TAGUM DOCTOR’S COLLEGE, INC.

Mahogany St. Rabe Subdivision, Tagum City

Bachelor of Science in Nursing

In Partial Fulfillment of the Requirements in

RLE 121: Intensive Nursing Practicum

Submitted to:

Heidi C. Cabanatan RN

Submitted by:

Rachelle R. Donasco BSN 4

March 23, 2022

The One Health of Rabies: It’s Not Just for Animals
Dr. Pamela J. Wilson, Dr. Rodney Rohde
Sept. 27, 2021
An ancient disease, rabies is one of the most diabolical and feared among neglected
infectious diseases. Because treatment is rarely succesful, education about prevention is
imperative for controlling the disease and saving the lives of humans and animals.
The inaugural World Rabies Day was held in 2007. The premise of this day is the value of
a One Health approach, which encompasses the connections among human health, animal health
and the state of the environment, to preventing rabies. World Rabies Day serves to raise
awareness of rabies and encourage people to vaccinate their pets, with a focus on rabies-endemic
countries and how to create community responsiveness to this disease.
 
Goals of World Rabies Day:

 Elimination of rabies spread by dogs to reach zero human deaths by 2030. (Although not
the case in the U.S., on a worldwide basis, approximately 99% of human rabies cases are
the result of exposure to a rabid dog; in the U.S., most human rabies cases are associated
with bat variants of rabies virus).

 Collaboration at all levels to eliminate rabies globally, because it knows no borders.

 Vaccination as a cornerstone of rabies prevention and control efforts

The Nature of the Virus and the Disease

The rabies virus has a bullet-shaped morphology and is highly neurotrophic. It belongs to

the family Rhabdoviridae, genus Lyssavirus. Rabies virus is a negative-sense, non-segmented,
single-stranded, enveloped RNA virus that contains a single glycoprotein on its surface and a
ribonucleoprotein core. Rabies is the only lyssavirus present in the Americas.

Rabies is a disease of warm-blooded animals, including humans. Some animals are

reservoirs for rabies and considered to be high risk; in the U.S., the high-risk animals for rabies
are bats, raccoons, skunks, and foxes (as well as mongooses in Puerto Rico). These reservoirs are
associated with species-specific rabies virus variants; rabies infection in a species other than the
reservoir species for the variant is considered “spillover.” An example of spillover would be a cat
infected with a skunk variant of rabies virus.
  Transmission occurs when saliva containing the rabies virus is introduced into an opening
in the skin, usually via the bite of a rabid animal. Though rare, transmission can also occur
through infected saliva contacting mucous membranes (eyes, nose, mouth) or a scratch or other
break in the skin. The potential for these rarer modes of transmission creates the need for rabies
laboratory and biologics workers and other at-risk people to use personal protective equipment.
Masks and goggles or face shields protect mucous membranes, while gloves and gowns cover
any breaks in the skin.

The virus multiplies in the muscle (possibly in the skin as well in bats) for a varying
amount of time before migrating into the nervous system, where it directly infects neurons. There
remain unknowns about why the incubation varies; some possible factors are the severity and
location of the bite, quantity of virus introduced and variant of virus involved. The virus acts
with cunning stealth, using the central nervous system for viral replication and causing acute,
progressive encephalitis (inflammation of the brain). Once the virus enters the nervous system,
rabies postexposure prophylaxis (PEP) is no longer effective and death is almost inevitable.
Since clinical signs (and symptoms in humans) do not appear until after the virus enters the
nervous system, it is futile to wait for the appearance clinical signs and symptoms to start
PEP. Hope for the development of an effective treatment once the virus has entered the nervous
system still lies in the heart of rabies research.

Its variable incubation period is one of the many enigmas of rabies. Another enigma is its
unpredictable manifestation of a wide array of clinical signs. Some signs that serve as a clue that
an animal is rabid include unexplained paralysis or paresis (muscle weakness caused by nerve
damage or disease), a change in behavior (for example, a normally playful puppy may become
withdrawn or a nocturnal animal may be out during the day), pica (eating strange, non-food
items), chewing at the site of the bite, pawing at the mouth, difficulty swallowing, altered
phonation (such as high-pitched howling in dogs or bellowing in cattle), hypersalivation (thick,
rope-like saliva), lack of coordination and a hypersensitive reaction to stimuli. These are similar
in nature to rabies clinical signs and symptoms in humans: pain or tingling at the bite site,
difficulty swallowing, hydrophobia (fear of water), altered phonation (voice changes or bark-like
sounds), autonomic instability (for example, slow heartbeat and hypersalivation), change in
behavior, lack of coordination, involuntary movements of the face, hypersensitivity to light,
sound and touch, aerophobia (fear of air drafts), involuntary muscle twitching, paralysis, paresis
and a plethora of others.

SUMMARY

"Rabies—99.9% lethal, 100% avoidable." This iconic slogan from End Rabies Now
emphasizes that, while rabies is 100% avoidable, it is estimated that a person dies of the disease
every nine minutes worldwide. Vaccinating household animals against rabies, including certain
pets and livestock (including horses), is critical for preventing human cases. Although wildlife
normally accounts for more than 90% of rabies infections in the United States, pets can be
exposed to rabid wildlife and then introduce the disease into the home. Vaccinating dogs and cats
is mandated by law in the majority of states; even if it were not, preexposure vaccination of dogs
and cats is a critical component of rabies prevention. Ferrets, horses, cattle, and sheep are also
eligible for preexposure rabies immunizations. Education on the importance of rabies
vaccinations is critical for completing this phase in the preventative process. Additionally, pet
owners can aid in rabies prevention by keeping their cats home and not letting their dogs to
roam.

Humans can also receive rabies preexposure immunizations, such as the human diploid-
cell vaccine or the pure chick embryo cell vaccine. Currently, the rabies preexposure vaccination
regimen consists of a primary course of three doses administered in the deltoid region over a
three- to four-week period. On the horizon, the Advisory Committee on Immunization Practices
(ACIP) has proposed a two-dose preexposure vaccination schedule (this proposal has not yet
been published or adopted; once again, check future Morbidity and Mortality Weekly Reports
(MMWRs) for any published information on final recommendations). Although preexposure
vaccines do not prevent the need for subsequent immunizations following rabies exposure, they
significantly minimize the quantity of PEP required in comparison to an individual who has not
received preexposure vaccinations.

Rabies preexposure vaccination is typically not recommended for the general population,
but rather for those planning travel to high-risk countries, particularly if they will be visiting a
location or participating in activities that increase their exposure to animals, or visiting areas
with limited access to medical care and PEP (vaccination is prudent for those staying for
extended periods of time, for example, in parts of rural Africa or Asia). Preexposure
immunizations are also recommended for persons whose jobs or hobbies expose them to the
virus. For example, personnel at rabies research laboratories and biologics manufacturing
facilities are considered to be at "continuous" risk, and their primary course of vaccinations
should be followed by serologic testing every six months and a booster if their antibody titer falls
below 0.5 IU/mL. Rabies diagnostic laboratory personnel are considered to be at "frequent" risk,
and the primary course of immunizations should be followed by serologic testing every two
years and a booster vaccination delivered if the antibody titer falls below an acceptable level. All
three of these professions may eventually come under ACIP's recently proposed "elevated" risk
category (with the same recommendations as the current "continuous" risk category), although
future MMWRs will likely contain any released information on final recommendations. Only a
few laboratories offer the fast fluorescent focus inhibition test (RFFIT) for doing rabies titer
tests.
REFLECTION

After death, the animal's skull is tested for rabies; if only the brain is tested, it must
include a complete transverse cross section of the brain stem and tissue from at least one of
these: cerebral cortex, cerebellum, and/or hippocampus Oftentimes, rabies testing laboratories
acquire unusual specimens. However, there are various procedures through which physicians can
perform an antemortem test; in either instance, a suitable specimen is required (e.g., brain tissue,
cerebrospinal fluid and other specific specimens). Overall, the specimen is ready for a
fluorescent antibody test (FAb), where antibodies attach to tissue antigens. The result is a
luminous green microscopic image of rabies antigen. The FAb test is still gold. There are newer
and more specific rabies tests, such as polymerase chain reaction (PCR), as well as older assays
(e.g., Negri body detection, serological, etc.).

A rabies diagnostic laboratory's capacity can only be increased by its staff.

Microbiologists and medical laboratory technicians must be properly trained to operate safely
with viruses. Again, pre-exposure rabies vaccinations and personal protective equipment for
anyone working with rabies virus are crucial.

Rabies is one of the most stressful diagnoses a doctor or veterinarian can make. Anxiety
over rabies virus exposure spreads like a virus to the brain when one detects exposure.
Awareness and prevention are crucial, as therapy rarely succeeds. There is still much to learn
about illness detection, prevention, and management.

Keep in mind that bats' potential exposure to rabies poses particular problems. A bat bite
is a tiny puncture, less than 1 mm in diameter. As a result, PEP should be considered for anyone
sleeping in the same room as a bat, or a youngster, a cognitively challenged person, or an
alcoholic person.