Rabies, derived from the Latin rabies, meaning madness, is a deadly viral disease present in more than 150 countries worldwide. It was historically called hydrophobia (fear of water) because victims panicked when offered water to drink. The disease has been known about since 2000BC.
The virus is transmitted in saliva and most infections, both in animals and humans, are caused by bites from an infected animal, usually a dog or a bat.
The virus enters the central nervous system and once classical symptoms of rabies appear the disease is almost always fatal. Rabies is 100 per cent preventable and a vaccine that can prevent rabies is available for humans and animals. Consequently rabies, once rampant throughout the world, is a much smaller problem than it once was.
The first rabies vaccine was produced by Émile Roux (1853-1933), a French physician and a colleague of Louis Pasteur (1822-1895). This involved growing the rabies virus in rabbits and then weakening it by drying the infected nerve tissue.
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The vaccine was tested in 50 dogs before being used to treat the first human. Pasteur used this vaccine on Joseph Meister in 1865, a nine-year-old boy bitten by a rabid dog.
Pasteur was running a serious risk here because he was not a licensed physician and could have been prosecuted. Meister received 13 inoculations over 11 days. After three months, Pasteur examined Meister and found him in good health. Pasteur was lauded as a hero.
More than 59,000 human deaths from rabies occur every year and about 40 per cent of these occur in children under 15, mostly caused by bites from rabies-infected dogs.
Some 95 per cent of human deaths from rabies occur in Africa and Asia. The estimated global monetary cost of rabies is about $8.6 billion annually including lost lives and livelihoods plus associated costs.
There have been no indigenous cases of rabies in Ireland since 1903. The disease is notifiable here and anyone suspecting that an animal shows signs of rabies must report this immediately to the Department of Agriculture, Food and Marine.
People working in or travelling to countries affected by rabies should take precautions and avoid direct contact with dogs, cats, small mammals and bats – as detailed in a department advisory note.
Western Europe has been free of rabies in recent years though a few isolated cases are reported from time to time, usually in dogs and cats and related to imported infected animals.
Rabies is still endemic in some EU countries including Romania and Poland. Rabies surveillance and eradication programmes are carried out in these countries involving biannual aerial distribution of the vaccine bait to foxes, raccoons and dogs.
Clinical signs of rabies can take weeks or even months after infection to develop. The first signs of rabies include sudden changes in behaviour, eg the animal may become fearful and aggressive and hypersensitive to noise and light. The sound of the bark and miaow may change. When clinical signs appear they quickly become severe – reluctance to eat/drink; aggression, a staring expression, muscle weakness, droopy face, drooling or frothing at the mouth, difficulty swallowing, seizure, coma and death.
The elimination of the canine rabies variant from the US in 2007 was one of the premier human health achievements of the 20th century. But recent criticisms and suspicions of vaccines in the United States, particularly under the influence of Robert Fitzgerald Kennedy jnr, president Donald Trump’s health secretary, have made many people hesitant to even vaccinate their dogs.
Kennedy stated in a 2023 podcast: “There’s no such thing as a safe and effective vaccine”, though he claims he was about to add the words “for all people” to this statement when he was interrupted by the podcast host. He also claimed at a recent Senate hearing he isn’t anti-vaccines, he merely wants to see them more stringently controlled.
Kennedy campaigns under the slogan Make America Healthy Again (MAHA). America may have to soon deal with the return of canine rabies as vaccination rates of dogs against rabies decline. He needs to take care that MAHA doesn’t lead to MRGE – Make Rabies Great Again!
William Reville is an emeritus professor of biochemistry at UCC
