Pathogen and transmission
Rabies is caused by the rabies virus, and is almost always fatal once symptoms manifest. The virus can infect any mammal and then be transmitted from animals to humans. Key reservoir animals for rabies in Europe are foxes and bats, while the virus is primarily carried by dogs in tropical and subtropical countries. Transmission to humans is via bite or scratch wounds inflicted by an infected animal, or by the infected animal’s saliva coming into contact with a person’s mucous membranes (such as in the eyes, the nose or the mouth).
Pathology
The period between infection and the onset of the disease can vary substantially, but tends to be between 20 and 60 days. The initial stage of the disease is characterised by general malaise, headaches, fever and itching, along with sensitivity in the area around the bite or scratch wound. In its acute phase, the disease brings muscle twitches, hyperactivity, anxiety and breathing and swallowing difficulties. This is then followed by paralysis, and ultimately the patient will fall into a coma. Since this paralysis will extend to the respiratory centre within the central nervous system, rabies is almost always fatal.
Treatment – i.e. post-exposure prophylaxis – is only possible before the first symptoms appear, and must always be based on a doctor’s assessment. Guidelines and further information on this will be found in the links below. The Swiss Rabies Centre can also provide assistance and advice.
Distribution and frequency of occurrence
Rabies is found almost all over the world. But most countries of the European Union, Australia, New Zealand and Japan are considered rabies-free. Thanks to extensive actions involving vaccine bait, rabies has also been eradicated from Switzerland’s fox population. It can, however, still infrequently occur in bats or in illegally imported animals (dogs in particular). The latest cases of rabies in animals in Switzerland (excluding bats) were seen in 1996. Switzerland has been officially free of terrestrial rabies since 1999. Western Europe has, however, seen several fatalities from rabies in the last few years among persons who had been infected with the disease while travelling in risk areas (specifically Asia and Africa).
Prevention
Care should always be taken to avoid touching wild animals, unfamiliar pets or any dead animals. Specialist assistance (such as gamekeepers or veterinary surgeons) should be sought if necessary.
After any exposure to a bat (e.g. anyone waking up and finding a living, sick or dead bat in the room) or after any injury caused by a sick or unknown animal in a rabies risk region, the wound should be thoroughly cleaned immediately with soap and water and a doctor should be seen without delay. As long as no symptoms have yet appeared, a rabies vaccination can prevent the development of the disease.
Precautionary rabies vaccination is recommended in Switzerland for veterinary surgeons and their staff, animal keepers and handlers exposed to possible rabies infection, persons who come into contact with bats (such as cave explorers) and laboratory personnel who work with rabies viruses. In the travel medicine field, rabies vaccination is also recommended for anyone planning a longer stay in a rabies risk region and also – regardless of the length of stay – for any travel with an increased individual risk (e.g. for cyclists or motorcyclists, hiking in remote areas, any trip to places where medical care may be hard to access and, depending on the situation, when travelling with children).
For further information on the global distribution of rabies and ways and means to avoid infection, consult your GP or a doctor specialising in travel medicine (see also the links below).