September 29, 2017 is World Rabies Day

Today is World Rabies Day. 

To many Neurologists, no other medical condition can ever be more dreadful and most dismaying to manage as rabies. For me rabies has no competition. My lowest moments as a Neurologist have been at my encounters with rabies patients, especially children. It is a death sentence carried out with ruthless execution. None has survived in my watch.

Despite the advances of medical science, mortality from rabies remains 99%. Most fatalities from the viral encephalitis (inflammation of the brain) occur in Asia and Africa, with India having the highest case fatalities (> 20,000/year). In the Americas and Europe other animals apart from dogs (bats, foxes etc) are involved. In Asia and Africa dogs are the major culprits. 

The action of health workers to rabies patients alone kills the spirit before the virus kills the body. All due to the known fact that they are most infectious at that moment and no therapy is available. It can be traumatic for the relations to behold. 

I still remember a 10 year- old boy being led away by the distraught mother from the Emergency Department of UNTH Enugu in 2001. He had been bitten by a stray dog more than two weeks earlier, only to start barking repeatedly two days prior to presentation. The doctors had told them nothing could be done. Death hovered around the boy. The mother knew. The boy did not. I cried inside of me. 

I came away then with the feeling that ‘only a dead dog was the good dog’. I still keep far from them.

The terrible mortality rate has been known since antiquity. Suspected human cases often committed suicide or were killed by people (? euthanasia).  There are only six known survivors in recorded history. Just two of these survived without receiving post exposure prophylaxis (PEP). 

One survivor in modern era is Jeanna Giesen (see picture attached), who contracted rabies after sustaining a bite from a fruit bat on September 12, 2004 in Wisconsin, USA. She was a 15 year-old high school student. She endured a grueling novel therapy called the Milwaukee Protocol which required her to bear 6 days of medical induced coma. In all she stayed 31 days in isolation and 76 days in hospital. She was discharged January 1 2005 and went on to graduate as Biology major in 2011. She still has some residual coordination deficits but has remained functional and works as an anti-rabies advocate. In 2015 she got married.

Jeanna’s story cannot be replicated for most. Prevention is key. Regular and effective vaccination of dogs remains the major instrument to preventing rabies. Government participation and enforcement is central. Culling of stray dogs is also a component of this strategy. But in Nigeria, the story is one of official inattention.

So as we celebrate World Rabies Day, please ensure that your pets are regularly vaccinated. Keep dogs leashed. Avoid suspicious looking animals (too dull or ferocious) and if bitten seek prompt medical attention for post- exposure prophylaxis.

Stay safe please.

 Jeanna Giesen