Rabies (Latin rabies, obsolete - hydrophobia, hydrophobia) is an acute infectious viral disease transmitted through the bites and saliva of carnivorous animals and characterized by predominant damage to the central nervous system. In the active phase, it progresses quickly and with severe symptoms. In the absence of preventive measures, the probability of a fatal outcome in people and animals with rabies is 100%.

The clinical picture of rabies was first described by Aulus Cornelius Celsus (1st century AD), who also called this disease hydrophobia. Before that, it was known that the disease occurred in people after animal bites. In 1885, Louis Pasteur developed an anti-rabies vaccine that completely protected a person from developing the disease. Since 1906, Pasteur stations began to operate in the Russian Empire, where they gave vaccinations against rabies.

Every year, more than 55,000 people die from this disease worldwide, mainly in Latin America, Africa and Asia. In the Republic of Belarus, from 2013 to 2023, no cases of rabies were detected among the population, but cases of rabies among animals are constantly registered. In this regard, there is always a potential threat of human infection.

The reservoir and source of the rabies virus (rabies virus) are infected wild and domestic animals (foxes, wolves, dogs, cats, bats, rodents, horses, small and large cattle, etc.). The virus is released into the external environment with saliva, which becomes infectious 8-10 days before the onset of symptoms of the disease.

Human infection usually occurs through bites, less often through drooling by an animal with rabies. In recent years, it has been proven that in addition to contact, airborne (in caves inhabited by bats, laboratory infections), alimentary and transplacental routes of virus transmission are possible. A sick person in natural conditions does not pose an epidemiological danger. In-hospital cases of infection associated with corneal transplantation of people who died of rabies have been described.

The infection does not develop in all cases: the risk of developing the disease is largely determined by the severity of the damage and the location of the bite. Thus, when bitten by a rabid animal in the proximal parts of the arms and legs, the risk of developing the disease is about 23%, with bites in the hands - 63%, and in the case of damage to the face and neck - in 90% of cases.

The incubation period for rabies infection usually ranges from 1.5 weeks to 3 months and depends on the location of the bite or saliva. With multiple bites to the head and neck, the disease develops after 2 weeks - 1 month, with damage to the lower extremities, signs of rabies in humans can appear after 2-3 months and even 1 year. Penetrating the human body, the virus spreads along the nerve fibers, can be carried by the blood and lymph flow.

In the initial period of the disease, nagging pains, burning and itching appear in the area of ​​the already healed wound after the bite. The body temperature may increase slightly. The psyche of the sick person changes: he is depressed, withdrawn, sometimes irritable, refuses to eat, complains of general malaise, headache. Dyspeptic symptoms and a feeling of tightness in the chest are possible.

After 2-3 days, the period of depression is replaced by a period of excitement, which is characterized by the development of typical symptoms - hydrophobia, aerophobia, acoustophobia, photophobia. Hydrophobia is manifested by a painful spasm of the muscles of the pharynx and larynx when trying to drink water. However, these reactions do not occur in all cases of rabies, which can prevent the doctor from making the correct diagnosis. Noise, bright light, air movement can provoke painful spasms of the facial muscles, an expression of horror on the face, dilation of the pupils. The patient is excited, aggressive, can hit, bite or spit at others. Strong salivation is observed. Attacks of excitement gradually become more frequent. Auditory, visual and olfactory hallucinations develop. Consciousness becomes confused only towards the end of the disease. This period lasts 2-3 days, rarely 6 days.

In the final period of the disease, agitation is replaced by apathy. The manifestations of the previous period may gradually disappear. However, against this background, the body temperature quickly rises to high numbers and paralysis of the limbs develops. Death occurs from paralysis of the respiratory and vasomotor centers.

Diagnosis of rabies is complex and is usually made on the basis of the clinical picture and epidemiological history.

At the same time, lifetime verification of the diagnosis using laboratory research methods (if the patient develops clinical signs of the disease) is usually carried out too late, when a fatal outcome can no longer be prevented. Tests also help to adjust supportive therapy for a fatal infectious disease.

It is necessary to contact a doctor immediately after contact with an aggressive animal. The doctor determines the characteristic features of the wounds, the depth of tissue damage by the animal's teeth, and assesses the degree of salivation. All this is necessary to determine the estimated duration of the incubation period. During further observation, the doctor notes the presence of visual signs of rabies - changes in behavior, pupil size, etc.

There are currently no drugs that can cure rabies. The efforts of medical workers can only be aimed at reducing the patient's suffering. To do this, he is placed in a darkened room with good sound insulation, prescribed anticonvulsants, sleeping pills, administered painkillers and tranquilizers.

In these conditions, rabies prevention is of vital importance, which includes both measures to prevent the disease in humans and measures to prevent the spread of this infection among animals.

In the Republic of Belarus, about 20 thousand people who have suffered from contact with animals seek anti-rabies assistance every year, about 30% of those who seek help are children under 18. Most of those who seek help have suffered from contact with dogs and cats. Cases of injuries to humans from wild and farm animals are not uncommon.

In case of bites, scratches and drooling by animals, the victim must wash and treat the wound, and then contact a traumatologist or surgeon at a healthcare facility as soon as possible to decide on the appointment and implementation of a course of anti-rabies vaccination.

Vaccination against rabies is effective only if the course is started no later than the 14th day from the moment of the bite. The protective level of antibodies is formed no earlier than 12-14 days after vaccination, therefore, if a short incubation period is suspected (extensive soft tissue lesions, bite localization close to the brain), in addition to the vaccine, anti-rabies immunoglobulin is administered. Timely and thorough prophylaxis after contact with a sick animal almost always prevents the development of rabies in humans.

It is very important to take measures to organize observation of the animal simultaneously with seeking help regarding contact with a doctor. Veterinary specialists establish observation of a known animal (the owner's contact information is available) for a period of 10 days from the moment of interaction with the animal. If, according to the results of veterinary observation, the animal is healthy, then the vaccination course may be stopped by the decision of the surgeon (traumatologist).

In the Republic of Belarus, preventive immunization of individuals with a high risk of infection with the rabies virus is also carried out (veterinary workers, hunters, foresters, individuals performing work on catching and keeping stray animals, etc.).

Animals with rabies are registered in our country every year. The disease occurs among wild (foxes, raccoon dogs, wolves, etc.), domestic (dogs, cats) and farm animals (cattle, etc.). Thus, in 2022, a total of 260 cases of the disease were registered, including 164 among wild animals, 69 among domestic (dogs and cats, including strays) and 27 among farm animals. The largest number of rabies cases among wild animals was detected in foxes, among domestic animals - in cats and dogs, among farm animals - in cattle.

Animals with rabies can often be recognized by their strange behavior: they may be excited and aggressive, or weakened and paralyzed, and at the same time not feel fear of people. Animals that lead a nocturnal lifestyle may appear during the day. Also, a sick animal is characterized by profuse salivation and lacrimation. If you have the slightest suspicion of rabies, you should not approach the animal.

Rabies is one of the most dangerous and severe infectious diseases of humans and animals. Everyone is at risk of contracting this infection. Only compliance with the rules for keeping animals and timely seeking medical help will help prevent rabies!