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Rabies in humans

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Etiology and route of transmission of rabies

The virus is extremely dangerous for birds and animals for their ability to cause different diseases. It exists because of the circulation in nature, spreading with live warm-blooded organisms. A person infected most often from dogs (and home, and wandering), and they are from wild animals. Directly from representatives of wild fauna people become infected no more than 28% of cases. Cats are the source of infection in 10% of cases.

Infection occurs through contact with the saliva of an infected animal, most often by the bite. Especially dangerous in this respect, trauma to the head and hands. The more bites, the higher the risk of infection. The peak incidence occurs in spring and summer. Theoretically, a man is a source of danger during the development of the symptoms of the disease, especially in the period when it ceases to control their own behavior.

In Russia, in 2012 it has been infected 950 people. 52% of the patients lived in the Central Federal district, in the Volga is even less (17%) and the Urals (8%), in the South and Siberia – 7%.

A vector of diseases are considered to be foxes, their population in the country is great. So, for every 10 square kilometers accounts for up to 10 individuals. In order to prevent the spread of the disease, at this square should have no more than one animal.

In addition, the growing population of wolves and raccoon dogs, they spread the infection was not less active than foxes. Ache can also hedgehogs, moose, lynx, bears, although for them this is not typical. Also registered cases of attacks on people rabid crows.

Hence the importance of rabies shots for Pets. There are cases of export of vaccinated dogs in the country, where they attack the infected hedgehogs. After some time their behavior becomes inadequate, they go to dark places and die.

In the past, the vaccine was administered to the person only after 10 days. At this time watched to his animals. If it is during this time did not die, the victim did nothing. However, if one does not go to the doctorwithin 4 days after the onset of symptoms, the likelihood that he will survive is 50%. If people began to undergo vaccination only on the 20th day, the probability of death is 100%.

But if after a bite to promptly seek medical care and undergo vaccination, then any consequences are avoided at least in 96-98% of cases.

The incubation period for rabies in humans

The incubation period of this disease can be as short (9 days) and long – up to 40 days. The disease will develop faster if the virus entered the body through the bite on the face and neck. Extremely dangerous and bites on the hands – in this case, the incubation period may be reduced to 5 days. So the virus moving up the nerve pathways to the spinal cord and enters the brain, causing cell death. If the infection occurred through the legs, the incubation period is greatly increased. There were cases when the virus does not appear in the course of a year or more. It should be noted that in children the disease develops faster than in adults.


Structure of cases with clinical manifestations of rabies

Because the modern vaccine can relieve the patient from the disease, the patients presenting with obvious clinical signs of rabies is very rare. The onset of disease may be due to the following factors:

  • The long absence of medical care;
  • Violation of the vaccination regime;
  • Self-termination of vaccination.

In most cases the reason for illness is the lack of people of essential knowledge and careless attitude to their own health. People often neglects the fact that was bitten. To the wound he refers to as common scratch, which actually is a direct threat to life. While for help you need to apply not only after the bite, but even after contact with saliva on the skin, the integrity of which is broken.

In the body after infection, the following processes occur: the virus enters the spinal cord and brain, destroying its cells. The death of the nervous system causes a number of symptoms and leads to death.


Diagnosis of human rabies

In order to make a diagnosis, the doctor will need to check the fact of the bite or saliva of the animal to the person. Clinic in all patients monotonous. In the blood increases the level of lymphocytes, the eosinophils are completely absent. Smear-imprint taken from the surface of the cornea indicates the presence of antibodies produced by trapped in the body of the infection.


Symptoms of rabies inman

The virus can exist without symptoms in the body from 30 to 90 days. Rarely, the incubation period is shortened to 10 days, and rarely extended to one year. The duration mainly depends on the location of the injury. The longer the virus will have to get to the brain, the longer people will remain apparently healthy. In medicine have been described cases where the disease was evident even 4 years after the bite of an infected cow.

The disease passes through three stages of development, each of which manifests different symptoms.

The first signs of rabies in humans

For the initial phase, which lasts from 24 hours to 3 days, characterized by the following signs:

  • First the patient begins to disturb the wound. Even if a bite this time already healed, the person begins to feel it. The injured area is aching, pulling sensations are the nature, localized in the center of the injury. The skin becomes more sensitive, itchy. The scar is inflamed and swells.

  • The body temperature exceeds 37.3 degree, but does not drop below 37 (low-grade fever).
  • There are headaches, there is a weakness. The patient may feel sick and vomit.
  • When the bite was inflicted in the face area, a person frequently develop hallucinations: the olfactory and optic. The victim begin to pursue missing really smells, there are non-existent images.
  • Manifest mental disorders: the patient is depressed, he pursues irrational fear. Sometimes the change comes increased anxiety excessive irritability. A person experiencing apathy to everything, is closed.
  • The appetite disappears. Night's rest is broken, to replace normal dreams come nightmares.

The symptoms of the second stage of rabies in humans

The next stage lasts from 2 to 3 days, it is called the initiation phase. It is characterized by:

  • Due to lesions of the nervous system, is an increase in the excitability of neuro-reflex system. The tone of the autonomic nervous system dominates.
  • A bright symptom of the progression of the disease is the development of hydrophobia. When you try to take a SIP of fluid from an infected person occurs spasm. He exposed the breathing and swallowing muscles, until the occurrence of vomiting. Asthe progression of the disease such a spasm will occur in response to the sound of running water and even its appearance.
  • As the breathing becomes rare and spasmodic.
  • Appear facial spasms. Any external stimuli cause an acute reaction of the nervous system.

  • Cramping be a reaction to even the smallest healthy human stimuli: bright light, wind or draught, sharp sound. It makes the patient fear.

  • Pupils dilate, eyeballs protrude (exophthalmos), the gaze is fixed in one point. The pulse quickens, stands perspiration, saliva constantly flows, its volume increases significantly.
  • Mental disorders progress, the patient is excessively agitated, becoming violent. He is a threat to themselves and others, behaving aggressively and even violently. The infected are thrown at others, fight and bite, tearing their clothes, hair, beating against the walls. In fact, people during this attack is really suffering from terrible haunting images and sounds. During the peak of the attack the person can stop breathing and stop the heartbeat.
  • When an attack takes place, people behave appropriately, non-aggressive, their speech is logical and correct.

The symptoms of the third stage

The final phase of the disease – the stage of paralysis. It lasts no more than a day, and is characterized by the extinction of motor function. The patient is disturbed sensitivity, seizures and hallucinations no longer haunt him. Paralyzed various muscle groups and organs. Outwardly, the person looks calm. Thus there is a significant temperature jump. It rises to 42 degrees, increased heart rate, and blood pressure falls. People die because of paralysis of the heart muscle or the respiratory center.

From the onset of symptoms until death of the patient takes place from 3 days to a week. Sometimes rabies is characterized by rapid progression and the erased clinical picture. When the victim can die during the first night after will appear the first symptoms is scarce.

Treatment of human rabies

After the symptoms first showed themselves,the disease becomes incurable. All the action will be consolidated only to the relief of the human being. It is seeking to isolate from external stimuli, administered opioid analgesics, perform supportive therapy. Helps extend the life of artificial lung ventilation, however, death is inevitable.

Post-exposure vaccine

First aid to the victim is the responsibility of a surgeon operating in the heart rabies help. The patient receives an injection on the same day when asking for help.

If you had entered up to 30 vaccinations in the abdomen, under the skin, since 1993, such schemes prevention of the disease declined. Now use a modern vaccine (KOCHAV). It is purified and gives you the opportunity to significantly reduce treatment and reduce the dosage, enter the one-time.

Important: the vaccine is not injected in the buttock! Her children put in the thigh (the outer surface), and adults and adolescents in the deltoid muscle. Standard dosage – 1 ml. the Effect of the administered vaccine reaches 98%, however, it is important to make first injection no later than two weeks after the injury or bite.

The first treatment of the patient even months after dangerous contact it will show the treatment course.

After were vaccinated, the first antibodies to the virus appear after 14 days, the maximum concentration will occur within a month. When there is a risk of reduction of the incubation period, the patient is administered rabies immunoglobulin.

When the course is completed, the person formed immunity, which starts to work, 14 days after the last injection.

Act protection will be formed throughout the year.

Despite existing vaccines and immunoglobulin, people continue to die from the virus. This occurs as a result of their low awareness of the dangers of the disease and not treatment to the doctor. Some victims refuse medical care and in 75% of cases die because of the infection. Sometimes the blame for the death of such patients lies with the doctors who incorrectly assessed the degree of threat to human health (to 12.5%). Some patients (12.5%) die due to the interruption of the course or the violation of the regime of vaccination.

It is strictly forbidden to patients under treatment, and 6 months after graduation: to consume any alcoholic beverages, excessive physical fatigue, stay in the bath and sauna, hypothermia. This is due to lower production of antibodies and loss of immunity. If the patient receives concurrent treatment with immunosuppressants or corticosteroids, it is necessary to controlantibodies to the virus. If they are produced in insufficient quantities, you need an additional therapy.

As a rule, most people do not experience any side effects after the vaccine. It is often well tolerated. Minor allergic reactions are marked not more than 0.03% of cases.

Contraindications for administration of vaccines against rabies are absent due to a death threat sick person.

Injection will be administered and women who bears a child, and patients with acute pathologies.

In some cases, do not need to be vaccinated?

  • After contact with animal's saliva or touch holistic skin;
  • If the animal has bitten a person through the fabric, which is thick and it will not be damaged;
  • When the injury happened beak or claw of a bird;
  • By the bite of animals living in the home, if they have been vaccinated against the virus and within a year showed no signs of illness.

As for Pets, that person is not vaccinated in that case, if he wasn't bitten in the neck, face, fingers, or brushes, and if the bite are rare. When the injury is localized to a dangerous place or is multiple in nature, a person make 3 inoculations. This is necessary due to the fact that a carrier of the virus can be even vaccinated Pets.

For causing injury to the animals you want to monitor, if it shows signs of disease, vaccination should begin immediately.

If an infestation has likely occurred. The vaccine must be done, if the injury (bite, scratch, contact with saliva to broken skin) from a wild animal. If you have the opportunity to follow him, the man put all 3 injections.

Prophylaxis is stopped if the animal remains healthy for 10 days after injury.

Also quite 3 vaccines if the animal was killed, and his brain have not found the rabies virus.

The course is carried out in full if:

  • The fate of the animal is unknown;
  • It had contact with the wildlife.

If the injured person has been vaccinated with the full course previously, and since that time has passed 365 days, then he put three vaccines (the first 3 and 7 days). If the year has expired, you must undergo the full therapeutic course.

Rabies immunoglobulin

Therapy with immunoglobulin is essential to implement during the day after the injury. This period should not exceed 3 days after possible infection and before was3 introduced the vaccine. The dose is 20 IU/kg of immunoglobulin.

One half of the calculated dose of injection is injected around the damaged tissue (the wound can be irrigated). The rest is injected into the muscle (thigh in its upper third and one in the buttocks). Vaccine and immunoglobulin are not entered in one syringe!

It is possible to combine in the presence of the following readings:

  • The bite is deep, there is bleeding;
  • Has multiple bites;
  • Injuries inflicted in the danger zone.

Remember the deadly threat of the virus. You need to consult a doctor immediately after the injury or after the occurrence of the risk of infection situations.


Prevention of rabies

It is important to know that even a minor bite, a person should seek medical assistance. The further course of treatment will be determined by the doctor. It implements emergency treatment by introducing active or passive vaccines of rabies immunoglobulin.

Immediately after the bite, it is important to wash the injured place with running water. In addition, a preventative vaccine can be administered to persons with occupational risks, for example, trainers, hunters, veterinarians.

The vaccine is administered immediately after treatment of the injured person to the hospital. It is performed on the first day, then on the 3rd and 7th day, after 14 and 28 days. The world health organization makes a recommendation to vaccinate more and 3 months later, after it was introduced last injection, injected it into the muscle. It is sufficient to provide an immune response schema.

Vaccine administered if:

  • The bite occurred in wild rodents;
  • There was a hit of saliva on the skin were the bite or scratch of an animal, just carrying the virus, or even if you suspect its presence;
  • The bite occurred through the thin layer of fabric, after being wounded by any object soiled with the saliva of an infected animal.

The vaccine is not administered if:

  • The injury happened a bird (not a predator);
  • The bite occurred without damaging the skin (through a thick cloth);
  • Ingesting milk or meat of an infected animal, the last heat treatment;
  • The bite occurred homemade rodent;
  • The bite occurred rodent in the territory where the disease has not been recorded for 2 years;
  • There was contact with an infected person withoutskin damage or getting his saliva on the mucous membranes;
  • There was contact, but the animal is not killed after 10 days of exposure (measure not relevant).

The vaccine has few adverse reactions in comparison with possible disease. In some cases, manifest an allergic reaction, the injection site can swell, harden or get sick. Sometimes the rise in body temperature (not more than 38 degrees), a fever and headaches. Can enlarged lymph nodes.


To what doctor to address?

Primary rabies assistance is provided by the surgeon (traumatologist) of the center rabies care (according to the order of Ministry of health No. 297, dated 7.10.1997). The rabies vaccine is introduced on the first day of treatment in the emergency room.