Rabies Quiz

[Doc Alan]

• NO prizes for this quiz – donation already made to the Forum :xxgrinning--00xx3:.


• Complementary to the general quiz set by Les ( which I had no chance of winning :NoNo: ! ).


• Answers, with a few key links, in my next posts :smile:.


• 20 questions on rabies ( T / F = True or False ) :-


1. Present on all continents except one – which ?


2. Caused by what ?


3. Everyone bitten by an infected animal develops rabies. T / F


4. Bites by infected dogs cause :- a. 75% / b. 85% /or c. 95% of cases ?


5. Untreated rabies kills :- a. 75% / b. 85% / or c. over 95% humans and animals ?


6. Humans bitten by rabid animals :- a. 1/5 / b. 2/5 / or c. 4/5 are children ?


7. Estimated worldwide deaths / year :- a. 30,000 / b. 70,000 / or c. 150,000 ?


8. Human rabies in UK acquired abroad, through dog bites, - about half a dozen since 2000. T / F


9. Less than 160 recorded deaths from rabies in Philippines in 2013. T / F


10. Can be passed between people. T / F


11. Can be treated with antibiotics. T / F


12. First rabies vaccines developed in 1985. T / F


13. Vaccine doesn’t work in humans AFTER being bitten by rabid animal. T / F


14. Incubation period usually varies from several weeks to six months. T / F


15. “ Furious “ rabies, with hydrophobia, less common than “ paralytic “ rabies. T / F


16. Rabies can be diagnosed before any symptoms appear. T / F


17. Mass vaccination of dogs against rabies more expensive than prevention in humans. T / F



18. “ Pet Travel Scheme “ for dogs entering UK requires microchip, vaccination, and entry is allowed after 21 days without blood test. T / F


19. Vaccine is free on the NHS in UK. T / F


20. Rabies treatment in the Philippines can only be obtained at San Lazaro Hospital and RITM ( Research Institute for Tropical Medicine ) . T / F

[Doc Alan]

Answers ( Part 1 ) :-


1. Present on all continents except one – which ?
• Antarctica. Most cases reported in Africa and Asia ( half in India ). Occurs in over 150 countries and territories.


2. Caused by what ?
• Rabies virus ( one of a group of lyssaviruses – from Greek lyssa = rage ).


3. Everyone bitten by an infected animal develops rabies. T / F
• False :NoNo: – but there IS a risk if the skin ( or mucous membrane like mouth, eyes ) is broken, greater if deep / multiple bites.


4. Bites by infected dogs cause :- a. 75% / b. 85% /or c. 95% of cases ?
• c. Over 95% are caused by dogs ( remainder by cats, other terrestrial animals, and bats ).


5. Untreated rabies kills :- a. 75% / b. 85% / or c. over 95% humans and animals ?
• c. Over 95% - proven recovery without treatment is extremely rare.


6. Humans bitten by rabid animals :- a. 1/5 / b. 2/5 / or c. 4/5 are children ?
• b. About 2/5 are children under 15 years old. Diagnosis may be delayed because children don’t realise risk / give a history of bites.


7. Estimated worldwide deaths / year :- a. 30,000 / b. 70,000 / or c. 150,000 ?
• b. 70,000 – probably an underestimate as rabies not notifiable in every country and death may occur without confirmation of diagnosis.


8. Human rabies in UK acquired abroad, through dog bites - there have been no more than half a dozen since 2000. T / F
• True :xxgrinning--00xx3: – the last case was a British woman bitten by a puppy in India. An unvaccinated bat-handler in Scotland died from rabies in 2002.

[Doc Alan]

Answers ( Part 2 ) :-


9. Less than 160 recorded deaths from rabies in Philippines in 2013. T / F
• True :xxgrinning--00xx3: - there have been 200 – 300 in recent years.



10. Can be passed between people. T / F
• False :NoNo: – no proven cases of human- human spread ( apart from a few from organ transplants where donors found later to have rabies ).


11. Can be treated with antibiotics. T / F
• False :NoNo: – there is no cure for symptomatic disease.


12. First rabies vaccines developed in 1985. T / F
• False :NoNo: - Louis Pasteur and colleagues developed first rabies vaccines in 1885 – made from nerve tissue of infected rabbits. In 1911 Dr David Semple developed inactivated vaccine in India, using infected sheeps’ brains, injected into stomach, NOT recommended now ( after a century ).


13. Vaccine doesn’t work in humans AFTER being bitten by rabid animal. T / F
• False :NoNo: – it DOES work. This is because the virus invades nerves and eventually travels to brain and spinal cord, then salivary glands. Unlike other infections, it’s worthwhile giving ACTIVE vaccination ( with safe, modern vaccines ) and PASSIVE immunisation with rabies-specific immunoglobulin, for those not previously vaccinated.


14. Incubation period usually varies from several weeks to six months. T / F
• True :xxgrinning--00xx3: – it may be as short as a few days or over a year.


15. “ Furious “ rabies, with hydrophobia, less common than “ paralytic “ rabies. T / F
• False :NoNo: – “ furious “ or “ classical “ rabies is the usual ( over 2/3 cases ), starting with pain / tingling near the site of exposure and progressing to hyperactivity, seizures, hydrophobia ( fear of water / swallowing ) ; “ paralytic “ rabies is slower to develop, ultimately similar to “ classical “.

[les_taxi]

2 so far out of 8 - but highly specialized subject Doc :yikes:

[Doc Alan]

Answers ( Part 3 ) :-


16. Rabies can be diagnosed before any symptoms appear. T / F
• False :NoNo:– rabies is “ screened “ from the immune system during its early activity in the nervous system, so antibodies don’t appear until about 2 weeks after symptoms. It may be weeks before the diagnosis can be proven through tests on blood, other body fluids like saliva, scans, skin biopsy ( and post-mortem tests on humans as well as suspect animals ).


17. Mass vaccination of dogs against rabies more expensive than prevention in humans. T / F
• False :NoNo: – mass vaccination, especially dogs, would be much cheaper than prevention in humans. A logistical problem is the number of wild / non-domestic dogs – “ asong kalye “ in Philippines – but it’s thought most rabies result from bites by pet dogs. In April 2014 the Philippines started a vaccination programme aimed at injecting up to 9 million dogs. Be cautious of animals in general, especially asong kalye. No animal bite should be ignored. The hope is to eliminate rabies by 2020; numbers don’t seem yet to have declined.



18. “ Pet Travel Scheme “ for dogs entering UK requires microchip, vaccination, and entry is allowed after 21 days without blood test. T / F
• True :xxgrinning--00xx3:– from 2012 a blood test and 6 months’ quarantine has no longer been required. More dogs – including illegal imports - have entered the UK since then, a cause for concern.


19. Vaccine free on the NHS in UK. T / F
• False :NoNo: – a course of 3 vaccines, at GP surgery or travel clinic, may cost £ 150 ( + ). This “ pre-exposure prophylaxis “ is recommended only where the risk might be high / with limited access to medical care, so not routinely required for the Philippines.
After possible exposure to rabies, and cleaning / dressing of wound(s), EITHER 5 doses are given over a month with rabies immunoglobulin, OR ( if already immunised ) 2 doses of vaccine. Tetanus vaccination ( booster, or course ) and immunoglobulin is also recommended.


20. Rabies treatment in the Philippines can only be obtained at San Lazaro Hospital and RITM ( Research Institute for Tropical Medicine ) . T / F
• False :NoNo: – rabies vaccination is available in many government and private hospitals ( http://www.doh.gov.ph/content/animal-bite-treatment-centers.html
).

[Doc Alan]

• Other useful links :-


http://www.nhs.uk/Conditions/Rabies/Pages/introduction.aspx



http://www.who.int/mediacentre/factsheets/fs099/en/



http://blogs.wsj.com/searealtime/2014/05/07/philippines-goes-to-the-dogs-to-eliminate-rabies/



http://www.philstar.com/headlines/2014/03/09/1298782/rabies-cases-rise



http://www.gmanetwork.com/news/story/344417/lifestyle/healthandwellness/gov-t-aims-to-eliminate-rabies-as-public-health-threat-within-two-years

[les_taxi]

10 correct :doh

[Doc Alan]

10 correct:doh

Well done Les :xxgrinning--00xx3:

As you say, it's a specialised topic. Thanks for your interest. I was motivated by your own quiz to inform members on this health topic in a different format :smile:

Hopefully my answers are correct. Don't want to be listed as a Dodgy Doc in Dedworth's " Doctors in the Dock " thread :biggrin:

[les_taxi]

I see where you're coming from. I can imagine it's a more popular way to get facts across as we all like a quiz.

[Dedworth]

. Don't want to be listed as a Dodgy Doc in Dedworth's " Doctors in the Dock " thread :biggrin:


No chance of that Doc.

:xxgrinning--00xx3:Thanks for a very interesting set of info. I wonder how many cases there are in Europe nowadays I thought the .who link might give the answer but not

[les_taxi]

Cheers for the Rep Alan :xxgrinning--00xx3:

[raynaputi]

Thanks for this Doc! :xxgrinning--00xx3:

But you shouldn't have given the answer right away. LOL! :icon_lol:

[Doc Alan]

Thanks for this Doc! :xxgrinning--00xx3:

But you shouldn't have given the answer right away. LOL! :icon_lol:

Thank YOU Rayna :xxgrinning--00xx3:

You're correct, maybe I should have kept you all waiting, but I thought members might be put off because it was rather difficult :biggrin:

Maybe next time, if there's sufficient interest, I will set a more general " healthy quiz ", with easier questions :smile:.

[Doc Alan]

To answer Dedworth's question :-

Human rabies is rare in Europe, but each year one or two cases are reported in European citizens, travel-related or " indigenous " . In 2012 Romania reported a domestically acquired, and sadly fatal, case in a 5 year old girl who had been bitten by a stray dog. This was the same year as a travel-associated case reported in the UK ( the patient who had been bitten by a dog in her country of origin, India ).


In 6 years between 2006 – 2011 there were 12 cases in Europe in 7 EU countries, of which 6 were imported. Sources of infection included rabid dog, cat or bat. Poland and Romania account for most positive findings in domestic animals and wild animals other than bats.


The concern is that, with the UK " Pet Travel Scheme ", animals from EU and approved non-EU countries like USA / Australia no longer need a blood test and have to wait only 21 days following vaccination. There is a greater risk if animals are imported – legally or illegally – from Eastern Europe.
(http://www.bbc.co.uk/news/uk-24569593 ).


Rabies is supposed to be a notifiable disease in all EU Member States. Their eradication plans include oral vaccination of wild animals, not culling ( some may be hunted ), with sampling of bats, wild and domestic animals for presence of rabies virus / vaccine and immune status. Detailed information is available from this link :-

http://www.ecdc.europa.eu/en/healthtopics/rabies/pages/index.aspx

[Arthur Little]

Cheers for the Rep Alan :xxgrinning--00xx3:

And, Les :Erm: ... "thanks, Arthur" ... for the previous rep given to you for your quiz! :icon_rolleyes:

[les_taxi]

And, Les :Erm: ... "thanks, Arthur" ... for the previous rep given to you for your quiz! :icon_rolleyes:

I've lost track with what rep I've been given sorry - so thanks Arthur :xxgrinning--00xx3:

[Arthur Little]

I've lost track with what rep I've been given sorry - so thanks Arthur :xxgrinning--00xx3:

:smile: Ah ... no worries, mate! :olddude: ... just me being a "touchy" :biggrin: old bugger.

[les_taxi]

I'm busy outlining the music quiz :xxgrinning--00xx3:

[Arthur Little]

I'm busy outlining the music quiz :xxgrinning--00xx3:

:xxgrinning--00xx3: ... good luck with that, we're looking forward to it.

[Doc Alan]

Even if you choose not to do this quiz, I hope at least reading the answers have helped awareness of the facts known so far about this terrible disease. If you look at just one link, I suggest this one :-

• ( http://www.doh.gov.ph/content/animal-bite-treatment-centers.html
).

[Doc Alan]

The Philippines Government announced in January this year that they would aim to eliminate rabies nationwide by 2016 instead of 2020.


• For this to succeed it needs to " go to the dogs " by transfer of about 70 million pesos from the Department of Health to the Department of Agriculture. Why ? Almost all cases of human rabies results from bites of infected dogs – especially " asong kalye ". The way forward is to buy dog anti – rabies vaccines, and aim for mass dog vaccination ( at least ¾ of the estimated 10 million dogs in the country ).


• Rabies has practically a 100% mortality rate in animals and humans. There is no cure. There have been several hundred cases of animal – and human – rabies each year in the Philippines. Last year less than 160 deaths were recorded in humans. At least a third of these are in children under 15 years old. Of course MOST of possibly a quarter of a million animal bite cases each year are NOT rabid, but there’s also a risk of tetanus.

Worldwide, 60,000 annual human fatalities from rabies is probably an underestimate. Mass vaccination of dogs is agreed to be the best way to reduce human cases. Rabies is almost never transmitted between humans.


• The rabies virus is transmitted by the bite of a rabid animal. There is no test to prove it during life. Other infections may have similar symptoms / also be present. The incubation period is unpredictable. Ideally after immediate first aid ( simple wound cleaning ), vaccination should be started ( whether or not there has been previous vaccination ). The suspect animal should be quarantined and watched for up to 2 weeks, when ( if it’s still healthy ) the human vaccination may cease.


• Such " post exposure prophylaxis " has for over a century been an effective counter-measure to rabies infection for millions each year.

Good luck to the Philippines in their aim to eliminate – or at least reduce numbers – of this terrible disease sooner rather than later .

[Doc Alan]

The number of deaths from rabies in the Philippines does appear to be declining – around 200 in 2013, and apparently none in 2014 , although the number of animal bites ( mostly dogs ) appears to be rising (well over 0.5 million in 2013 ). It’s estimated that a million of the country’s 9 million dogs are vaccinated against rabies.


• Already this year a few human rabies deaths have been reported from elsewhere in the country, and recently it was necessary to vaccinate 13 people around Zamboanga after finding they had eaten meat from a dog which was later diagnosed with rabies ( a known way of becoming infected ).


http://i1265.photobucket.com/albums/jj517/DocAlan/Rabies%20Ph_zpswo24wybm.jpg (http://s1265.photobucket.com/user/DocAlan/media/Rabies%20Ph_zpswo24wybm.jpg.html)



• This is how rabies infects animals such as dogs : -


1. Bite wound allows viruses into muscle …

2. Viruses enter nervous system …

3. Reach spinal cord and brain, where they …

4. Multiply …

5. Then involve salivary glands, so bites are infectious …

6. Multiply in other organs, causing them to fail.


http://i1265.photobucket.com/albums/jj517/DocAlan/Rabies%20virus_zpsqnxftlvt.jpg (http://s1265.photobucket.com/user/DocAlan/media/Rabies%20virus_zpsqnxftlvt.jpg.html)



• Rabies virus infection may be confirmed in brain cells ( A = human, B-D = mice ) - nerve cells stain brown with antibodies. Normally the diagnosis would be made clinically ( post mortem examinations in such cases are risky ).



http://i1265.photobucket.com/albums/jj517/DocAlan/Human%20rabies%20IHC_zps3t7m1sat.jpg (http://s1265.photobucket.com/user/DocAlan/media/Human%20rabies%20IHC_zps3t7m1sat.jpg.html)


( Source :-

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62707-5/abstract ).



http://www.enca.com/world/philippines-treats-13-people-after-eating-rabid-dog


http://www.philstar.com/headlines/2015/03/04/1429839/300-400-pinoys-die-rabies-annually


http://www.wpro.who.int/philippines/areas/communicable_diseases/rabies/continuation_rabies_area_page/en/

[Tawi2]

There was a 50+ year old pinoy guy who was living in the UK and working as a postman who died maybe 7 or 8 years back,he was being treated at University College Hospital in London,he was bitten by a rabid dog while on vacation back home in pinas.,that always stuck in my mind,there was a rabid bat found in Staines town centre in 2004,a little too close to home :cwm24: hydrophobia is an Interesting subject Doc :smile:

[Doc Alan]

This month is the first time human and animal health sectors have combined in an attempt to tackle this dreadful disease. The aim of World Health Organization, World Organization for Animal Health and others is to eliminate rabies by 2030.


Rabies is preventable by vaccination - even after being bitten by a rabid animal. But as we know, without vaccination it’s fatal. Up to 70,000 - 300 in the Philippines - still die from it every year.


99% of human infections are from dog bites. Mass vaccination of dogs - at least 70% of them - plus management of stray dogs and responsible dog ownership, is the best way to control the disease. The cost of dog vaccines is far less than for humans. It’s vital to make human vaccines ( and immunglobulin ) affordable and accessible.


The medical journal " Lancet " highlights progress in the Philippines ( also Tanzania, South Africa and Bangladesh ) to show that elimination of rabies IS possible and affordable. Another New Year resolution - the time to act is now :xxgrinning--00xx3:.


http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01287-8/fulltext?rss=yes

[Michael Parnham]

Nice one Alan, I wasn't aware that there was a vaccine available, good news so yes act now!:xxgrinning--00xx3:

[Terpe]

If anyone should unfortunately suffer dog bite here in the Philippines it might be helpful to know that Republic Act (RA) 9482 or the Anti-Rabies Act of 2007 was enacted primarily to address prevalence of rabies in the country.
Section 5 makes it mandatory for owners of dogs to faithfully and religiously comply with the following responsibilities:-

“Sec. 5. Responsibilities of Pet Owner. – All pet owners shall be required to:-

(a) Have their dog regularly vaccinated against rabies and maintain a registration card, which shall contain all vaccinations conducted on their dog, for accurate record purposes.
(b) Submit their dog for mandatory registration.
(c) Maintain control over their dog and not allow it to roam the streets or any public place without a leash.
(d) Be a responsible owner by providing their dog with proper grooming, adequate food and clean shelter.
(e) Within 24 hours, report immediately any dog-biting incident to concerned officials for investigation or for any appropriate action and place such dog under observation by a government or private veterinarian.
(f) Assist the dog-bite victim immediately and shoulder the medical expenses incurred and other incidental expenses relative to the victim’s injuries.”

I have no idea if many (or even any) dog owners comply or if many (or any) could be dragged through the courts.

Keep well away from any of the extremely numerous wandering dogs here is my best advice.

[Doc Alan]

Keep well away from any of the extremely numerous wandering dogs here is my best advice.

Thank you Peter - I would certainly agree with your advice, and indeed be very cautious about ANY dog in the Philippines. Although as the " Lancet " confirms, there HAS been progress in the Philippines, we only have estimates, since there's a need to improve " surveillance, reporting and diagnostics ".


Most travellers to, or people living in, the Philippines wouldn't pay for a course of rabies vaccination to prevent the disease ( " pre-exposure " prophylaxis ), unless there's an increased risk of exposure, but POST-exposure prevention is vital BOTH for fully immunised individuals and for unimmunised individuals. Better safe than sorry ( dead ) - if the animal can be subsequently proven NOT to have had rabies, that's a bonus.


Details are in previous posts ( this thread ) - unfortunately the illustrations are not now available ( #22 ).

[cheekee]

Just caught up with this.

What is it that causes the hydrophobia symptom with rabies?

[Doc Alan]

What is it that causes the hydrophobia symptom with rabies?


Hydrophobia ( fear of water ) is the historic name for rabies. Once rabies viruses enter the body, they multiply and spread in nerves to the spinal cord and brain.


While there’s no way of diagnosing rabies before symptoms appear ( any time between a week and a year after exposure ), that’s the time to treat a bite victim with vaccine ( and maybe immunoglobulin ). Once symptoms appear, it’s too late.


Rabies vaccines are safe, but expensive for humans ( and not free on the NHS for travellers ) ; while they’re much cheaper for dogs. Making vaccines more affordable is one of the aims of the organizations trying to eliminate this terrible disease.


Because of widespread involvement of the nervous system, salivary glands and other organs, it becomes difficult to swallow ( hence hydrophobia ), despite being thirsty and producing much saliva ( foaming at the mouth ) ; with hyperactive excited behaviour, seizures, and perhaps also aerophobia ( fear of air draughts ).


Infected animals ( usually dogs ) also have hydrophobia, and hyperactivity - if they can be caught and impounded, they nearly always die within 15 days of becoming infective. If they’re still alive 15 days after a bite it’s unlikely they were infective when they bit. Don't assume because they have a " vaccination certificate " that they may not have rabies.


It’s vital to keep those countries, like the UK, rabies-free by public health measures, such as the " Pet Travel Scheme " which allows pet animals to enter such countries without quarantine so long as they have a licence confirming vaccination. This should also include a stricter licensing scheme for dog breeders. There’s concern that puppies are entering the UK from Eastern Europe, where rabies is still endemic, with fake paperwork and bogus health checks, then sold over the internet. This could put the country - virtually free of rabies for over a century - at risk of a epidemic.

[Doc Alan]

The Philippines Department of Health has announced that this year ( 2016 ) it will provide a full course of anti-rabies vaccines in 480 " Animal Bite Treatment Centers " nationwide.


In 2015 there were 226 reported deaths due to rabies.


As the Health Secretary said, " None of these deaths should have occurred since we have the necessary interventions to prevent rabies such as promotion of responsible pet ownership, early consultation when bitten by animals, and timely administration of vaccines. "


As part of the rabies elimination campaign, 33 provinces were declared " rabies-free " by DOH and Department of Agriculture, Bureau of Animal Industry.


http://www.gov.ph/2016/01/05/free-anti-rabies-vaccines-in-2016/



Please remember ( as in previous posts in this thread ) that vaccines may be used both for PRE- and POST- exposure prevention. The vaccine contains inactivated rabies virus. There are NO specific contra-indications to its use whenever someone has been attacked by an animal in a country such as the Philippines, even if there is no direct evidence of rabies in the attacking animal. Because of the consequences of untreated rabies exposure and because vaccination has not been associated with fetal abnormalities, it may still be offered in pregnancy.