Rabies: What You Should Know About This Deadly Virus

Rabies Symptoms

Infected animals most commonly transmit rabies to humans through contact, particularly via bites. The virus resides in the salivary glands of animals and enters the human body through broken skin, eventually reaching the brain and causing severe damage. According to the CDC (2011), the primary carriers of rabies in the United States have shifted over the past century. While rabid dogs were once the main source, particularly in developing countries, changes in urban development—such as Glasgow’s expansion—and the introduction of routine pet vaccinations in the 1940s (Finnegan et al., 2003) have contributed to a reduction in domestic dog transmission. In the U.S., rabies is now more commonly spread by wild carnivores like raccoons, foxes, coyotes, and skunks. These changes highlight the importance of continued vaccination efforts and public health measures to control the spread of rabies and protect both humans and animals from infection.

Since the 1900s, rabies mortality in the United States has decreased from approximately 100 fatalities annually to about one or two (World Health Organization [WHO], 2017).

Suppose it is mainly due to the routine vaccination of domestic animals. Furthermore, the majority of the population in the United States has easy access to health care, and post-exposure prophylaxis is readily available (CDC, 2011). The population of the United States is also well-informed about health risks. It has access to various resources that would allow them to research the risks of being bitten by an animal, especially a wild animal such as a bat, raccoon, skunk, fox, or coyote, and domestic pets as well.

These resources may not be as accessible to the rest of the world, which likely contributes to the majority of rabies deaths occurring in areas with inadequate health care, where domestic animals are not vaccinated and residents lack access to the internet or other educational resources unless they are provided.

Global Rabies Statistics and Healthcare Access

In Thailand, despite a high level of knowledge about rabies and its severity, there was a deficiency in awareness regarding bat transmission. Only 10% of the people who took a survey identified bats as a potential source of rabies, and 36% said they would likely not take any specific action if bitten by a bat (Robertson, Kis, Boonlert Lumlertdacha, et al., 2011). According to the WHO, although rabies affects all continents, 95% of deaths occur in Asia and Africa. Even if rabies post-exposure prophylaxis (PEP) is readily available to people in these areas, the costs of PEP are $40 and $49, respectively (WHO, 2017). Even some uninsured American citizens might find it challenging to afford this cost, let alone an individual in Asia or Africa whose “average daily income can range from $1-2 per person” (WHO, 2017).

Furthermore, the diagnosis of rabies has also evolved.

Previously, the disease was a post-mortem diagnosis in animals, which means that the animal, if not already dead, had to be euthanized to take brain samples and confirm the diagnosis (CDC, 2011). Today, instead of euthanizing a perfectly healthy animal, it can be watched for ten days after it bites someone. If no symptoms of rabies appear, it means the animal is rabies-free (CDC, 2011). That not only decreases harm to healthy animals but also reduces the need to treat prophylactically, which, according to the WHO, is high, “typically exceeding 3,000” (WHO, 2017). Diagnosing rabies in humans is quite different, and although there are many diagnostic tests available, the WHO reports that those are not “suitable for detecting rabies infection before the onset of clinical disease.”

Fatal Infestations

The video “Fatal Infestations” highlights the tragic impact of rabies, a preventable and treatable disease if caught early. Rabies affects the nervous system, causing symptoms like seizures, aggression, drooling, hydrophobia, paralysis, and coma. Once symptoms appear, recovery is highly unlikely. Despite being familiar with rabies symptoms, physicians often miss the diagnosis. As the video suggests, rabies wasn’t initially considered. This reflects a common medical issue—“If you don’t think of it, you won’t diagnose it”—emphasizing the need for awareness.

The investigator must take specific steps in whichever order they deem necessary during an epidemiological investigation (Gregg, Michael B., 3-13, free from Fortunately).

The class video showed a brief look at a real epidemiological investigation. It began when local health departments contacted the CDC about a possible outbreak. The CDC interviewed families and gathered descriptive epidemiology data—when, where, who, and how many. They searched for links between the three coma patients in the ICU and ran various lab tests and imaging, but were ultimately unable to determine the cause of the illness.

When the first fatality occurred, and the organ donor was identified as the source, descriptive epidemiology continued, now centering on the donor himself.

The CDC visited the patient’s home and spoke with friends and family, uncovering a recent bat bite on the donor’s chest. They requested an autopsy and investigated the donor’s home using infrared lenses, where they found multiple bats. The bats were tested and confirmed to carry the same rabies virus as the donor. This identified the source of infection. The video concludes with the death of the final victim, highlighting the deadly outcome of undetected rabies exposure.

When someone is near death from an unknown but fatal cause, local health departments and the CDC must investigate quickly. An initial investigation involves defining the case—such as erratic behavior, seizures, and coma—and counting cases, which in this scenario totals three, with the first as patient zero. The video shows symptoms appeared 3–7 days after organ transplant surgery, suggesting a fast-acting, deadly cause. This urgency places pressure on investigators to work both accurately and swiftly to prevent further spread. My next step would be to begin data collection.

Descriptive epidemiology

Descriptive epidemiology includes demographics, exposures, similarities among the three cases, hospital information, and discussions with doctors to determine whether the infection originated from the surgical room, the tools used, or the staff present. Since it is unknown whether or not any of these things are the source, I would be concerned about a larger range of exposure and a possible epidemic.

This information helps form a hypothesis of the possible source of infection and diagnosis; it would also help me decide whether or not to launch a full investigation (Gregg, Michael B, 186). In this case, I would proceed with caution due to the high risk of an epidemic caused by an unknown disease that can be fatal within 3-7 days. Once I ruled out the organ recipient hospital as the source of infection, I shifted my hypothesis to the donor hospital and the donor himself as the possible sources.

I would use visual aids and maps to help graph the case count and orient them in place (Gregg, Michael B, 191-196). This approach will assist me in gathering information from the donor hospital. Doing this may show the point of origin of infection and narrow down the possible source. This experiment shows that as investigators progress through the investigation, they will also change and narrow the hypothesis until they find the true source.

Key Information Required About the Donor

The information I would require about the donor includes his symptoms on arrival at the hospital, which included erratic behavior, seizures, and drooling. I gathered information from friends and family about recent exposures, which revealed the bat bite from weeks ago. With the combination of the bat bite and the symptoms, the doctor in me would immediately be concerned about rabies.

Like the CDC, I’d request a brain biopsy and home investigation; rabies diagnosis leaves little treatment for surviving recipients. Regrettably, symptoms have already manifested, and as previously stated, the likelihood of recovery is low.

Rabies is a viral disease that usually spreads to humans by contact with infected animals.

Although the video ends with the victim’s death, an epidemiological investigation continues to uncover causes and prevent future cases. It is imperative to continue assessing risks of exposure to other people besides the initial victims. Since rabies symptoms appear 1 week to 3 months after exposure, it’s vital to check for fluid exchange with others. (CDC, 2011).

If rabies is likely and no neurological symptoms appear, providers should give PEP to help prevent further casualties. Furthermore, I would be concerned about the presence of bats in the neighboring areas of the donors’ homes.

If his house had bats, others likely do too, putting their residents at risk of rabies from bites. A key part of an epidemiological investigation is writing a report that summarizes findings and provides recommendations for action.

Educational Outreach and Preventive Measures

Executing recommendations and implementing prevention measures is vital to keep healthy individuals safe and free from disease risk. This includes surveillance for bat, wild carnivore, and rabid dog sightings. Bats and rabid animals can infect domestic animals, so monitoring changes in domestic animal behavior is essential.

I would distribute pamphlets warning about rabies risk and advising immediate soap-and-water cleaning after an animal bite. 2)Make an appointment with your doctor to evaluate your potential exposure risk and receive PEP if necessary. I would ask Animal Control to help remove raccoons, bats, and other rabies carriers from the streets.

The above includes what I would do if I were the investigator on the rabies case.

As previously mentioned, my approach would differ from the actions depicted in the video. Because of my medical background, I believe I may have been able to detect the possibility of rabies sooner and avoid the delay in diagnosis. I would have also used visual aids to help identify the common area of exposure and the pattern of transmission. The U.S. investigation prioritized certain risks, while international research would face added challenges like language, culture, and politics. These challenges would lead to significant delays in both acquiring data and quickly arriving at a diagnosis.

Challenges in International Rabies Investigations

Some places in the world do not trust the Western world, which affects forming hypotheses and collecting data. This distrust also delays the creation of prevention and treatment plans to control the spread of infection. Internationally, I would focus less on wild animals and more on domestic animals. Unvaccinated dogs cause most rabies cases outside the U.S.; the plan involves mass dog vaccination with veterinary support. We would monitor street dogs for rabies symptoms and put them down if rabies is confirmed. They are teaching the population about ways to protect themselves and others. Inform families that those most at risk of acquiring rabies are their children (Finnegan, C. J., S. M. Brookes, et al., 2003).

Community Education and Prevention

Educating people about rabies reservoirs is crucial to preventing the challenges currently faced by countries like Thailand. Preventing the re-emergence and epidemics of a disease is the goal. They implement prevention measures. They will struggle to supply enough rabies vaccines for all dogs and cannot eliminate every risk of exposure. Another thing to consider is access to health care.

If a dog bites someone, do they know where to go to get PEP? Can they arrive there quickly and safely? Will it be affordable? Public health officials must address obstacles, especially internationally, where limited healthcare access demands a clear plan for timely treatment. Overall, the investigation conducted during the rabies video does show the typical course of an epidemiological investigation.

I believe there were delays in reporting the issue to the CDC and diagnosing the donor with rabies. Fortunately, the three victims had only just contracted the disease. People and practicing physicians must stay informed about rabies, its hosts, transmission, treatment options, and prognosis.

Rabies: What You Should Know About This Deadly Virus

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Rabies Symptoms

Since the 1900s, rabies mortality in the United States has decreased from approximately 100 fatalities annually to about one or two (World Health Organization [WHO], 2017).