This article is the first in a series on health issues provided by World Access Medical

Services.

In Cambodia diseases such as malaria, dengue fever, and giardia are well known among

the general community. Rabies, on the other hand, is often forgotten.

Rabies is considered a problem both in rural and urban areas in Cambodia, and can

be transmitted by a number of animals. The disease is transmitted by being bitten

or licked by a rabid animal; i.e. an animal which already has the disease. The virus

resides in the animal's saliva and enters a person's body when the rabid animal bites

or licks an open cut or wound.

Occasionally rabies is contracted by breathing in the virus from close contact with

infected animals. Rabies can also be spread through the saliva of a rabid person.

In Cambodia, rabies is mainly transmitted by dogs and monkeys. However, any fur-bearing

animal has the potential to be infected.

The Disease

Rabies is a viral disease which attacks the brain. The virus travels via the nerve

trunks upwards to the central nervous system, where it proliferates in the nerve

cells of the brain. Affected cells can be either irritated or depressed, leading

to "furious" rabies, or "dumb" rabies.

The incubation period varies from 2 weeks to 4 years. There have been cases reported

up to 19 years following exposure. The average incubation period is six to 12 weeks.

In general the larger the bite and the nearer it is to the brain, the shorter the

incubation period.

Once symptoms appear, the disease progresses quickly with fever, anxiety, insomnia,

and often pain or numbness at the site of the bite. Painful spasms of the throat

muscles then follow. The fear center in the brain becomes overactive and the afflicted

person becomes terrified. The spasms spread to the respiratory muscles, leading to

breathing difficulties.

Because it becomes very painful to swallow, the infected person dribbles and often

does "froth at the mouth." "Hydrophobia" (fear of water) occurs

because people with rabies are unable to swallow water. A spasm can also be provoked

by air blowing on the affected person's face-"aeropho-bia."

Treatment

Intensive care in western countries can prolong life with the use of life support

systems. The treatment involves painkillers and sedation. As a rule, once symptoms

set in, the person will die from brain damage no matter what is done, usually within

a week, although bat-transmitted rabies victims survive longer.

Prevention

Rabies can be prevented by first aid, and either pre- or post-exposure rabies vaccine.

Vaccinating your pets, of course, will lower the threat of becoming infected at all.

Pre-exposure:

This is a course of three injections given over a period of three to four weeks,

and is considered effective for two years. This does not eliminate the need for post-exposure

vaccination, but has the following advantages:

1. Your chances of survival are much higher.
2. You will not need rabies immuneglobulin (a blood-based product).
3. You will need only two post-exposure injections as opposed to five or six.
4. Allows you slightly more time to reach a doctor or hospital.
5. Post-exposure:

First Aid: The single most important prevention is first aid treatment of the

wound. Treat all wounds as follows:

1. Immediately wash and flush with soap and water, or water alone. Do this for a

   long period of time-20 minutes if possible.

2. Then apply either 40-70 percent alcohol or tincture of iodine.
3. Seek Medical Aid
4. If you have not had pre-exposure vaccination, anti-rabies serum must be injected

   into and around the wound, and intramuscularly.

5. The wound must not be stitched.
6. Start a course of post-exposure rabies vaccination (the preferred post-exposure

   rabies vaccine is a course of human diploid cell rabies vaccine, HDCV).

7. Stop taking the anti-malarial drug Chloroquine, as this interferes with the absorption

   of the vaccine.

8. If your tetanus injections are not up to date (needed every 5 years), obtain

   one.