Biology Investigatory Project

100% FATAL 100% PREVENTABLE: A brief look into rabies encephalitis

Name: Siddharth Bhattacharya
Roll: 3
Class: XII ScB
Board roll no : 12199660
Sr No Contents Pg No

1 Abstract 3

2 Understanding rabies 3

3 Aetiology and Transmission 3

4 Symptoms and Progression 4

5 Animal control measures 5

6 Treatment Protocols 5

7 Milwaukee Protocol 7

8 Interview with Dr Sanjay Bhattacharya 8

9 Conclusion 10

10 Acknowledgements 11

11 Bibliography 12
Abstract

Rabies is a viral disease that causes encephalitis in humans and other mammals. It was
historically referred to as hydrophobia ("fear of water") due to the symptom of panic when
presented with liquids to drink.
Early symptoms can include fever and tingling at the site of exposure. Progressive symptoms
include nausea, vomiting, violent movements, uncontrolled excitement, fear of water, an
inability to move parts of the body, confusion, and loss of consciousness. Once symptoms
appear, the virtually universally fatal, regardless of treatment.
Rabies causes about 59,000 deaths worldwide per year, about 40% of which are in children
under the age of 15. More than 95% of human deaths from rabies occur in Africa and Asia
In people who have been exposed to rabies, the rabies vaccine and sometimes rabies
immunoglobulin are effective in preventing the disease if the person receives the treatment
before the start of rabies symptoms. Washing bites and scratches for 15 minutes with soap
and water is effective at preventing transmission.

The aim of this study is to go through the epidemiology and pathophysiological factors
involved in rabies encephalitis

Understanding Rabies

Etiology and Transmission of Rabies

Rabies is a viral disease that affects the nervous system
of mammals, including humans. It is caused by the
rabies virus, which belongs to the genus Lyssavirus
within the family Rhabdoviridae. The rabies virus is a
bullet-shaped, single-stranded RNA virus.

Modes of Transmission:
 Animal Bites: The most common mode of
transmission is through the bite of an infected
animal. The virus is present in the saliva of an
infected animal and can be transmitted when it
bites and breaks the skin. The primary source of
human rabies cases worldwide is dogs, but other
animals such as cats, bats, foxes, raccoons, and
skunks can also transmit the virus.
  Scratches and Licks: The virus can also be transmitted if the saliva from an infected
animal comes into contact with broken skin or with mucous membranes like the eyes,
nose, or mouth. This can happen through direct contact with an infected animal or by
touching surfaces or objects contaminated with infected saliva.
 Inhalation: In rare cases, the virus may be transmitted through inhalation of
aerosolized particles, such as in bat caves where high concentrations of the virus may
be present.
It is important to note that the rabies virus does not spread through casual contact with an
infected person or through touching or petting an infected animal. The virus needs to enter
the body through a bite or a scratch where the skin is broken or come into contact with
mucous membranes to cause an infection.

Symptoms and Progression

The incubation period of rabies, which is the time between

exposure to the virus and the onset of symptoms, can vary
widely, ranging from a few days to several years. However,
it typically lasts for 1 to 3 months.

Prodromal Stage: This stage is characterized by non-specific

symptoms that may last for 2 to 10 days. Common early
signs and symptoms include fever, headache, malaise,
fatigue, and discomfort at the site of the animal bite or
exposure. Behavioural changes such as agitation, increased
anger and frustration may also occur

Rabies generally presents as two different forms after initial

onset of nonspecific symptoms
 Furious Rabies: This form of rabies is more commonly associated with aggressive
and hyperactive behaviour. Individuals may experience extreme agitation,
hallucinations, hydrophobia (fear of water), and aerophobia (fear of drafts or air
movement). They may exhibit uncontrolled movements, excessive salivation, and
have difficulty swallowing. This stage is often accompanied by periods of agitation
alternating with periods of relative calm.
 Paralytic Rabies: This form of rabies is characterized by muscle weakness, paralysis,
and a lack of coordination. Individuals may experience difficulty in moving or
speaking, excessive salivation, difficulty swallowing, and respiratory distress. This
stage is marked by progressive paralysis, leading to a coma and eventually death.
Animal Control Measures for Rabies Prevention

 Responsible Pet Ownership: Promoting responsible pet ownership is crucial in

preventing the spread of rabies. This includes vaccinating pets against rabies, ensuring
they receive regular veterinary care, and keeping them confined to prevent roaming
and potential exposure to rabid animals. Responsible pet owners should also spay or
neuter their pets to reduce the population of stray animals and prevent uncontrolled
breeding.

 Stray Animal Management and Sterilization Programs: Stray animals, particularly

dogs, are often a significant source of rabies transmission. Implementing effective
stray animal management programs can help control the population and reduce the
risk of rabies. These programs typically involve capturing, vaccinating, sterilizing,
and releasing stray animals (also known as "trap-neuter-vaccinate-release" programs).
It helps to control the spread of rabies and other diseases while addressing the issue of
stray animals in a humane and sustainable manner.

Treatment Protocol and preventive measures

Vaccination for Rabies

Vaccination plays a crucial role in the prevention of

rabies. There are two main types of rabies
vaccination: pre-exposure prophylaxis (PrEP) and
post-exposure prophylaxis (PEP).

Pre-exposure Prophylaxis (PrEP)

PrEP involves administering the rabies vaccine to
individuals who are at high risk of exposure to the
virus. This includes individuals who work with animals, such as veterinarians, animal
handlers, and laboratory workers, as well as travellers visiting regions where rabies is
endemic. Pre-exposure vaccination helps to build immunity against the virus and provides a
protective response, making it easier for the body to fight the virus if exposed. PrEP typically
involves a series of three doses of the rabies vaccine, given on specific days.

Post-Exposure Prophylaxis (PEP) for Rabies

When a person is potentially exposed to the rabies virus, prompt and appropriate post-
exposure prophylaxis (PEP) is crucial to prevent the onset of rabies symptoms. PEP involves
a combination of rabies immunoglobulin (RIG) and the administration of rabies vaccines.

Immediate Actions Following a Potential Exposure:

• Wash the Wound: If an animal bite or scratch occurs, the wound should be immediately
and thoroughly washed with soap and water for at least 15 minutes. This helps to remove the
virus from the wound and reduce the risk of infection.

• Seek Medical Attention: Regardless of the severity of the bite or scratch, medical attention
should be sought without delay. A healthcare professional will assess the risk of rabies
exposure, evaluate the wound, and determine the appropriate course of action.

Administration of Rabies Immunoglobulin and Vaccines:

Rabies Immunoglobulin (RIG): RIG is a blood product that contains ready-made rabies
antibodies. It provides immediate, temporary protection against the virus while the rabies
vaccine stimulates the person's immune system to produce their own antibodies. RIG is
typically administered to individuals who have not been previously vaccinated against rabies
and have a high risk of exposure. It is usually injected near the bite wound and is given as
soon as possible after the exposure.

Rabies Vaccine: The rabies vaccine is a critical component of PEP. It stimulates the body's
immune system to produce antibodies that neutralize the rabies virus. The vaccination series
usually consists of four to five doses given over a period of 14 to 28 days. The first dose is
administered at the same time as the RIG, and subsequent doses are given on specific days as
recommended by healthcare professionals. In most cases, the vaccine is injected into the
deltoid muscle of the arm for adults and in the thigh muscle for children.

It's important to note that PEP is highly effective when administered promptly after a
potential exposure, before the onset of symptoms. PEP should be initiated as soon as
possible, even if there is a delay in procuring the vaccine or RIG. It is considered a
medical emergency, and any delays in seeking treatment can significantly reduce its
effectiveness.

Milwaukee Protocol
The Milwaukee protocol was conceived in 2004 by a team of medical professionals, led by
Dr. Rodney Willoughby, after a 15-year-old girl was admitted to a Milwaukee hospital after a
rabies diagnosis.
After consulting with researchers at CDC in Atlanta, the team formulated and implemented a
novel procedure. The patient was placed in a drug-induced coma and given an antiviral
cocktail composed of ketamine, ribavirin, and amantadine. Considering the theory that
rabies pathology stems from central nervous system neurotransmitter dysfunction, doctors
hypothesized suppressed brain activity would minimize damage while the patient’s immune
system developed an adequate response.
The patient was discharged from the hospital 76 days after admission. She demonstrated
speech impediment and difficulty walking during a clinic visit 131 days after discharge. It is
unclear how long those conditions persisted.

It's important to note that the Milwaukee protocol is highly controversial and has not been
widely accepted or recommended as a standard treatment for rabies. Several factors
contribute to its limited use:
 Lack of scientific evidence: The Milwaukee protocol is based on a few isolated cases
where patients survived rabies despite the grave prognosis. However, there have been
many cases where the protocol was attempted without success, leading to scepticism
regarding its overall effectiveness.

 Potential risks and complications: Inducing a therapeutic coma carries significant

risks, including infections, blood clots, and organ damage

 Time sensitivity: The Milwaukee protocol needs to be initiated before the onset of
neurological symptoms, which can be challenging given the nonspecific early signs of
rabies. Once symptoms appear, the disease progresses rapidly, making it difficult to
implement the protocol in a timely manner.

Interview with Dr Sanjay Bhattacharya Senior Consultant,

Department of Microbiology, Tata Medical Centre, Kolkata,

Interviewer: Good morning! Today, we have the pleasure of speaking with Dr. Bhattacharya,
a clinical microbiologist who specializes in virology. Thank you for joining us
Dr. Bhattacharya: Good morning! I'm glad to be here and share my knowledge about rabies
in India.
Interviewer: Excellent. Let's begin. Could you provide us with an overview of the current
situation regarding rabies in India?
Dr Bhattacharya: Certainly. Rabies is a significant public health concern in India. It is
estimated that India accounts for approximately one-third of the global rabies burden, with an
estimated 20,000 to 25,000 deaths occurring annually. Most of these cases are due to dog
bites, as dogs are the primary reservoir and transmitter of the rabies virus to humans.
Interviewer: What are the major challenges in tackling rabies in India?
Dr. Bhattacharya: There are several challenges in combating rabies in India. One of the key
challenges is the lack of awareness and understanding of the disease among the general
population. Many people, especially in rural areas, do not recognize the early signs of rabies
and may not seek prompt medical attention after a dog bite. Another challenge is the
availability and accessibility of post-exposure prophylaxis (PEP) across the country. PEP
consists of wound cleansing, administration of rabies immunoglobulin, and a series of rabies
vaccine doses. Ensuring that PEP is accessible, affordable, and administered promptly after
exposure is crucial in preventing rabies deaths.
Interviewer: Are there any specific initiatives or programs in place to address these
challenges?
Dr. Bhattacharya: Yes, the Indian government has taken several initiatives to tackle rabies.
The National Rabies Control Program was launched in 2018 with the goal of eliminating
human rabies deaths in the country by 2030. The program focuses on dog population
management, mass dog vaccination campaigns, awareness programs for communities, and
strengthening surveillance and diagnostic capabilities.
Additionally, organizations, both governmental and non-governmental, are actively involved
in raising awareness about rabies, conducting vaccination campaigns, and providing
education and training to healthcare professionals, veterinarians, and community members.
Interviewer: That's great to hear. In your opinion, what are the key areas that require further
research and development in relation to rabies in India?
Dr. Bhattacharya: There are a few areas that require further research attention. First, we
need to better understand the epidemiology of rabies in India, including the distribution and
dynamics of rabies virus variants and their transmission patterns. This information can help in
designing targeted control strategies. Secondly, research is needed to develop cost-effective
and locally appropriate rabies vaccines that are easily accessible, especially in remote areas.
Innovative approaches, such as heat-stable vaccines and extended-duration vaccines, could
significantly improve vaccination coverage and compliance.
Lastly, we should invest in research to develop effective strategies for dog population
management, including mass dog vaccination campaigns, sterilization programs, and
responsible pet ownership initiatives. These efforts are crucial in reducing the incidence of
rabies and preventing human exposure to infected animals.
Interviewer: Thank you, Dr. Bhattacharya, for sharing your insights on rabies in India. It's
clear that there are significant challenges, but with ongoing initiatives and further research,
we can strive towards reducing the burden of rabies and saving lives.
 Dr. Bhattacharya: You're welcome. It was my pleasure to discuss this important topic.
Continued efforts in public awareness, access to PEP, and research advancements are key to
combating rabies effectively in India and achieving the goal of eliminating human rabies
deaths.

Conclusion

In conclusion, rabies remains a significant global public health concern, with a high fatality
rate once symptoms appear. It is primarily transmitted through the bite of infected animals,
with dogs being the main source of human cases. Prompt medical attention and appropriate
post-exposure prophylaxis (PEP) are crucial for preventing the onset of rabies symptoms.
Efforts to control rabies in India and other affected regions involve various strategies,
including responsible pet ownership, stray animal management, and mass dog vaccination
campaigns. These initiatives aim to reduce the transmission of the virus and prevent human
exposure. Vaccination plays a vital role in preventing rabies. Pre-exposure prophylaxis
(PrEP) is recommended for individuals at high risk of exposure, while post-exposure
prophylaxis (PEP) involves the administration of rabies immunoglobulin and a series of
rabies vaccine doses after a potential exposure. Immediate wound washing and seeking
medical attention are essential following an animal bite or scratch. While the Milwaukee
protocol, which involves inducing a therapeutic coma and administering antiviral drugs, has
been attempted in rare cases, its effectiveness remains controversial due to limited scientific
evidence and potential risks. Further research is needed to better understand the
epidemiology, transmission dynamics, and pathophysiology of rabies. Developing cost-
effective vaccines, improving access to treatment, and enhancing dog population
management strategies are areas that require continued attention and investment. Overall, a
comprehensive approach that includes public awareness, effective animal control measures,
and accessible healthcare services is crucial for reducing the burden of rabies and ultimately
eliminating human deaths caused by this devastating disease.

Acknowledgments

I would like to express my gratitude to all the people who have helped me to successfully
complete my project.
I would like to express my heartfelt gratitude to the CBSE board for giving me such this
opportunity to create a project and gain knowledge on this research project.
Secondly, I would like to thank our principal ma’am Mrs. Loveleen Saigal for handing us this
project to work on so we can expand our knowledge.
Thirdly, I would like to thank Dr Sanjay Bhattacharya, for helping me tremendously for this
project and taking time out of his schedule for me to interview him.
Lastly, I would like to thank my biology teachers, Dr. Sreetama Gupta and Ms Debanjali
Gupta, for letting me choose this topic
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