Rabid dogs spread death in Yemen [Archives:2006/976/Health]

August 28 2006

Ahmed Al-Bukhari
Taiz Bureau

Several local newspapers recently reported that rabies has become a serious problem in many Yemeni governorates and districts. For example, over the past six months in Ibb, newspapers reported approximately 400 rabies cases, most involving children, shepherds and farm guards.

Hundreds of cases also were reported in Taiz governorate. However, these numbers, based on medical sources at anti-rabies units, may not reflect actual statistics, as many patients living in remote areas aren't able to reach such units to receive medication.

Dr. Abdul Jabar Al-Muhia of the Yemeni-Swedish Hospital's anti-rabies unit in Taiz referred to another problem, which is lack of injections to treat rabies patients. “Within the first six months of 2006, the hospital treated approximately 375 dog bite victims, one of whom died; whereas the hospital is provided only 300 vaccine injections monthly, which doesn't cover patients' needs,” he explained.

Patients are to receive five free injection doses over the course of seven to 28 days. “However, we only give patients three of the five injections because the hospital isn't able to treat all of the cases, which sometimes come to us from other governorates. In this case, patients must buy the two extra injections, which costs a lot,” Al-Muhia confirmed.

“In the past, we provided patients the entire course; however, we were shocked to discover that some individuals somehow receive the injections and then sell them to pharmacies, so we decided to give only three doses at the unit,” he added.

Not just dogs

Many Taiz citizens have complained of the spread of dogs that feed on hospital and medical center waste sometimes containing human organs, as such waste is disposed in residential area waste containers.

However, dogs aren't the only animals that transmit the disease. According to Al-Muhia, rabies is an acute, contagious infection of the central nervous system caused by a specific virus that enters the body through the bite of infected animals like dogs, cats, skunks, foxes, wolves and bats. In humans, the incubation period varies from three weeks to 120 days, averaging approximately four to six weeks.

Patients with hydrophobia

Al-Muhia described rabies symptoms, noting that they begin with warning symptoms usually lasting one to four days, thus indicating the beginning of the disease. During this period, symptoms include fever, headache, malaise (a generally ill feeling), muscle aches, loss of appetite, nausea, vomiting, sore throat, cough and fatigue.

There also may be a tingling or twitching sensation around the area of the animal bite, which is one of the most specific rabies symptoms at this stage of infection.

After this initial period, a second stage begins with symptoms mimicking those of encephalitis (inflammation of the brain). There may be fever as high as 40.6 degrees Celsius (105 degrees Fahrenheit) with any of the following symptoms: irritability, aggressiveness, confusion, hallucinations, bizarre or abnormal thoughts, excessive movement or agitation, muscle spasms, abnormal posture, seizure (convulsions), weakness or paralysis (the person can't move some part of the body), extreme sensitivity to bright light, sound or touch and increased tears or saliva production.

Patients are extremely thirsty but experience spasms of the larynx when water is presented or even mentioned, hence the disease's original name, hydrophobia [Greek hydro = water, phobos = fear]. There also may be an inability to speak as the vocal cords become paralyzed.

The last stages of rabies produce symptoms reflecting the infection's destruction of many important areas in the nervous system, such as possible double vision, problems moving facial muscles, abnormal movements of the diaphragm and muscles that control breathing and difficulty swallowing. It's the difficulty in swallowing – combined with increased saliva production – which leads to the “foaming at the mouth” usually associated with rabies infection.

Finally, the individual infected with rabies can slip into a coma and stop breathing. Without life support measures, death usually follows within four to 20 days after rabies symptoms begin.

However, Al-Muhia pointed out that urgent measures can be taken as first aid. “The wound should be treated by cleansing with hot water, an antiseptic solution like iodine and a sterile dressing,” he explained. “However, the patient must be given the daily vaccine injection course according to a doctor's schedule,” he insisted, “as rabies virtually always is fatal if the vaccine isn't administered.”