The One Health Initiative is a movement to forge co-equal, all-inclusive collaborations between all healthcare providers. Veterinarians are used to taking treatments and medications from human medicine, but our important role as human health protectors is now being recognized. Indeed our puppy plan is set up around the human risk of abarent parasite migration risks. By treating the puppy at the appropriate time, the human does not have the fatal disease.
Another fatal disease that I work with is rabies. We do not see much rabies in the United States. There have only been twenty-three cases of human rabies in the United States in the past decade and eight of those were contracted outside of the U.S. That means it is rare in the U.S., with only 1 to 3 cases reported annually.
Human rabies deaths have been declining due to successful animal control and vaccination programs, successful outreach programs, and the availability of modern rabies vaccine and antiserum treatment. In the 1970’s, dogs were an important rabies reservoir or place where rabies was kept alive. Animal vaccinations have reduced this, but there are still between 60 to 70 dogs and more than 250 cats testing positive for rabies each year. Most of these were unvaccinated and became infected from rabid wildlife (such as bats, raccoons, and skunks).
There is also a program to vaccinate wildlife. The oral vaccine, packaged in bait, is dropped from aircraft for raccoons and skunks. It is not as effective as our pet vaccines, but much more practical than grabbing up all the raccoons to inject them.
Once contracted, rabies is virtually always fatal. Rabies symptoms start out like the flu virus. There can be a general weakness or discomfort, fever, or a headache all which may last for days. There may be a tingling or discomfort at the site of the bite, and within days it progresses to symptoms of cerebral dysfunction, anxiety, confusion, agitation. As rabies progresses, the person may experience delirium, abnormal behavior, hallucinations, and insomnia.
In the acute phase (2 to 10 days), passive antibody (injections of human immune globulin) and rabies vaccine may be effective but are best given at the time of the bite or exposure.
The rabies virus is unique in the disease world. Almost all mammals can carry it, but carnivores are some of the best hosts. Once an animal (or human) is bitten, the virus travels up the nerves to the brain. All nerves lead to the central nervous system just like all veins lead to the heart. If the bite is close to the brain, like the face, this happens quickly. If it is on the little toe or a superficial bite, it might take years. Once in the brain, the virus lives in the part of the brain that controls emotion and creates a rage emotion. (Think of the phrase “mean as a rabid dog.”) Animals become aggressive and more likely to bite which allows the virus to jump to a new host. The virus also reproduces in the salivary glands, while decreasing the swallowing reflex. Hence the classic ‘foaming at the mouth’ vision of a rabid dog.
There is another form of rabies called the dumb form of rabies. Farm animals that drool and don’t act right or skunks that present to be petted are the dumb form of rabies.
Let there be no question, that we vaccinate pets and domestic animals to protect humans. That is why there is a law to vaccinate in our state. Since exposure to disease symptoms can be so long, it is even possible to have rabies in a vaccinated dog. But if the disease is to the point of spreading virus particles, the animal or human will be dead or dying within ten days.
The quarantine periods are set up because of this time period. But if the animal has not been vaccinated or dies or is euthanized within the 10 to 15 day period, the health department can force the submission of neural tissue for testing. That doesn’t sound bad until you figure out that means brain tissue. Brain tissue that has not been compromised by sampling. One of my least favorite jobs is to cut off heads to submit on ice for rabies testing. This is also an important reason to vaccinate so that your dog/cat/ferret/horse/pig does not have to be tested for rabies.
Despite the control of rabies in domestic dogs in the United States, each year interactions with suspect animals result in the need to observe or test hundreds of thousands of animals and to administer rabies postexposure prophylaxis to 30,000 to 60,000 persons.
Backing up to the bite or exposure, one of the best treatments is post-exposure washing of the wound with soap and water. Then treat it with alcohol or iodine. Then head to the ER. Even bites that do not break the skin, need to be washed. Indeed one of the most common transmission bites is a tiny animal that cannot break the skin to have it bleed, but plants virus particles into the skin.
If you skip the washing, disinfecting and ER trip, and clinical signs of rabies appear, the disease is nearly always fatal. You will get treatment, but you will still die. That is why we stress and understand the importance of prevention.
But around the world, under served communities have limited access to health and veterinary systems. This is why I will be joining The Big Fix in Uganda. According to the World Health Organization, successful rabies control programs comprise of three pillars: community participation; education, public awareness and access to mass vaccination of dogs; and access to post bite treatment. I will be working with all three phases and we will be providing free spays and neuters also.
I have always felt driven to give back. This year I will be working with the One Health concepts to prevent human rabies by vaccinating African dogs. Oh, and by vaccinating dogs in Raceland at Race Days at a free vaccine clinic.
Dr. MJ Wixsom owns and practices at Guardian Animal Medical Center on Bellefonte Road in Flatwoods, KY. 606.928.6566 and online at www.GuardianAnimal.com and has her fourth book out.