BY GEOFFREY MULINDWA
Director Medical Services, Allan Galpin Health Centre
During the Easter break in 2014, a spouse to an employee at the university was bitten by a stray dog while sitting on a boda boda at a junction on Jinja Road. That was a source of anxiety on the part of the family.
Allan Galpin contacted the Department of Veterinary Services at the district, who were not of much help. She was treated, recovered from her wounds and has been followed with no incident.
Last (Trinity) semester, an employee from the Dining Hall was bitten by a dog on campus while going for work at 6.30 am in the morning. This employee was also treated for her wounds and received human Anti-Rabies vaccine. She has also been treated and she recovered from her wounds.
In both incidences neither the patients developed symptoms of rabies nor were the dogs diagnosed to have rabies.
All species of mammals are susceptible to rabies virus infection, but only a few species are important as reservoirs for the disease. Here in Uganda cases of rabies have been identified in domestic animals like dogs, cats, cattle and goats and also in wild animals like foxes, jackals, monkeys, rabbits and the mongoose. Several species of insectivorous bats are also reservoirs for strains of the rabies virus.
Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The majority of rabies cases reported to the Center for Disease Control and Prevention (CDC) each year in USA occur in wild animals like raccoons, skunks, bats, and foxes.
Transmission of the rabies virus usually begins when infected saliva of a host is passed to an uninfected animal. The most common mode of rabies virus transmission is through the bite and virus-containing saliva of an infected host.
Though transmission has been rarely documented via other routes such as contamination of mucous membranes (i.e. eyes, nose, mouth), aerosol transmission, and corneal and organ transplantations, it is possible.
The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. The early symptoms of rabies in people are similar to those of many other illnesses, including fever, headache, and general weakness or discomfort.
There may be also discomfort or a prickling or itching sensation at the site of bite. As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hyper salivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water).
Death usually occurs within days of the onset of these symptoms. The acute period of disease typically ends after 2 to 10 days. Once clinical signs of rabies appear, the disease is nearly always fatal, and treatment is typically supportive.
Disease prevention includes administration of both passive antibody, through an injection of human immune globulin and a round of injections with rabies vaccine.
Once a person begins to exhibit signs of the disease, survival is rare. To date less than 10 documented cases of human survival from clinical rabies have been reported and only two have not had a history of pre- or post-exposure prophylaxis.
In animals, rabies is diagnosed using the direct fluorescent antibody (DFA) test, which looks for the presence of rabies virus antigens in brain tissue. In humans, several tests are required.
Within a few hours, a diagnostic laboratory can determine whether or not an animal is rabid and inform the responsible medical personnel.
The laboratory results may save a patient from unnecessary physical and psychological trauma, and financial burdens, if the animal is not rabid.
In Uganda diagnosis is mainly done on clinical grounds. Laboratory diagnosis can only be carried out in the Veterinary Central Laboratory in Entebbe.
Management of suspected rabies cases
Following potential exposure to rabies, the wound or site of exposure should be cleansed under running water and washed for several minutes with soapy water as soon as possible after exposure. Disinfectant and dressing should be applied.
The use of vaccines after exposure should be considered whenever a person has been attacked by an animal. In the un-immunized individuals 5 doses of human anti-rabies vaccines is given over a month on days 0, 3, 7, 14 and 30.
Rabies in humans is 100% preventable through pre-exposure prophylaxis (prevention) and prompt appropriate medical care.
Yet, more than 55,000 people, mostly in Africa and Asia, die from rabies every year, a rate of one person every ten minutes.
Pre-exposure prophylaxis should be offered to those at high risk like those working in quarantine stations, animal handlers, veterinary surgeons and field workers likely to be bitten by wild animals.
The most important global source of rabies in humans is from uncontrolled rabies in dogs.
Children are often at greatest risk from rabies. They are more likely to be bitten by dogs, and are also more likely to be severely exposed through multiple bites in high-risk sites on the body.
Severe exposures make it more difficult to prevent rabies unless access to good medical care is immediately available.
This major source of rabies in humans can be eliminated through ensuring adequate animal vaccination and control, educating those at risk, and enhancing access of those bitten to appropriate medical care.
Recently, at the prompting of the UCU Health and Safety Committee, the Facilities and Capital Projects in collaboration with the District Veterinary Department has carried out killing of stray dogs on the campus.
The control of stray dogs off-campus is the mandate of the Municipality Veterinary Department .