According to data released by the World Health Organization (WHO), rabies is prevalent in 150 countries around the world, mainly occurring in Asia and Africa, causing 59,000 deaths every year. In recent years, my country has continuously strengthened rabies prevention and control work. According to the data released by the National Bureau of Disease Prevention and Control of , rabies ranks 10th in 2021 infectious disease .
In addition, the number of rabies cases in my country is characterized by "three more": there are many cases in rural areas, with farmers accounting for more than 65% of the total number of cases; the number of male cases is about twice that of females; there are more cases of children under 15 years old and people over 50 years old.
To this end, the editorial department of this issue has sorted out the source of infection, transmission routes, emergency response methods, existence and prevention and control history of rabies, and explained the significance of this year's theme for readers.
Understanding Rabies virus
As we all know, rabies is a fatal but preventable zoonotic disease. Rabies is caused by rabies virus infection, a bullet-like enveloped viral particle (size 180×75 nm). According to researcher Yan Jiaxin , a researcher at the Wuhan Institute of Biological Products, there are currently more than a dozen different rabies virus genotypes, and the classic rabies virus (RABV-genotype 1) and its various variants are widely distributed around the world and cause rabies in humans and animals. Human rabies are basically caused by this virus.
Rabies virus mainly invades the human body through damaged skin or mucosa, and is clinically manifested as specific wind fear, water fear, pharyngeal muscle spasm , paralysis, etc. According to reports, the most common way for rabies virus to enter the human body is through bites or scratches from a diseased animal and infection through incomplete skin. Non-bite exposure routes include inhalation of atomized rabies virus, corneal/organ transplants, abrasions, open wounds, mucosa stained with rabies virus-containing saliva or infectious substances such as animal brain tissue. "The success rate of mucosal contamination exposed to rabies is very low," said Yan Jiaxin. After being bitten by known animals with rabies, the probability of untreated individuals suffering from rabies varies depending on the bite site, including 50% to 80% of head bites, 15% to 40% of hand or arm bites, and 3% to 10% of leg bites.
It is worth noting that WHO clearly confirms that raw meat or other tissues of animals infected with rabies are not one of the sources of infection for human rabies.
It is reported that the rabies virus can infect all mammals, but cannot infect birds, reptiles, amphibians and all other lower animals . The storage host of rabies virus is only distributed in the two orders: Carnivorous and Pterocarpa, the rabies virus can continue to spread in this animal population, and neither the virus nor the animal will be extinct. 99% of human rabies originate from dogs, so dogs are the most important storage host animal for rabies virus. Yan Jiaxin said that the host accidentally cannot maintain the persistence of the rabies virus. Such animals include domestic animals such as horses, cattle, pigs, and rats. These animals usually do not spread rabies.
, Deputy Director of Emergency Surgery Department and Deputy Director of Trauma Treatment Center, , Wang Chuanlin, , said that after people are infected with rabies virus, they will go through three periods: latent period, prodromal period, and typical period.
The period when the diseased dog bites and develops clinical symptoms is the incubation period. Rabies is asymptomatic during the incubation period. The incubation period is generally 0 to 3 months, as short as 1 week, as long as 1 year (very rare). The longest incubation period is currently found to be 8 years. The closer the wound is to central nervous system , the faster the disease occurs.
The virus in the prodromal stage follows the nerves, goes upward and reaches the spinal cord. There are abundant nerve roots in the spinal cord, and the virus will replicate in large quantities, causing spinal cord radiculitis. At this time, the patient will experience early symptoms such as headache, nausea, numbness and pain in the bitten area.
The typical stage viruses along the spinal cord reach the brain and replicate in large quantities, destroying the blood-brain barrier. Subsequently, the virus spreads along the surrounding nerves throughout the body, and typical clinical manifestations will appear, such as fear of water, wind, pharyngeal muscle spasm, and excessive saliva secretion. Once the typical period is entered, the patient will suffer very much.Some foreign scholars have said that there is no disease in the world that can compare with rabies.
Rabies can be eliminated
GARC The main purpose of setting up World Rabies Day is to increase people's awareness of rabies prevention, and to know the progress made by humans in fighting this terrible disease, and to jointly participate in the global elimination of rabies.
This year’s purpose of adopting this theme is to focus on “One Health” and remind people to achieve the goal of “Zero by 30” – it is entirely possible to eliminate dog-mediated human rabies.
It is reported that the global overall goal of eliminating rabies is to achieve zero deaths in human rabies by 2030 (Rabies: Zero by 30). In December 2015, WHO and World Organization for Animal Health cooperated with the United Nations Food and Agriculture Organization and the Global Rabies Control Alliance to launch a global framework for achieving zero deaths in human rabies by 2030. This move marks the first time the human and animal health sectors have come together to adopt a common strategy to conquer this terrible but still neglected disease. This is a new and important milestone in the global eradication of rabies.
This year's theme includes two meanings.
First, "Same Health" is a concept that is becoming more and more popular in the disease control project. As the COVID-19 pandemic and antimicrobial resistance have shown to the world, the health of humans, animals and the environment is inseparable and interdependent.
Novel Coronavirus Pneumonia The pandemic has exposed the serious vulnerability of the health system, but it also shows that cross-sectoral cooperation can achieve common goals. Elimination of rabies is a role model for the “same health” approach taken with the participation and cooperation of the human, animal and environmental sectors. Rabies control planning provides an example for the implementation of “same health” and the structures that underlie these planning are crucial for other zoonotic diseases, including those prone to pandemics.
Second, "zero death" means "zero deaths from rabies before 2030", emphasizing that rabies can be prevented and eliminated. In fact, rabies is the only one that is neglected tropical disease that can be prevented with vaccines. This part of the topic also reminds us that although significant progress has been made in rabies prevention and control, joint efforts are still needed to achieve this goal.
GARC staff pointed out that there are currently vaccines, drugs, tools and technologies that are enough to break the vicious cycle of one of the oldest diseases.
Global Strategic Plan to Eliminate Human Rabies Deaths caused by Dogs by 2030 is an ambitious document that can achieve its goals. It is consistent with the WHO roadmap on neglected tropical diseases (NTDs), which stipulates that comprehensive interventions will be prioritized for mainstreaming NTD planning into the national health system.
The Global Strategic Plan for Rabies and the Roadmap are directly related, where the integrated approaches advocated are of great significance, especially in collaboration with stakeholders, advocates, and people at all levels of the community, local, national and globally, to rebuild and strengthen health systems and rabies control plans. Rabies can be eliminated through collaboration and resource integration, community mobilization, and a commitment to continuing to vaccinate dogs across the board.
Rabies has existed in ancient Chinese books
The earliest record of rabies in ancient Chinese books is found in "Zuo Zhuan", which records that "In November of the 17th year of Duke Xiang of (Lu) (i.e. 556 BC), the people of the Chinese people chased dogs." This shows that mad dog (i.e. rabies) existed in my country 2,500 years ago, and at that time it realized that mad dogs were extremely harmful to people, and took measures to expel mad dogs. According to a modern perspective, more than 95% of human rabies are caused by rabies . Deportation of rabies can significantly reduce the incidence of this disease in the population.
1708, Italy recorded a large-scale outbreak of domestic dog rabies incident. Many mad dogs also appeared in Britain between 1734 and 1735. In the 19th century, rabies prevalence occurred in almost all European countries, causing great fear among the people.The clearly recorded rabies in Africa can be traced back to 1772. It was introduced from the UK and gradually developed into the entire Africa. There are more , , , and , and less , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , html
Combining historical data from various countries, it was found that the origin of rabies may be in , , Asia or Europe, in the eastern hemisphere. Rabies in the Western Hemisphere are likely introduced from Europe in the 18th century. North America did not first find rabies in dogs in the Virginia colony until 1753, and human rabies was first found in Boston in 1768. By 1785, rabies had occurred throughout the northern United States. Dog rabies were not found in South America until 1803 in Peru , and rabies in Argentina dated back to 1806 and were introduced by a dog carried by a British official.
Prevention and control history is shorter
Yan Jiaxin pointed out that humans have only had a history of effective prevention and control of rabies for more than 100 years, and this history mainly includes the following six major events.
1885, French microbiologists Pasteur and others found ways to produce rabies vaccines in practice without knowing the nature of rabies virus , laying the foundation for fundamentally solving the prevention and control of rabies. To prevent viral diseases with vaccines, rabies vaccine is the earliest successfully applied one of the smallpox vaccines.
1903, Italian Negre discovered the inclusion body of rabies virus infectious cells - Negrene in infected nerve cells, which can be used for early diagnostic research on rabies (most of the methods are currently replaced by fluorescent antibody tests, namely FAT).
In the 1940s, scientists began to apply effective rabies vaccines to dogs in large quantities, which significantly reduced the incidence of rabies in humans and promoted the production of more rabies-free countries and regions.
In 1954, researchers added hyperimmune antiserum (immunoglobulin) to human rabies immune programs, further increasing the survival rate of people with severe rabies bites.
In 1958, scientists successfully adapted the rabies virus to proliferate in cell culture. Subsequently, the cell culture vaccine produced using this technology has been increasingly improved in terms of safety and efficacy, and has been popularized in developed countries such as Europe and the United States, but has a high cost.
In recent years, new oral recombinant vaccines produced using genetic engineering technology (such as vaccinia - rabies virus glycoprotein recombinant vaccine) have been proven to be extremely effective and convenient vaccines in experimental animals, and have been widely tried in wild animals in Europe and the United States.
Yan Jiaxin said that since more than 95% of human rabies are related to dogs, the successful experience of many countries that have eliminated rabies proves that as long as rabies are controlled in dogs and other domestic pets, the incidence of human rabies can be greatly reduced.
Chinese Academy of Sciences Academician Gaofu also mentioned that eliminating rabies requires strengthening rabies monitoring of animals, including wild animals, improving the laboratory diagnosis rate of reported cases, and continuing to analyze and evaluate rabies monitoring data; give priority to animal rabies prevention and control, preventing the spread of wild animal rabies into dog groups, and the immunity rate of dogs in high-risk areas must reach more than 70%.
At the same time, Wang Chuanlin pointed out that it is necessary to promote civilized dog raising and dog raising in accordance with the law, improve the shelter system of stray dogs, continuously popularize the prevention knowledge and treatment methods of rabies, and enhance the public's understanding of rabies. Only when the whole society pays enough attention can human rabies be eliminated as soon as possible and tragedies will not happen again.
Learn to emergency treatment
What should I do if I am accidentally bitten and scratched by a sick animal? The WHO proposed the " 10-day observation method ", which means to observe whether the injured animal will become ill within 10 days. If the animal does not become ill, the human is safe. Theoretically, the infected animal cannot survive for 10 days without treatment. However, my country is a high-risk country for rabies. If the animal dies on the 10th day, it will take 10 days to treat it as rabies.
So, Wang Chuanlin introduced the "three-step" emergency response.
Prevent wound infection, early treatment is the key. Both rabies infection and tetanus infection have a certain incubation period. After being injured by animals, you should not underestimate the carelessness even if you are minor injuries.Once rabies and tetanus attack, they are both serious diseases with difficult treatment and high mortality rate. But at the same time, both are completely preventable, and the key to prevention lies in early treatment. For example, if you are bitten or scratched by a dog or cat, clean and disinfect it as soon as possible, which can effectively reduce the local bacterial load on the wound and reduce the risk of wound infection. At the same time, seek medical treatment in a timely manner, and take post-exposure treatment and tetanus prevention measures based on the wound condition and personal immunity history.
wounds are divided into severity and seriousness, and treatment is based on principles. For the treatment of severe wounds, especially those with active bleeding, , you should first press and stop the bleeding, and then rush to the hospital; the principle of handling mild wounds is to rinse, rinse, and then rinse, disinfect, or go directly to the hospital to find professional medical staff for standardized treatment. If the wound is not big, you can first clean the wound with running water (or weakly alkaline detergent) at home for 15 minutes. After rinsing, suck out the residual liquid in the wound with a clean cloth or towel, cover the wound and seek medical attention as soon as possible.
eliminates rabies, and animal immunity comes first. After an animal with a high risk of rabies infection is injured, it is recommended to seek medical treatment in time and prevent and deal with rabies after exposure. The treatment after exposure is almost 100% effective.
Vaccine safety
Phone Associate Chief Physician of the Department of Infectious Diseases, Peking University First Hospital Wu Chihong said that the only way to prevent rabies is to get vaccinated. Injecting rabies vaccines in humans is actually a remedial measure and is the last line of defense to prevent rabies. To eliminate dog-transmitted rabies, we must prevent dogs from getting sick. Vaccinating dogs with rabies is the most economical, effective and lasting strategy.
rabies vaccines can be divided into two categories: one is post-bite prevention, and the other is no bite prevention. "Bites or scratches by animals (including seemingly healthy animals) must be vaccinated with post-bite prevention vaccine. In addition, people who often come into contact with stray cats and dogs should be vaccinated before exposure," Wu Chihong explained.
"Rabies vaccine needs to be vaccinated in batches, and common injection methods include the 'five-application method' and '211' method." Wu Chihong introduced that the "five-application method" means one injection on the 0th day of exposure, the 3rd day of exposure, the 7th day of 7th day of exposure, the 14th day of 28th day of exposure; the "211" method means one injection on the upper arms around the 0th day of exposure, and one injection on the 7th day of the 21st day of exposure.
In addition, Wang Chuanlin introduced that the rabies vaccine belongs to the inactivated vaccine . Inactivated vaccines can be used simultaneously or at any time between any other type of vaccine and will not affect each other's effectiveness. If vaccination is required at the same time, it is recommended to take vaccination at different parts to avoid the inability to distinguish the source when local adverse reactions occur. If the vaccination is not possible at the same time, the mortality rate of rabies is almost 100%, and rabies vaccination should be given priority.
Do rabies vaccines have to be vaccinated within 24 hours after the injury? Wang Chuanlin reminded that rabies is a fatal disease and must be dealt with after exposure in a timely and standardized manner. The earlier the rabies vaccination, the better, but the vaccination is still effective after more than 24 hours after the injury. For those who have not been treated after rabies exposure, even if the health status of the injured animals is unknown after several months, it is recommended to receive rabies vaccination according to the procedures to avoid risks.
Wang Chuanlin said that it is safe to get rabies vaccination for pregnant women and breastfeeding women and will not have adverse effects on the fetus or infants.
Original text is published in "Medical Science Journal" (2022-09-30 Edition 4 cover)
