Management of Rabies in Kids - An Overview

Introduction:

Rabies is a rare severe infection that attacks the nerves and the brain. If not treated immediately, it can be fatal. However, if the rabies vaccine is given after exposure to an infected animal, the illness can be prevented. Children are often infected through a bite or scratch from an animal with rabies, and in 99 % of cases, it is transmitted to children by rabid dogs.

How Is Rabies Transmitted in Children?

The rabies virus can enter the body through a scratch, cut, or bite and through the mouth or eyes. The virus is transmitted through an infected animal’s saliva and passed between animals by biting or licking their claws. Therefore, children may acquire this infection if they have been scratched or bitten by an animal infected with rabies. The virus can also be transmitted if the child has sores that an infected animal licks. The rabies virus can also spread if a child touches their mouth or eyes with hands contaminated with an infected animal’s saliva.

In the United States, bats are now the primary source of human rabies death because the chain of transmission by dogs has been broken. In addition, rabies caused by bats is an emerging public health issue in Western Europe and Australia.

What Are the Symptoms of Rabies?

The primary symptoms of rabies can be noticed between a few days to more than a year after the bite from an infected person. Initially, the symptoms include a tingling or itching sensation around the bite site. A child may also experience flu-like symptoms that include:

• Fever.

• Headache.

• Muscle aches.

• Loss of appetite.

• Nausea.

• Tiredness.

After a few days, neurological symptoms appear, including

• Irritability.

• Aggressiveness.

• Excessive agitation.

• Confusion, strange thoughts, or hallucinations.

• Muscle spasms lead to unusual postures.

• Seizures (convulsions).

• Weakness and paralysis (when someone cannot move some body part). Paralytic rabies for about 20 % of the total number of human cases.

• Extreme sensitivity to bright lights, sounds, or touch.

Children with rabies may produce a lot of saliva and muscle spasms in the throat that causes difficulty in swallowing. The "foaming at the mouth" effect has long been associated with rabies infection. It can also cause fear of choking or fear of water (hydrophobia), another well-known sign of rabies.

What Are the Risk Factors for Rabies in Children?

Child is at a higher risk for rabies if they live in a region where the rabies virus is known to exist. In the United States, rabies is mainly found in bats, raccoons, foxes, and coyotes. In some regions, wild animals may cause infection in cats, dogs, and livestock such as horses. In the United States, cats are more likely to carry the virus than dogs. However, in various other parts of the world, dogs are more prone to infection. Each state is aware of animals that may carry rabies, and the government should inform the public about the animals with which contact is to be avoided.

How Is Rabies Diagnosed in Children?

Currently, no suitable diagnostic tool is present for the detection of rabies infection before the onset of clinical signs of hydrophobia or aerophobia. Diagnostic techniques to confirm human rabies involve identifying the whole virus, viral antigens, or nucleic acids in infected tissues like the skin, spinal fluid, or saliva.

How Is Rabies Treated in Children?

If symptoms of rabies begin, no effective treatment can be provided. Therefore preventive measures should be encouraged to stop the disease if a child is exposed. Physicians should provide two shots of vaccines as soon as possible:

1. Rabies Immune Globulin: This provides protection immediately while the vaccine starts working.

2. Rabies Vaccine: It is administered as a series of four doses on days 0, 3, 7, and 14. Children with a weak immune system get an extra dose on the 28th day.

Post-exposure Prophylaxis:

It is the immediate treatment after rabies exposure and prevents the entry of the virus into the central nervous system, which results in impending death. Post-exposure prophylaxis includes:

• Extensive washing and treatment of the bite as soon as possible after a suspected exposure.

• A course of effective rabies vaccine should be administered that meets W.H.O. standards.

• The administration of rabies immunoglobulin, if necessary.

Starting the treatment just after exposure to the rabies virus can effectively prevent the onset of symptoms and death.

Extensive Wound Washing:

The first-aid measure includes immediate and thorough wound washing for a minimum of fifteen minutes with soap and water or Povidone-iodine to kill the rabies virus. The immunization status of the suspect animal should not be the deciding factor post-exposure prophylaxis or not when the vaccination status of the animal is questionable.

Integrated Bite Case Management:

The veterinary services should be made alert. The biting animal should be identified, removed from the community, quarantined for observation, or submitted for immediate laboratory examination. Post-exposure prophylaxis should be continued during the ten days or while waiting for the laboratory results. Treatment should be discontinued if the animal is proven to be free of rabies.

What Are the Preventions That Should Be Taken to Avoid Rabies?

1. Eliminating Rabies in Dogs: Vaccinating dogs is the primary cost-effective strategy for preventing rabies in people. In addition, dog immunization reduces deaths caused by dog-mediated rabies.

2. Awareness of Rabies and Preventing Dog Bites: Awareness of dog behavior and bite prevention for children and adults is an essential extension of a rabies immunization program. Engagement of the program at the community level will enhance the reach and uptake of critical messages.

3. Immunization of People: Pre-exposure vaccination can also be suggested for travelers living in remote areas with a high rabies exposure risk. Immunization should also be done for children living in or visiting such places.

Conclusion:

If clinical symptoms of rabies have appeared, it can be 100 % fatal. In approximately 99 % of cases, domestic dogs are responsible for the virus transmission to humans. Over 95 % of human deaths occur in Asia and Africa. Rabies is among the neglected tropical diseases that significantly affect poor and vulnerable populations who live in rural locations. Although efficient human vaccines and immunoglobulins for rabies are available, they are not entirely accessible to those in need. Globally, children between the ages of 5 and 14 are usually victims. In addition, around 29 million people worldwide receive a post-bite immunization, estimated to prevent millions of rabies deaths annually.