Research Paper on Rabies
The cause of rabies is a bite from an infected animal. The virus is carried in the saliva of the animal. Symptoms include fever, headache, nausea, vomiting, and other flu-like symptoms, which may lead a person to think that they have the flu. By the time they figure out that it is rabies, it is too late because the sickness nearly always ends in death. Other symptoms that are not flu-like include anxiety, confusion, hyperactivity, difficulty swallowing, excessive salivation, hallucinations, insomnia and partial paralysis. Rabies can be prevented if the person who is bitten by an animal suspected of having rabies is given the rabies vaccine right away. Since there is no way of telling for sure if the animal who has bitten a person has rabies, it is best to get the vaccine, which includes a series of injections of rabies immune globulin over a two week period (Mayo Clinic, 2019). Otherwise, there is no treatment for rabies and people who contract it nearly always die from it, although a few have been treated successfully. Manning, et al. (2008) of the Center for Disease Control and Prevention (CDC), says the incubation for rabies is usually several weeks or months, but can ranges anywhere from days to years (Manning, et al., 2008).
The people most likely to acquire rabies are those who work or spend time around wild animals, since most domestic animals that may be exposed to rabies, such as dogs, are given rabies shots to prevent them catching the disease. According to Pieracci, et al. (2019) of the Morbidity and Mortality Report, the people most likely to acquire rabies are children under the age of 15. The animal most likely to contract rabies and then bite humans are bats, but raccoons are also common carriers of the disease (Pieracci, et al., 2019, p. 526).
Determinants of Health
Rabies has the highest fatality rate of any infectious disease. Rabies is most common in developing countries where wild animals are potentially a source of infection for both humans and domestic animals. Most of the reported cases of rabies in animals occur in carnivores such as raccoons, skunks, foxes and bats. “Rabies among insectivorous bats occurs throughout the continental United States. Hawaii remains consistently rabies-free” (Manning, et al., 2008). Most cases of rabies in the United States in recent years has come from bats. One case of rabies in 2005 and two or three cases in 2006 were attributed to bat exposure. In 2004, eight people acquired rabies. All those cases came from bats. One of the people who acquired rabies survived the disease in 2004 (Manning, et al., 2008). One sad result of a rabies death is that it is not always recognized. One of the patients who died from rabies in 2004 donated his or her organs and a vascular graft to four other people. They all died from rabies (Manning, et al., 2008).
Somewhere between 16,000 and 39,000 people come into contact with potentially rabid animals and receive the rabies injections every year. Social determinants of health for acquiring rabies include location, occupation, tendency to interact with wild animals, location of nearest medical facility, and income. Another determinant of health may be knowledge about which animals are likely to have the rabies virus.
Epidemiological Triad
The host factors for rabies in the United States is any animal that comes into contact with the virus. Since the time that leash laws and animal control laws have required that domestic dogs be immunized against rabies, the incidence of rabies has decreased dramatically. With the more frequent occurrence of people building homes and communities near wildlife habitations, the incidence of rabies has increased. Humans must be bitten or scratched by an animal that has the rabies virus go acquire the disease. The symptoms of rabies appear anywhere from between one and two weeks after exposure, so animals with rabies can be asymptomatic when they bite a human. Therefore, every person who is bitten by a dog whose owner is unknown or a wild animal should get the postexposure prophylaxis (PEP).
In recent years, animal control experts and epidemiologists have developed a vaccine wrapped in a flavored bait. This is left near where raccoons are known to live. According to Pieracci, et al. (2019), these vaccine baits have been effective in controlling the spread of rabies. Outside of those areas where the bait is used, raccoons account for 75% of animal rabies cases in the United States. Where both raccoons and bats have rabies, human rabies exposure is 600% higher than where just bat rabies occurs (Pieracci, et al., 2019, p. 525).
People who are bitten or scratched by wild animals or by dogs of unknown ownership should get the PEP as soon as possible. It is not a matter of emergency, but of urgency. Humans are most likely to acquire the rabies virus from a bat because vaccinating bats is not feasible. There have been no rabies vaccines approved for use on bats. “Despite the rabies exposure risk, the vast majority of bats submitted for testing (94%) do not have rabies. Thus, widespread killing of bats is not recommended to prevent rabies” (Pieracci, et al., 2019, p. 526). Humans need to understand that bats can carry rabies. They should also know when to seek PEP. Americans should also be aware that travel-related rabies cases can occur and the likelihood of dogs carrying the virus is greater in some foreign countries where there are no leash or vaccination laws.
Some people do not want to get their dogs vaccinated for rabies, cannot afford the cost of the vaccination, or do not have access to an outlet for the rabies vaccination for their dogs. If a person is around a dog like that, their chances of acquiring rabies from that dog increases. While requiring rabies vaccinations for dogs has all but eliminated the risk of humans being bitten by a rabid dog, controlling rabies in the wildlife population is not as simple. The vaccination bait for raccoons is only effective in the areas where it is used, but that has helped to control the occurrence of rabies in raccoons. Bats are now the main culprit for the spread of the rabies virus. “Efforts to control rabies in wildlife and maintain canine rabies elimination in the United States require ongoing, high-quality rabies surveillance and timely response capabilities. Rabies continues to be a priority zoonotic disease for One Health collaboration (17), requiring multi-agency cooperation to ensure continued success of the U.S. rabies control program” (Pieracci, et al., 2019, p. 526). Approximately, 100,000 animals per year are tested for rabies, with only about 5,000 testing positive.
Role of the Nurse Practitioner
A nurse practitioner (NP) may encounter a person who has been bitten or scratched by a wild animal that may have rabies. The NP should advise the person to get the PEP so that the chances of getting rabies is diminished. However, there may be some factors that will help the NP and the patient to know if the PEP is warranted. For instance, where the animal bite occurred. Rabies is more prevalent in some countries than in others. Also, knowing what type of animal bit the patient is important because most dogs have rabies shots. If the animal is not wearing a tag that says they have had the rabies vaccine, and their owner cannot be contacted, then the PEP should be given. If the PEP is required, the NP should administer it if it is within the NP’s scope of practice. If not, the NP should refer the patient to a physician who can administer the PEP. The NP should also report the suspected case of rabies exposure to the local health department who can then alert the proper animal authorities. The NP may also know if the animal is available for testing, and if so, the NP can alert the proper lab responsible for testing for rabies.
References
Manning, S. E., Rupprecht, C. E., D. F., Hanlon, C. A., Lumlertdacha, B., Guerra, M., . . . Hull, H. F. (2008). Human Rabies Prevention --- United States, 2008. CDC. Retrieved from https://www.cdc.gov/mmwr/previ...
Mayo Clinic. (2019, October 4). Rabies. Retrieved from Mayo Clinic: https://www.mayoclinic.org/dis...
Pieracci, E. G., Pearson, C. M., Wallace, R. M., Blanton, J. D., Whitehouse, E. R., Ma, X., & Olsen, V. (2019). Vital Signs: Trends in Human Rabies Deaths and Exposures —United States, 1938–2018. Morbidity and Mortality Weekly Report, 68(23), 524-528. Retrieved from https://www.ncbi.nlm.nih.gov/p...
