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Rabies Virus
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In
Islam the keeping of pets is discouraged and the careful and kind treatment of
animals is encouraged. Prophet Mohammad (saaw) deemed it necessary for dogs to
be kept as protection and for work only. “Whoever keeps a [pet] which is
neither a watchdog nor a hunting dog, will get a daily deduction from his good
deeds” (Bukhari 7:389). However, the increase of domestic pets and lack of
caution with wild animals has cause a mass increase in cases of rabies around
the world.
“Rabies”
comes from the Sanskrit “rabhas” - which means “to do violence.”
This ancient disease kills 50,000 people worldwide annually mostly in Africa and
Asia where canine rabies is common. However, recently indigenous rabid rats have
been reported in every U.S. state except Hawaii where rabies can also be found
in bats, foxes, raccoons and skunks (CDC #1, p.1). The cost of tackling the
problem in the wild was $450 million annually in the year 2000 when an emergency
was declared releasing $4.2 million for an oral vaccine to tackle the problem
amongst wildlife (ENS, p.4).
The
bullet-shaped rabies virus cannot reproduce and survives by inserting genetic
material into the host’s nervous tissue and salivary glands (clincohd, p.1).
Infection through a bite or an open wound can also be transmitted via mucous
membranes, corneal transplants and aerosols (Nelson, p.1). Because of this any
domestic animal that is infected is put in a 10-day quarantine so there is time
to ascertain if the animal is infected.
Symptoms
of rabies in animals include a lack of fear, disorientation, partial or full
paralysis and difficulty in standing or walking. There can also be
hyper-alertness, nervousness, aggressiveness and a tendency to salivate
excessively including hydrophobia (clincohd, p.1). In humans, the first stage
takes up to four days showing flu-like symptoms, a general feeling of sickness
and general twitching or tingling around the infected area. The second stage
involves similar symptoms to encephalitis - inflammation of the brain. Fevers
can soar up to 105º with accompanying hallucinations, convulsions and
paralysis. In the final stage there is a deterioration of the central nervous
system: foaming at the mouth, lack of muscle control, difficulty breathing or
swallowing and sometimes…coma (Nelson, p.1).
Increased
cases of rabies in Europe have occurred lately due to the longer autumn and
winters. These seasonal changes have given rise to the dispersal of young foxes,
increasing the rate of contact. Contact is often made first with pets and then
transferred to the owner of that pet. In total, 10,435 cases were accounted for
in Europe last year. There were twelve cases of rabies amongst humans - ten in
Russia and two in Britain (WHO #1, p.1). In Iran, the increase in stray dogs has
increased human exposure to animal bites. In 1996 there were 57,070 incidences,
which rose to 66,632 by 1998. Infection of domestic livestock has been frequent
and human fatalities have taken place among ten teenage males (Zeynali et al,
p.1,2).
In
the USA, currently, the main source of rabies is bats. The most common U.S. bats
are the “Silver-Haired” and the “Eastern Pipistrelle” bats (Young, p.1).
The habitat of the Silver-Haired are forests, spaces under loose bark and
daytime retreats include buildings. The bats have thick sooty brown to black fur
with white tips of hair creating a frost-like appearance (TMOT, p.1). The
“Eastern Pipistrelle” hangs around leaves of trees and shrubs. The females
gather in spring inside buildings to form nurseries for their young. Both bats
only weigh up to 10g with jaws less than 1cm across. Their bites can be mistaken
for a thorn prick or a bee sting. Robert Gibbon of the Walter Reed Army
Institute in Silver Springs found that 24 of the 26 fatalities were of a subtype
that infects bats. However, only two of the 26 infected people reported that
they were bitten by a bat (Young, p.1).
Several
human tests are necessary to establish the presence of rabies. Samples include
saliva, serum, spinal fluid and skin biopsies of hair follicle from the nape of
the neck. However, once symptoms set-in, regardless of post-vaccination the
result is death. Consequentially this has placed emphasis on preventative
vaccination.
Chiron
Corporation markets RabAvert™ rabies vaccine as a pre-exposure and
post-exposure vaccine. Clinical trials occurred in Croatia, Thailand, the U.K.
and the U.S. Reactions include pain, swelling and reddening at the injected site
and systemic reactions that cause headaches, myalgia and malaise (docguide p. 1,
2). The rabies Human Diploid Vaccine (HDCV) is offered as post-exposure
and pre-exposure vaccine. It is given intradermally and intramuscularly. It is
the only vaccine approved by the FDA along with Imovax Rabies (AVMA, p.2). It is
sterile and stable consisting of inactivated rabies cell-culture from material
grown in the brain of rabbits refined and cultured with the human diploid cell.
On days 0, 21 and 28 of the treatment, three doses of pre-exposure vaccine are
given. The vaccine stimulates rapid production of specific antibodies. A serum
test is taken three weeks after the HDCV course of vaccination to assess if the
antibodies against rabies have produced sufficiently. If one has no previous
immunization, a course of five injections of IM-HDCV is given followed by rabies
immune globulin (RIG) according to weight. This allows for temporary protection
while the antibodies stimulated by the vaccine are in production.
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chart
of rabies cases
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Experts
advise, however, that the vaccine shouldn’t be taken if there is a temperature
of over 100ºF or if one is pregnant. Side effects include headaches,
nausea, abdominal pain and muscle-aches. Boosters have been linked to allergic
reactions like hives, itching and swelling under the skin (McKinley, p.1, 2).
The American Veterinary Medical Association reported that corticosteroids, other
immune suppressive agents, anti-malarial, immuno-suppressive illnesses interfere
with the development of immunity after vaccination. Doctors should also be
informed beforehand if one has any allergies and those who have a hypersensitive
reaction to rabies vaccine should not re-vaccinate (AVMA, p.5).
In
Iran, all rabies patients receive Vero Rabiea vaccine. In 1998 22.4% received
RIG. Unfortunately, the frequent vaccination places a financial burden on the
country. In 1996 alone, 10,000 people received a complete course of five
injections and 47,000 received an incomplete course of three injections (Zeynali
et al, p.1, 3). In the USA, the actual costs of vaccines are 60-95c but clients
are charged $15 - $25 per injection (Fudens, p.1). Life-saving treatment can
cost as much as $1,000 per person and the pre-exposure course of treatment can
cost as much as $400. As such, preventative human vaccine is only given to
veterinarians and animal researchers (Seppa, p.1). Because of this high vaccine
cost, emphasis is still being put on prevention. One example of a successful
rabies errdication campaign occurred in Iceland. Paula Heikkman-Lehkonen
commented “there are only about 270,000 inhabitants in the whole country, half
of whom live in the capital, Reykjavik, which became infamous in dog circles
world-wide some years ago by completely banning dogs. Even today you are not
allowed to keep dogs in the city, and the dog license fee is quite high”
(Abdul-Rahman, p.2).
Rasulullah
(saaw) spoke of a man who quenched the thirst of a dog that was eating mud.
Rasulullah (saaw) said, “Allah thanked him for his [good] deed and forgave
him.” Then the people asked “O Allah’s Apostle! Is there reward
for us in serving [the animals]?” He replied,“Yes, there is a reward for
serving any animate [living thing]” (Bukhari, 3:551). By serving animals
with kindness and medical treatment the result will be a decrease in the
incidence of rabies among humans.
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