Esaunggul.ac.id, World Rabies Day is celebrated around the world every September 28. The observance, which has been held since 2007, aims to raise awareness about efforts to eradicate the virus that causes the deadliest disease and to disseminate important information about prevention efforts, as well as to encourage increased efforts in rabies vaccination programs around the world.
The theme for World Rabies Day 2024 is Breaking Rabies Boundaries. This theme was chosen to encourage stakeholders and all levels of society to unite to achieve the goal of a world free from rabies deaths by 2030.
Why We Should Commemorate World Rabies Day
For more than 4,000 years, rabies has been a public health problem around the world, including in Indonesia.
According to https://www.dogster.com/lifestyle/world-rabies-day, more than 59,000 people die from this deadly disease every year worldwide, mostly in Africa and Asia. About 99 percent of the cause comes from dog bites.
Rabies, a zoonotic disease transmitted from animals to humans, is one of the oldest and deadliest diseases. Rabies is caused by an RNA virus belonging to the genus Lyssavirus of the family Rhabdoviridae.
Methods of Rabies Transmission
Rabies is mostly transmitted through the bites and scratches of animals infected with the rabies virus, or the licks of infected pets on open wounds.
Rabies is often transmitted through the bite of a dog. However, other mammals such as cats, monkeys, bats, wolves, foxes and squirrels can also be infected with the rabies virus and transmit it to humans.
The pathogenesis of rabies virus consists of two phases: the incubation phase and the entry phase of the virus into the brain. The rabies virus, which enters the body through a bite wound or scratch from an infected animal, will replicate in the muscle tissue in the wound area.
In this phase, the endogenous micro-ribonucleic acid of the muscle will bind to the transcription process of the viral genome and limit the synthesis of viral proteins in such a way that the rabies virus is not detected by antigen-presenting cells (APC) in the immune system, so that the rabies virus can replicate rapidly.
The rabies virus then binds to motor neuron junctions at nicotinic acetylcholine receptors, affecting the performance of the motor nervous system.
Subsequently, the virus rapidly passes through motor axons and chemical synapses into ganglia and neuronal radices and into the spinal ganglion, eventually causing damage to the nervous system.
During the incubation period of the rabies virus, which generally lasts 2-3 months, there are no symptoms of disease. During this incubation period, the rabies virus is not detected by the immune system, so it does not cause an antibody response.
The next phase is the entry of the rabies virus into the brain cells. Once the virus reaches the central nervous system, it replicates rapidly and spreads widely through nicotinic acetylcholine receptors in the brain. Multiplication of the virus in the ganglion will lead to initial symptoms of pain and paresthesias.
Subsequently, the virus will spread from the central nervous system to other organs, resulting in a fatal outcome due to complete neurotransmitter blockade and extensive neurological dysfunction.
Various studies have shown that the binding of the virus to acetylcholine neurotransmitter receptors causes neurotoxic effects on nerve cells, especially in the central nervous system.
Clinical Symptoms
Signs of rabies generally appear 20-90 days after a person is bitten by an animal infected with the rabies virus. Initial indications are usually similar to the common cold, including fever, headache and fatigue.
The next stage is called the prodromal phase and includes behavioral disturbances such as restlessness or anxiety, itching or burning at the bite site.
After that the person with the disease will enter the acute phase, where there will be difficulty swallowing, seizures, anxiety, insomnia, and progressive muscle paralysis. The next stage is the terminal phase, where the patient will lose consciousness and fall into a coma, respiratory failure.
Once advanced symptoms appear, rabies is usually fatal, causing the patient to lose consciousness, and leading to death. Death usually occurs from day 4 to day 7 after the coma starts.
Detection Methods of Rabies Virus
Rapid and accurate laboratory diagnosis of rabies virus in humans and animals is essential for the provision of timely medical treatment, or postexposure prophylaxis.
According to https://www.who-rabies-bulletin.org/site-page/diagnosis-rabies, the main diagnostic test recommended by WHO as the gold standard is the fluorescent antibody test (FAT).
This test is based on antigen detection for rabies diagnosis. Specimens taken from patients are reacted with antirabies serum or globulin labeled with fluorescein isothiocyanate (FITC) compound.
Specific aggregates of rabies virus antigens are detected for fluorescence using fluorescence microscopy. This detection method is accurate, sensitive and rapid.
In addition, a test method using reverse transcriptase polymerase chain reaction (RT-PCR) technique has been developed that can also be used to detect the presence of rabies virus genetic material.
Another method used is immunohistochemistry. This method is sensitive and specific for detecting rabies virus antigens in tissues. Rabies virus antigens are detected using specific antirabies monoclonal or polyclonal antibodies.
Immunohistochemical testing is more sensitive and specific than histological staining methods, such as hematoxylin and eosin and Sellers staining.
Prevention and Treatment
As of today’s World Rabies Day, there is no effective cure for rabies once the virus has spread to the brain and central nervous system.
When rabies symptoms such as seizures and paralysis appear, it is almost certainly fatal. Treatment can only be given symptomatic and supportive medication. Therefore, prevention is a very important factor to protect yourself and your pets.
Some preventive measures include vaccinating pets with rabies vaccines regularly according to a set schedule, and avoiding bites from animals that have the potential to transmit the rabies virus.
Without proper vaccination, pets will be vulnerable to infection. If a rabies-infected animal then bites or scratches a human, the rabies virus can be transmitted and can harm humans.
Rabies vaccination is able to stimulate the body to form antibodies, so that it can fight against rabies viruses that enter the body. Antibodies will form after 7-10 days to protect the body.
Rabies is a serious disease that can cause death. The virus can infect the central nervous system. When the infection from rabies attacks the body, severe complications can be avoided due to the administration of this vaccine.
The vaccine is given by intramuscular injection, in the thigh muscle for children and upper arm muscle for adults. It is recommended to receive the vaccine at least 1 month before traveling to a rabies-prone area.
If the vaccine is administered to treat a rabies infection following an animal bite or scratch, clean the wound immediately with soap and running water.
After that, clean the wound with alcohol and cover with a bandage, then immediately go to the hospital for further treatment. Rabies vaccines can also be given as soon as possible after exposure, before symptoms appear.
In Indonesia, there are two types of rabies vaccines that can be given to humans: Pre-exposure Prophylaxis (PrPP) and Post-exposure Prophylaxis (PEP).
The PrPP vaccine is usually given to people considered at high risk of exposure, such as animal control officers, veterinarians, or people living in or traveling to rabies endemic areas.
Periodic booster administration of the PrPP vaccine is also recommended for extra prevention, for people whose jobs pose a high risk of exposure to the rabies virus. The PEP rabies vaccine is intended to stop the onset of rabies symptoms after exposure to the virus.
This vaccine aims to protect the body after an animal bite. PEP consists of an injection of antibodies against the rabies virus (human rabies immune globulin or HRIG). The rabies vaccine is given on the day of exposure to the virus, with follow-up vaccine doses on days 3, 7 and 14. With World Rabies Day being celebrated, it is hoped that the public will be more aware of how to manage and treat rabies.
Celebrate World Rabies Day
Until World Rabies Day in 2024, this is still a complex and deadly disease that is not fully understood and which scientists have yet to eradicate.
The main significance of World Rabies Day is the momentum to raise awareness and the importance of eradicating this disease worldwide.
The participation of stakeholders including the government and all levels of society is needed to help prevent the rabies virus through vaccination programs and other preventive efforts so that this disease can be eliminated worldwide as soon as possible.
