rabies n : an acute viral disease of the nervous system of warm-blooded animals (usually transmitted by the bite of a rabid animal); rabies is fatal if the virus reaches the brain [syn: hydrophobia, lyssa, madness]
- Arabic: (kálab) , (dā’ ul-kálab)
- Chinese: 狂犬病 (kuángquǎnbìng)
- Czech: vzteklina
- Dutch: hondsdolheid
- Finnish: vesikauhu, raivotauti
- French: rage
- German: Tollwut
- Hebrew: כַּלֶּבֶת (kallevet)
- Hungarian: veszettség
- Italian: rabbia
- Japanese: 狂犬病 (きょうけんびょう, kyōkenbyō)
- Korean: 광견병 (gwanggyeonbyeong)
- Polish: wścieklizna
- Portuguese: raiva
- Romanian: turbare
- Russian: бешенство (béšenstvo)
- Spanish: rabia
Rabies (lang-la rabies, "madness, rage, fury" also "hydrophobia") is a viral zoonotic neuroinvasive disease that causes acute encephalitis (inflammation of the brain) in mammals.
In non-vaccinated humans, rabies is almost invariably fatal after neurological symptoms have developed, but prompt post-exposure vaccination may prevent the virus from progressing. There are only six known cases of a person surviving symptomatic rabies, and only one known case of survival in which the patient received no rabies-specific treatment either before or after illness onset.
StructureThe virus is a Lyssavirus. This genus of RNA viruses also includes the Aravan virus, Australian bat lyssavirus, Duvenhage virus, European bat lyssavirus 1, European bat lyssavirus 2, Irkut virus, Khujand virus, Lagos bat virus, Mokola virus and West Caucasian bat virus. Lyssaviruses have helical symmetry, so their infectious particles are approximately cylindrical in shape. This is typical of plant-infecting viruses; human-infecting viruses more commonly have cubic symmetry and take shapes approximating regular polyhedra. Negri bodies in the infected neurons are pathognomonic.
The virus has a bullet-like shape with a length of about 180 nm and a cross-sectional diameter of about 75 nm. One end is rounded or conical and the other end is planar or concave. The lipoprotein envelope carries knob-like spikes composed of Glycoprotein G. Spikes do not cover the planar end of the virion (virus particle). Beneath the envelope is the membrane or matrix (M) protein layer which may be invaginated at the planar end. The core of the virion consists of helically arranged ribonucleoprotein. The genome is unsegmented linear antisense RNA. Also present in the nucleocapsid are RNA dependent RNA transcriptase and some structural proteins.
Longitudinal and cross-sectional schematic view of rabies virus
Differential diagnosisThe differential diagnosis in a case of suspected human rabies may initially include any cause of encephalitis, particularly infection with viruses such as herpesviruses, enteroviruses, and arboviruses (e.g., West Nile virus). The most important viruses to rule out are herpes simplex virus type 1, varicella-zoster virus, and (less commonly) enteroviruses, including coxsackieviruses, echoviruses, polioviruses, and human enteroviruses 68 to 71. A specific diagnosis may be made by a variety of diagnostic techniques, including polymerase chain reaction (PCR) testing of cerebrospinal fluid, viral culture, and serology. In addition, consideration should be given to the local epidemiology of encephalitis caused by arboviruses belonging to several taxonomic groups, including eastern and western equine encephalitis viruses, St. Louis encephalitis virus, Powassan virus, the California encephalitis virus serogroup, and La Crosse virus.
New causes of viral encephalitis are also possible, as was evidenced by the recent outbreak in Malaysia of some 300 cases of encephalitis (mortality rate, 40%) caused by Nipah virus, a newly recognized paramyxovirus. Similarly, well-known viruses may be introduced into new locations, as is illustrated by the recent outbreak of encephalitis due to West Nile virus in the eastern United States. Epidemiologic factors (e.g., season, geographic location, and the patient’s age, travel history, and possible exposure to animal bites, rodents, and ticks) may help direct the diagnostic workup.
Cheaper rabies diagnosis will be possible for low-income settings according to research reported on the Science and Development Network website in 2008. Accurate rabies diagnosis can be done ten times cheaper, according to researchers from the Farcha Veterinary and Livestock Research Laboratory and the Support International Health Centre in N'Djamena, Chad. The scientists evaluated a method using light microscopy, cheaper than the standard tests, and say this could provide better rabies control across Africa. http://www.scidev.net/en/sub-suharan-africa/news/sub-saharan-africa-news-in-brief-13-25-march.html
Transmission and symptoms
There are an estimated 55,000 human deaths annually from rabies worldwide, with about 31,000 in Asia, and 24,000 in Africa.
One of the sources of recent flourishing of rabies in East Asia is the pet boom. China introduced in the city of Beijing the "One Dog policy" in November 2006 to control the problem. India has been reported as having the highest rate of human rabies in the world http://www.independent.co.uk/news/science/dead-as-a-dodo-why-scientists-fear-for-the-future-of-of-the-asian-vulture-818059.html.
The English Channel, dog licensing, killing of stray dogs, muzzling and other measures contributed to the elimination of rabies from the United Kingdom in the early 20th century. More recently, large-scale vaccination of cats, dogs and ferrets has been successful in combatting rabies in some developed countries.
The rabies virus survives in wide-spread, varied, rural fauna reservoirs. However, in Asia, parts of America and large parts of Africa, dogs remain the principal host. Mandatory vaccination of animals is less effective in rural areas. Especially in developing countries, pets may not be privately kept and their destruction may be unacceptable. Oral vaccines can be safely distributed in baits, and this has successfully reduced rabies in rural areas of France, Ontario, Texas, Florida and elsewhere, like in the City of Montréal (Québec) where baits are successfully used among raccoons in the Mont-Royal park area. Vaccination campaigns may be expensive, and a cost-benefit analysis can lead those responsible to opt for policies of containment rather than elimination of the disease.
Many territories, such as the United Kingdom, Ireland, Taiwan, Japan, Hawaii, Mauritius, Barbados and Guam, are free of rabies, although there may be a very low prevalence of rabies among bats in the UK; see below.
New Zealand and Australia have never had rabies.http://epix.hazard.net/topics/animal/rabies.htm However, in Australia, the Australian Bat Lyssavirus occurs normally in both insectivorous and fruit eating bats (flying foxes) from most mainland states. Scientists believe it is present in bat populations throughout the range of flying foxes in Australia.
The UK is not completely free of rabies, as a new form of the lyssavirus has been found in some bats which could possibly affect humans. There has been one case of a bite from an infected bat, but the victim showed no symptoms of the virus and was vaccinated quickly as a precaution.
Rabies in the United StatesRabies was once rare in the United States outside the Southern states, but raccoons in the mid-Atlantic and northeast United States have been suffering from a rabies epidemic since the 1970s, which is now moving westwards into Ohio.
Infections by corneal transplant have been reported in Thailand (2 cases), India (2 cases), Iran (2 cases), the United States (1 case), and France (1 case). Details of two further cases of infection resulting from corneal transplants were described in 1996.
In June 2004, three organ recipients died in the United States from rabies transmitted in the transplanted kidneys and liver of an infected donor from Texarkana. There were bats near the donor's home, and the donor had told others that he had been bitten. The donor is now reported to have died of a cerebral hemorrhage, the culmination of an unidentified neurological disorder, although recipients are said to have been told the cause of death had been a car crash. Marijuana and cocaine were found in the donor's urine at the time of his death, according to a report in The New England Journal of Medicine."[The surgeons] thought he had suffered a fatal crack-cocaine overdose, which can produce symptoms similar to those of rabies. 'We had an explanation for his condition,' says Dr. Goran Klintmalm, a surgeon who oversees transplantation at Baylor University Medical Center, where the transplants occurred. 'He'd recently smoked crack cocaine. He'd hemorrhaged around the brain. He'd died. That was all we needed to know'. Because of doctor-patient confidentiality rules, doctors involved with this case would not talk about it on the record, but a few did say that if no cocaine was found in the donor's blood, the E.R. doctors might have investigated his symptoms more aggressively instead of assuming he had overdosed. . (Because no autopsy was done, doctors have not been able to establish whether the rabies or the drugs actually killed him.)"On
In February 2005, three German patients in Mainz and Heidelberg were diagnosed with rabies after receiving various organs and cornea transplants from a female donor. Two of the infected people died. Three other patients who received organs from the woman have not yet shown rabies symptoms. The 26 year old donor had died of heart failure in December 2004 after consuming cocaine and ecstasy. In October 2004, she had visited India, one of the countries worst affected by rabies worldwide. Dozens of medical staff were vaccinated against rabies in the two hospitals as a precautionary measure. Associated Press reports that "Donated organs are never tested for rabies. The strain detected in the victims' bodies is one commonly found in bats, health officials said." According to CNN "Rabies tests are not routine donor screening tests, Virginia McBride, public health organ donation specialist with the Health Resources and Services Administration, said. The number of tests is limited because doctors have only about six hours from the time a patient is declared brain-dead until the transplantation must begin for the organs to maintain viability." This was the storyline for an episode of Scrubs ("My Lunch") in which Dr. Perry Cox was responsible for the death of three transplant patients.
Transport of pet animals between countries
Rabies is endemic to many parts of the world, and one of the reasons given for quarantine periods in international animal transport has been to try to keep the disease out of uninfected regions. However, most developed countries, pioneered by Sweden, now allow unencumbered travel between their territories for pet animals that have demonstrated an adequate immune response to rabies vaccination.
Such countries may limit movement to animals from countries where rabies is considered to be under control in pet animals. There are various lists of such countries. The United Kingdom has developed a list, and France has a rather different list, said to be based on a list of the Office International des Epizooties (OIE). The European Union has a harmonised list. No list of rabies-free countries is readily available from OIE.
However, the recent spread of rabies in the northeastern United States and further may cause a restrengthening of precautions against movement of possibly rabid animals between countries.
Rabies and dogsRabies has a long history of association with dogs. The first written record of rabies is in the Codex of Eshnunna (ca. 1930 BC), which dictates that the owner of a dog showing symptoms of rabies should take preventative measure against bites. If a person is bitten by a rabid dog and later died, the owner was fined heavily.
Three stages of rabies are recognized in dogs. The first stage is a one to three day period characterized by behavioral changes and is known as the prodromal stage. The second stage is the excitative stage, which lasts three to four days. It is this stage that is often known as furious rabies due to the tendency of the affected dog to be hyperreactive to external stimuli and bite at anything near. The third stage is the paralytic stage and is caused by damage to motor neurons. Incoordination is seen due to rear limb paralysis and drooling and difficulty swallowing is caused by paralysis of facial and throat muscles. Death is usually caused by respiratory arrest.
On April 25, 2008 three people were bitten by a rabid puppy which was in quarantine after arriving into the UK on 18 April 2008 from Sri Lanka. The incident happened in the Chingford area of Essex at a licensed quarantine centre and the people involved received vaccinations.
Rabies and opossumsExperimental studies of rabies infection in the Virginia opossum have shown the importance of the mode of transmission. Opossums became infected when exposed to air-borne virus but were found to be fairly resistant to intramuscular inoculations. The aerosol transmission of rabies in opossum was investigated following the death from rabies of two men who had visited the Frio Caves, Texas, and did not remember any direct contact with bats.
The spatial and temporal distribution of opossum rabiesRabies cases in the Virginia opossum are spillover cases from other wildlife species such as bats, skunks and the raccoon epizootic in the eastern United States. Cases have been reported across the United States from California to New York . In New York state, the Wadsworth Center lists laboratory confirmed cases in opossums 5 years out of 10 from 1989 to 1998.
Rabies and domestic skunks in the United StatesThere is currently no USDA-approved vaccine for the strain of rabies that afflicts skunks. When cases are reported of pet skunks biting a human, the animals are frequently killed in order to be tested for rabies.
Humans exposed to the rabies virus must begin post-exposure prophylaxis before the disease can progress to the central nervous system. For this reason, it is necessary to determine whether the animal, in fact, has rabies as quickly as possible. Without a definitive quarantine period in place for skunks, quarantining the animals is not advised as there is no way of knowing how long it may take the animal to show symptoms. Destruction of the skunk is recommended and the brain is then tested for presence of rabies virus.
Skunk owners have recently organized to campaign for USDA approval of both a vaccine and an officially recommended quarantine period for skunks in the United States.
Rabies and batsThe problem of bat-transmitted rabies is found over most of North and South America but was first closely studied in Trinidad in the West Indies which had a dreadful reputation for bat rabies, which took a significant toll of livestock and humans alike. In the 10 years from 1925 and 1935, 89 people and thousands of livestock had died from it - "the highest human mortality from rabies-infected bats thus far recorded anywhere.".
In early 1931, Dr. H. Metivier, a Veterinary surgeon, established the connection between the bites of bats and paralytic rabies. In September 1931, Dr. J. L. Pawan, a Government Bacteriologist found Negri bodies in the brain of a bat with unusual habits. In 1934 the Trinidad and Tobago Government began a program of vampire bat control, shooting, netting, trapping and poisoning, while encouraging the screening off of livestock buildings and free vaccination programs for exposed livestock.
After the opening of the Trinidad Regional Virus Laboratory in 1953, basic research on bats and rabies progressed rapidly under the able direction of Arthur Greenhall, who demonstrated that at least 8 species of bats in Trinidad had been infected with rabies - particularly the Common Vampire Bat, Desmodus rotundus (which "will attack any warm blooded creature"), the rare White-winged Vampire Bat, Diaemus youngi, (which "appears to have a special preference for birds and goats"), as well as two abundant species of Fruit Bats: the Seba's Short-tailed Bat or Short-tailed Fruit Bat, Carollia perspicillata, which commonly roosts with Vampires, and the Jamaican Fruit Bat, Artibeus jamaicensis.
Non-bite transmission of rabies in people has been reported by the CDC In 1967, rabies virus was isolated from the air in the same cave, presumably passed by the bats urinating, potentially forming a source for infection of other susceptible animals, and presenting a hazard to researchers and spelunkers. While the risks may be low, they are deserving of further study and monitoring.
The United Kingdom, which has stringent regulations on the importation of animals, had also been believed to be entirely free from rabies until 1996 when a single Daubenton's bat was found to be infected with a rabies-like virus usually found only in bats – European Bat Lyssavirus 2 (EBL2). There were no more known cases in the British Isles until September 2002 when another Daubenton's bat tested positive for EBL2 in Lancashire. A bat conservationist who was bitten by the infected bat received post-exposure treatment and did not develop rabies.
Then in November 2002 David McRae (1947-2002), a Scottish bat conservationist from Guthrie, Angus was bitten on the ring finger of his left hand by a bat, thereby becoming the first human to contract rabies in the United Kingdom since 1902. He subsequently died in hospital http://news.bbc.co.uk/1/hi/scotland/2509375.stm from EBL2 rabies on November 24 2002http://news.scotsman.com/topics.cfm?tid=659&id=1391162003.
In November 2004, Jeanna Giese, a fifteen-year old girl from Fond du Lac, Wisconsin, became one of only six humans known to have survived rabies after the onset of symptoms, and the first known instance of a human surviving rabies without vaccine treatment. Giese's disease was already too far progressed for the vaccine to help, and she was considered too weak to tolerate it. Doctors at the Children's Hospital of Wisconsin in Wauwatosa, a suburb of Milwaukee, achieved her survival with an experimental treatment that involved putting the girl into a drug-induced coma, and administering a cocktail of antiviral drugs. Giese had symptoms of full-blown rabies when she sought medical help, thirty-seven days after being bitten by a bat. Her family did not seek treatment at the time because the bat seemed healthy. Jeanna regained her weight, strength, and coordination while in the hospital. She was released from the Children's Hospital of Wisconsin on January 1, 2005.
On May 12, 2006 Harris County, Texas U.S.A. Health Department officials reported that a teenage boy, Zachary Jones of Humble, Texas, had died of rabies at Texas Children's Hospital in Houston, Texas. Zachary had contracted the disease after a bat flew in his bedroom and bit him in his sleep. He was unaware he had been bitten and was not hospitalized until he developed symptoms several weeks later. He died at Texas Children's Hospital after an attempt to cure the disease through a drug-induced coma, similar to that of Jeanna Giese.
On November 2, 2006 a 10 year old girl in Bourbon, Indiana, U.S.A. died of rabies. The Indianapolis Star reports that she was bitten by a bat in June 2006.
In August of 2006, a 73 year old rural resident located east of Edmonton, Alberta, Canada was bitten by a bat while he slept. He ignored the bite and became symptomatic in January 2007. Diagnosed with rabies in March of 2007, he was treated with the Milwaukee protocol, but died April 26, 2007.
On August 6, 2006, 950 Girl Scouts were urged to receive rabies shots by the Girl Scouts of America. The nine hundred and fifty girls had attended a camp in Virginia, U.S.A. in July, and had reported seeing bats in their cabins. Even though infections were relatively unlikely, the G.S.A. offered to pay for the shots, at a cost of nearly two million dollars. The Centers for Disease Control reports 27 cases of human rabies caused by the bat variant rabies virus in the United States from 1990 to 2002.
On December 8, 2007, a 34 year old Dutch medical doctor died from rabies. According to Dutch media, the woman, who worked at the Amsterdam Academic Medical Center (AMC), had been attacked by a small bat while on holiday in Kenya last October. The attack, which occurred at a camping site somewhere between Nairobi and Mombasa, resulted in some bleeding scratches on her nose. She was infected with Duvenhage-virus and succumbed to severe brain infection.
- Waterman, James A. 1965. "The History of the Outbreak of Paralytic Rabies in Trinidad Transmitted by Bats to Human Beings and the Lower Animals from 1925." The Caribbean Medical Journal. 1954. Vol. XXVI, Nos. 1–4, pp. 164–169.
- Fleming, Theodore H. 2003. A Bat Man in the Tropics: Chasing El Duende. University of California Press. ISBN 0-520-23606-8.
- Kaplan, Turner, and Warrell 1986. Rabies: The Facts, Oxford University Press. ISBN 0-19-261441-X
- Centers for Disease Control and Prevention
- World Health Organization factsheet on Rabies
- World Health Organization factsheet on Rabies vaccine
- Rules for importing pets to the United Kingdom
- A Rabies-Free World, Inc. - NPO dedicated to fighting rabies worldwide
- Kids4RabiesFreeWorld - RFW's site for kids & students
- Rules for importing pets to the European Union
- Rules for importing pets to the European Union Q&A
- Aspen Skunk Rabies Research
- "When Raccoons Attack" from Field & Stream Online
- "Only Known Unvaccinated Rabies Survivor Thrives" (USA Today) Progress report on the one known survivor of rabies
- "Filipino Child with Rabies" (metacafe.com) Disturbing video of a small child, exhibiting the advanced stages of rabies mentioned above
- Cheaper rabies diagnosis 'possible for low-income settings'
rabies in Arabic: داء الكلب
rabies in Min Nan: Siáu-káu-pēⁿ
rabies in Bulgarian: Бяс
rabies in Czech: Vzteklina
rabies in Danish: Hundegalskab
rabies in German: Tollwut
rabies in Estonian: Marutaud
rabies in Spanish: Rabia
rabies in Esperanto: Rabio
rabies in Basque: Amorru
rabies in French: Rage
rabies in Croatian: Bjesnoća
rabies in Indonesian: Rabies
rabies in Interlingua (International Auxiliary Language Association): Rabies
rabies in Italian: Rabbia
rabies in Hebrew: כלבת
rabies in Georgian: ცოფი
rabies in Kurdish: Harbûn
rabies in Latin: Rabies
rabies in Lithuanian: Pasiutligė
rabies in Hungarian: Veszettség
rabies in Dutch: Hondsdolheid
rabies in Japanese: 狂犬病
rabies in Norwegian: Rabies
rabies in Polish: Wścieklizna
rabies in Portuguese: Raiva (doença)
rabies in Romanian: Rabie
rabies in Russian: Бешенство
rabies in Sicilian: Raggia
rabies in Simple English: Rabies
rabies in Slovak: Besnota
rabies in Slovenian: Steklina
rabies in Serbian: Besnilo
rabies in Finnish: Vesikauhu
rabies in Swedish: Rabies
rabies in Thai: โรคพิษสุนัขบ้า
rabies in Vietnamese: Bệnh dại
rabies in Turkish: Kuduz
rabies in Ukrainian: Сказ
rabies in Urdu: مرض کلب
rabies in Walloon: Må d' araedje
rabies in Chinese: 狂犬病
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