TNR Trust Rabies Educator

TNR Trust Rabies Educator Course (TTRE) program is a free material for community educators, public health workers and anyone interested in learning how to prevent rabies in their

communities. The course will teach you about rabies, how it is caused, and how to prevent this disease. You will also learn about effective ways to communicate this life-saving information to

people in your community.

What is rabies, and how do people and animals get the disease?

What is rabies?Rabies is a zoonotic disease caused by a virus. A zoonotic disease means that, if an animal (more specifically warm-blooded mammals in the case of rabies) has the disease, it can pass it on to humans. So if a dog has rabies, and it bites a human, it can pass the disease on to the human.

Rabies is the deadliest disease on earth and you will have a 99.9% chance of dying if you do not get treatment immediately after getting infected. The treatment for rabies will however ensure that you are protected against the deadly disease.

How big is the rabies problem?One person dies of rabies somewhere around the world every ten minutes.

These people are mostly in Asia and Africa. In some parts of these regions, it can be more difficult for people to access health care, or to pay for vaccination. Dogs are often free-roaming and it is not always possible for people to vaccinate their dogs regularly against rabies.

Many of the victims of dog bites are children younger than 15 years of age. Children often play with animals (and may not understand when animals do not want to be disturbed) and are also less likely to report bites or scratches.

Hundreds of thousands of animals also die of rabies every year, creating suffering for individual animals and for the families who depend on these animals as a source of livelihood.

In most countries with high numbers of deaths caused by rabies, the main warm-blooded animals likely to spread the disease are dogs.

BUT...

Killing dogs does not prevent or control rabies. An estimated 20 million dogs are killed every year to try and control rabies, but it has little effect on controlling the disease.

Did you know…

• The best way to control rabies is to vaccinate dogs regularly

How do people and animals get the disease?Human beings can get rabies if an infected animal bites, licks or scratches them. In fact, someone can get the disease if the saliva from an infected animal gets into their body through any opening. If you get the saliva in your eyes, for example, it can give you rabies.

Can rabies be transmitted in food?There are no scientifically documented cases of rabies transmission by drinking the raw milk of an

animal that has rabies. However, such transmission is possible and drinking raw (unpasteurized)

milk and raw milk products from an animal that has rabies is considered to be a risk.

Both preparing and ingesting raw animal products from a rabid animal are considered a high risk.

There are documented cases of rabies transmission to butchers cutting meat from a rabid animal.

Preparing meat from wildlife is also considered a high-risk activity for rabies transmission.

Did you know…

• The rabies virus is primarily transmitted in the saliva when a rabid animal bites another warm blooded mammal

• Scratches from an infected animal can give you rabies because an animal’s claws sometimes have saliva on them? If an animal has rabies, it often drools excessively, and the saliva drips on to its claws.

After a person has been bitten, licked or scratched by an animal with rabiesThe time between the bite and the signs of rabies appearing in a person is called the incubation period.

the person usually shows signs of the disease in 1-3 months, but …

they could show signs in less than a week or it could take more than a year.

The time it takes for signs of rabies to appear depends on:

• Where the bite is located on the person’s body – the further away from the brain, the longer the symptoms will take to appear

• How severe the bite is• How much rabies virus is deposited into the wound during the bite

So, for example, if someone is bitten on their leg, it will usually take longer for the symptoms to appear than if they had been bitten on their shoulder or head.

After a person has been bitten:

• A rabies vaccination can only prevent rabies if it is given to the victim before the virus reaches the nervous system. There are no definite external signs of rabies before the virus has reached the nervous system.

• The vaccination cannot cure rabies once the clinical symptoms appear in the victim.

After an animal has been bitten, licked or scratched by an animal with rabiesThe time between the bite and the signs of rabies in animals is also called the incubation period.

After an animal has been bitten by an infected animal:

• animals like dogs and cats usually show signs of the disease between 2 weeks and 3 months, but …

• they could show signs within 10 days or it could take up to six months.• in animals like cattle, which are often bitten by rabid animals, it can take from 25 days to 5

months.

Did you know…

• Rabies vaccination is only effective during the incubation period• If you are bitten by a suspected rabid animal you should wash the bite wound with soap and

running water (from a tap or poured from a jug) for at least 15 minutes and then go to a clinic for further treatment

• After clinical symptoms appear the patient usually dies within a few days• There is NO test to diagnose rabies before the symptoms appear

So how do we know if someone has developed rabies?

The first signs of rabies can include:

• fever• often pain or an unusual or unexplained tingling, pricking or burning sensation at the site of

the bite wound

Rabies can manifest as one of two main forms, known as furious and dumb rabies, depending on which symptoms develop in the infected person or animal. Regardless of the form that has manifested, any of the following symptoms might be observed:

• fear of bright light, fear of water, aggressive behaviour, such as hitting out or biting• agitation• drooling• hallucinations – seeing or hearing things that are not real• fever and headache

• excessive sweating• muscles gradually become paralyzed, starting at the site of the bite or scratch.• The patient gradually slips into a coma and dies.

What should we do when a person shows any of these symptoms?If you see a person with any of these symptoms, take them immediately to the nearest health facility -- a clinic, a hospital, a doctor, a nurse or someone working in healthcare who knows what to do. This is very important as some of the symptoms are associated with other diseases that can be treated by medical practitioners.

Remember: Rabies cannot be cured once the symptoms appear in a person, but the person can be made comfortable and given medicines to help relieve the suffering, which can also be a comfort to the patient’s family.

What does rabies look like in animals?As in humans, one of the first signs of rabies in animals is a change in behaviour. A calm animal may become aggressive, or a very active animal may seem depressed.

Rabid animals may show some or many of the following signs:

• they might appear confused, restless or aggressive

• strange behaviour, such as trying to bite the air, turning in circles, or appearing unusually

tame around strangers

• they might try to attack or bite anything that comes near, including things that are not alive

• their voice might change (for example, you may notice a change in the pitch and tone of your

dog's bark or howl)

• they drool excessively

• they sometimes eat strange things, such as rocks, dirt or wood

• they lose their appetite

• they are fully or partly paralyzed

• and many other behaviour changes

Did you know

• Owners of pets should always observe their pets for behavioural changes as any change in behaviour could indicate that something is wrong with the animal

• If an owner notices a change in the behaviour of the animal, the animal should be taken to a veterinarian as soon as possible

What should we do if an animal shows signs of rabies?If you think an animal displays any of these signs, stay away from it. Warn other people to keep away and contact the local authorities (local leaders, local veterinary workers or the police) so they can come and manage the dog.

Don’t panic and harm the dog – it is easy to mistake other illnesses with early signs of rabies. If you can contain the animal without danger of exposure, do so before contacting the local authorities or a veterinarian.

If you can get no help from any local authorities or veterinarian, you can observe the animal for 14 days in a safe enclosure, providing it with food and water and space to exercise. If the animal is still alive at the end of that period then it does not have rabies.

How to avoid dog bites and prevent rabiesHow to avoid dog bitesLeave dogs alone when they are eating or near food.

Don’t grab a dog, as this can frighten it.

Never surprise a sleeping dog.

Don’t enter a strange dog’s yard without the owner being present and the dog being aware of your presence.

Don’t touch any dogs you don’t know or that don’t know you.

Don’t play with a dog with puppies, especially while the mother is still feeding them.

Don’t run away from strange dogs, as this can make them more likely to attack.

Children are considered at greater risk because they like to play with animals, often receive

more serious bites, or may not report bites.

Did you know

• Garbage can attract free-roaming animals into homes, so it should be wrapped up and disposed of where animals cannot reach it or smell it

If a strange dog comes close or attacksIf a strange dog comes close, stand still, keep quiet.

Imagine you are a tree.

If a dog attacks you and drags you to the ground, curl up into a ball, with your head tucked in. Keep still and be quiet. Imagine you are a rock.

If a rabid dog attacksA rabid dog is uncontrollable and may bite. If it shows signs of rabies, stay away from it, warn other people to keep away and contact the local authorities (e.g. local veterinary workers, animal welfare organizations, police officers) so they can come and manage the dog.

If it attacks, throw it something else to bite, like a bag, a shoe or the branch of a tree, and move away slowly before attracting attention for help. Do not scream and make loud noises as this might attract the dog to you.

How to prevent rabies after a bite

What should a health worker do?

• The health worker will clean the wound properly and check whether the bite is serious enough for the patient to need vaccinations and more treatment.

• If necessary, they will vaccinate the patient and give them medicine.• The health worker will explain when the patient has to come back for more vaccinations.

The risk of getting rabies is greater if:

• The biting animal is from a species which is often a source of rabies (dogs in most countries).• The animal looks sick or is behaving strangely.• The person has an open wound, and the animal’s saliva touched the wound.• The animal bit the person for no apparent reason.• The animal has not been given rabies vaccinations.

In all these cases, the bite victim should go to a doctor or health centre for advice about vaccinations as soon as possible. Always make sure to tell the health workers what happened and do not neglect to tell them any information regarding the incident.

Staff at the health centre will assess whether the patient needs a course of rabies vaccinations. The following factors will help them decide what to do:

• If the patient has only touched or fed an animal, they will not need rabies vaccinations.• If the animal has licked a person’s skin, but their skin is unbroken (there are no cuts or open

wounds on it), they will not need anti-rabies vaccinations.

• If the patient has small scratches, their wounds will be treated and they will be given anti-rabies vaccination immediately.

If the patient has been bitten once or several times, they will be vaccinated immediately and will also require RIG (rabies immunoglobulin). Although the use of RIG is advised in severe bite cases, if no RIG is available the vaccine should still be used, as it can still help to prevent the disease.

What should we do with a biting animal?

• The animal should be isolated from other animals and people, and should be watched for signs of rabies for 10 days. The animal should be cared for properly during this period, with enough food, water, and space to move around. People should be extra careful when dealing with a suspected rabid dog (feeding, cleaning the kennel etc). It can bite anybody, even its owner.

• If the dog dies within this period, it should be reported immediately to the local veterinary or agriculture office and the carcass tested for rabies

• Inform the doctor or health staff of the death of the animal. This will guide them in the further treatment of the bite victim.

• If the dog stays healthy for the entire 10 days that it is under observation then the dog is free of rabies and can go back to its normal life.

Did you know

• You can also get other diseases from animal bites, such as tetanus or other bacterial infections

• That is why it is very important to carry out steps 1 to 3 as you saw in the section: “How to prevent rabies after a bite”

How to prevent rabies in an animal that has been exposed to a rabid animalIf your pet has been bitten by a potentially rabid animal, there are different procedures depending on whether your pet’s rabies vaccinations are up to date:

• Dogs and cats that are up to date on their rabies vaccinations should be immediately revaccinated and observed by the owner in a safe environment for 45 days. If your pet shows no signs of illness during this time, it can resume its normal life.

• If your pet was unvaccinated before being bitten by a rabid animal, it will either have to be euthanized immediately, or put into isolation for 6 months, with rabies vaccine given to it when it enters isolation and a month before it is released.

Post Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP)PEP (Post Exposure Prophylaxis) is the name for rabies treatment given to a person who has already been bitten. It consists of immediate wound treatment and vaccination. The patient will usually need to go back to the health centre or hospital over the course of a month for at least three more vaccinations. Each person should thus receive at least 4 injections.

It is very important to complete the whole course of vaccinations as recommended by the doctor, otherwise the patient may not be fully protected against rabies.

Even if the biting animal had already been vaccinated against rabies, the person who has been bitten should consult a doctor.

Even if the bite victim has been vaccinated against rabies as a precaution before being bitten (PrEP), they will still need two booster injections.

PrEP (Pre-Exposure Prophylaxis) is an rabies vaccine given to anyone who lives with a greater risk of getting rabies, such as veterinarians and people who work in animal shelters. The use of PrEP helps to protect people if they are bitten and makes the bite treatment simpler and quicker.

Did you know

• Vaccinating dogs is the most effective way to prevent rabies in humans• If you have been bitten by a potentially rabid animal it is very important to complete the

whole course of vaccinations as recommended by the doctor

Caring for animals

Caring for animals to prevent rabiesWhen everyone understands how to treat animals properly, pets and humans will be safer from rabies.

Since dogs are involved in transmitting rabies more than any other animals, they are most often involved with spreading the disease to other mammals.

Like humans, animals have their own needs. We can only protect them from rabies and other diseases if we pay attention to these needs.

The Five freedoms ensure the well-being of an animal is:

1. Freedom from hunger and thirst

Animal owners should give their animals food and water to keep them healthy.

2. Freedom from discomfort

Animals need to have ways of avoiding the hot sun, rain, extreme cold, and they need a comfortable resting place.

3. Freedom from pain, injury and disease

Owners should take their animals to the veterinarian for treatment if they are ill or if they are injured. Pets should be vaccinated against rabies at the age of 3 months, and then taken for vaccinations every year. This is to protect them and to make sure that they do not infect other animals or people with rabies.

4. Freedom to express normal behaviour

Animals must have the opportunity to walk, run and play. This will keep them alert and active and make sure they are not bored. Animals should not be kept tied up for long periods of time.

5. Freedom from fear and distress

Animals should not be threatened or hurt, whether it’s intentional or unintentional. Don’t confine them for long periods of time alone, as this will cause them distress.

Pet owners should consider taking their animals to the veterinarian to have a simple operation so that they don't have puppies. This will not prevent them from getting rabies, but it will help reduce the number of unwanted animals that may not be properly cared for or vaccinated.

Animal vaccinations may be provided by local government veterinary clinics in your area and /or private veterinary clinics or animal welfare organisations. Vaccination campaigns may take place at certain times of the year. To find out where your nearest facility is, you could ask a government veterinary facility or the local government office, or other organisations working in the area. As a rabies educator it would be ideal if you could gather this information before you start sharing your knowledge, as this will help to spread the correct information within the community.

In most countries there are laws governing rabies vaccinations, animal welfare and responsible pet ownership. You can find out about these laws at your local government office or on government websites. You can also check with animal welfare organisations working in your area.

Understanding the role of a community educator in preventing dog bites and rabies

Working together for rabies prevention and controlAround the world, especially in Asia and Africa, people who live in both rural and urban areas still die of rabies because they cannot afford health care or cannot easily reach a health centre. In these cases in particular, clear, useful information regarding the prevention of bites and basic wound care could save their lives.

A TTREC graduate can help their community by:

• Sharing important and life-saving information in their community.• Giving people in the community correct information about rabies

and how to prevent it. They can explain the law about rabies and animals in the area.• Encouraging dog owners to bring their dogs for yearly rabies vaccinations.• Educating the community, especially children, on how to take care of animals and how to

behave around dogs.

• Encouraging animal bite victims to go to the nearest health centre or hospital, and give them details about where to go.

• Identifying signs of rabies in humans and animals, and report them to the proper authorities.• Staying in contact with people working for rabies prevention in the community and local

government.

These are just some of the roles you can play as a REC graduate to prevent dog bites and rabies.You are helping to save lives.

Rabies prevention and control requires different sectors to work together. These include

people working in animal health, human health, animal welfare, government, education, and

industry,

together with, the community. The challenge of preventing and controlling the disease cannot

be addressed by one sector alone. Everyone needs to work together.

Challenges in preventing rabies1. Some people are irresponsible pet owners.

2. People do not always understand how they can be infected or how they can prevent rabies.

3. People may not be aware of the need to vaccinate dogs, they may not have the opportunity to do so, or they may not be able to afford it.

4. People may have incorrect ideas about dog vaccination, and no one has explained it to them.

5. Instead of seeking medical care, some people may prefer to seek traditional treatments, which could be detrimental to their health.

6. Some people do not live close to health centres or hospitals, and have difficulties reaching them.

7. The costs of travel to health facilities, and vaccines, may be too high for poorer families.

8. Health care staff may not explain to bite victims that they need to return for the full course of treatment, and may not make it clear why this is essential.

9. Governmental authorities may not care enough about rabies to make sure laws are properly enforced.

10. The public health and veterinary authorities may not be able to work together to control rabies. Rabies affects both humans and animals, so regular vaccination of dogs and cats can contribute to human health as well.

Did you know

• Traditional or folk practices, like putting a stone, coin, garlic or a herb on the wound site, cannot cure or prevent rabies

• The use of traditional or folk practices could result in an infected wound

The story of AnnieThe story below is an example of a rabies case in the community where the disease is not understood. Read

through it and think about whether this could happen in your community.

Juan lives with his wife and children in a remote village. He takes care of their small parcel of land, and plants

fruits and vegetables. His wife, Karina, is a childcare worker. One day, Juan’s youngest daughter, Annie, is

bitten by a stray dog. Juan ignores it, thinking the bite will just heal like an ordinary wound. When Karina gets

home, she immediately asks her mother-in-law for advice. Her mother-in-law tells the couple to apply some

herbs to the wound, and she refers them to a local healer. The next day, they take Annie to the local healer

who applies more herbs and performs a ritual.

A few days later, Annie has a fever and complains about pain in the area where she was bitten. Karina has to

stay home to take care of Annie and she asks Rita, their neighbour, to take her place at work while she attends

to her daughter. When she hears what has happened, Rita advises Karina to take Annie to the nearest health

facility. Karina does as Rita says, but when they reach the health centre, they are referred to another clinic.

They decide to go home instead because the second clinic is 3 hours away, and they had to borrow money just

to get to the first health centre.

After 3 weeks, Annie’s condition has worsened and she has started showing signs of restlessness, confusion

and fear of water. When she is taken to the hospital, the doctor tells Juan and Karina that the rabies virus

has already spread through Annie’s body. Two days later, Annie is carried back home lifeless.

REFERENCES:

Internet References

Global Alliance for Rabies Control

http://www.rabiesalliance.org/

World Health Organization

http://www.who.int/rabies

World Organization for Animal Health (OIE)

http://www.oie.int/en/animal-health-in-the-world/rabies-portal/

US Centers for Disease Control and Prevention

http://www.cdc.gov/rabies/

Global Alliance for Rabies Control. What is Rabies? FAQs. http://rabiesalliance.org/rabies/what-is-rabies-and-frequently-asked-questions/

World Health Organization, Regional Office for South East Asia. 2013. Frequently Asked Questions on Rabies. http://rabiesalliance.org/uploads/media/Resources_FactsheetsActivity_Sheets/SEA-CD-278_FAQs-Rabies.pdf

World Organization for Animal Health, Iowa State University, Institute for National Cooperation in Animal Biologics. October2009. Rabies.http://www.oie.int/fileadmin/Home/eng/Publications_%26_Documentation/docs/pdf/rabi es.pdf.

Global Alliance for Rabies Control. Rabies and Children. http://rabiesalliance.org/rabies/rabies-and-children/

World Health Organization. About Rabies. http://www.who.int/rabies/epidemiology/en/

Doggone Safe. Dog Bite Prevention Information forParents.http://www.doggonesafe.com/Dog_bite_prevention_for_parents

Farm Animal Welfare Committee. Five Freedoms. March 31, 2011.http://www.defra.gov.uk/fawc/about/five-freedoms/

World Society for the Protection of Animals, Philippines. Rabies and Animal Welfare. March 2011. Retrieved from PowerPoint slides

One Health Initiative. About the One Health Initiative.

http://onehealthinitiative.com/about.php

Sustainable Health Improvement through Empowerment and Local Development (SHIELD) Project in ARMM, Philippines. 2007. CONNECT! Effective Interpersonal Communication