps or respiratory paralysis. There is rarely more than seven days between the onset of the first rabies symptoms and the fatal outcome.
You can find out what to look out for when getting a vaccination against rabies in the article Rabies - Vaccination.
Rabies: What You Can Do By Yourself
Before traveling abroad, you should find out whether rabies occurs in your travel destination. If this is the case, a preventive rabies vaccination may be recommended. In regions outside of the usual tourist centers in particular, it may not be possible to obtain a subsequent passive vaccination quickly enough. Therefore, seek advice from a tropical medicine specialist on how you can best protect yourself.
Rabies is very contagious. A bite through clothing, a slight scratch or contact with contaminated saliva can also lead to a fatal infection.
Wild animals are usually shy. If an animal is unusually trusting, stay away from it.
After contact with an animal suspected of rabies, you must thoroughly cleanse the affected areas of skin with soap and water and, if possible, disinfect them. This also applies if you have touched an animal that may have died of rabies. In any case, consult a doctor!
If you have found the carcass of an animal that may be infected with rabies, have a ranger find it.
Rabies: disease course and prognosis
If an infected person is not vaccinated against rabies, the prognosis depends on whether and how quickly they then receive active immune protection. Therefore, in the event of contact with a possibly infected animal, you must consult a doctor as soon as possible.
The earlier the post-vaccination with antibodies, the better the prognosis. If the virus has already lodged in the brain and the first symptoms of the disease appear, it can no longer help. Usually the symptoms lapse between the onset of the rabies and death for a maximum of seven days. In that case, the patient dies of respiratory or cardiac paralysis.
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