Guidelines for prophylaxis of rabies in Pakistan

Rabies is highly fatal and ends in an extremely painful and torturous death. All carnivorous animal [dog, cat, fox, jackal, skunk, mongoose, raccoon] and bats are considered potentially rabid. Rodents [rat, mouse, squirrel], rabbit or bird are not rabid. Transmission is usually through the bite of an infected animal. However, the percentage of rabid bites leading to clinical disease ranges from 10% [on the legs] to 80% [on the head]. Rabid animals can also transmit the disease by licking abraded skin or mucosa and by scratching. Patients with scratches from rabid animals are about 50 times less likely to develop rabies than those with bites. World Health Organization [WHO] Rabies Survey in 1992 estimated that 90% of human rabies occurred in the developing world. There are no known studies on the incidence of rabies in Pakistan; the problem of dog bite from possibly rabid dogs is rising alarmingly. Therefore the prevention of rabies infection after exposure is of utmost importance. It is preventable if WHO guidelines for post exposure treatment are followed. This guideline includes, immediate local treatment of the wound, passive immunization with rabies immunoglobulin and administration of an efficacious vaccine. Although there is a great urgency to improve post-exposure treatment, it will remain a costly and inefficient method of controlling rabies. It is the canine rabies epidemic which needs to be addressed