Human rabies which is seen frequently in Nepal in comparison to Western countries is a fatal illness. Eighty percent of the world human rabies ( annually about 30,000 cases) is found in our part of the world, South Asia. Rabies is caused by a virus and is transmitted in the saliva by the bite of rabid animals. In Nepal the most commonly infected animal that transmits rabies to humans are dogs. Cats come in a distant second in this transmission process basically because we don’t have so many cats around. Whoever said our capital should be renamed Dogmandu instead of Kathmandu had the right idea, in terms of rabies anyway.
People hypothesize that monkeys also transmit rabies, but in reality the rabies virus has not been detected from a monkey in our part of the world. However the reason why the virus has not been detected from a monkey may be because we do not look for this virus carefully enough in a proper, scientific manner as monkeys are certainly suitable hosts for the virus. Another theory is that the monkeys are so smart that they do not let a rabid dog bite them as they are too quick for the dog.
Children are especially vulnerable to rabies simply because they may be bitten or nicked by a rabid dog and not mention this to anyone. This may be fatal because after a usual incubation period of about a week to 2 months, the child may come down with rabies. It is clear that rabies is under diagnosed in the developing world because the history amazingly, may be unclear or even forgotten. And not all rabies illness presents with the full manifestations of hydrophobia ( fear of water) and terror stricken behaviour that is depicted in movies. Add to that the fact that ours( including the medical community) is a non documenting society!
So what can be done? Of course, prevention. Taking care of stray dogs would be a great idea, but increasingly this undertaking seems to lack political will. So the second best thing is to consider being properly vaccinated with human rabies vaccines which are available ( at a price) especially around Teku Hospital area in Kathmandu. In the case of a bite regardless of prior ( pre exposure) vaccination, the wound needs to be properly cleaned daily with liquid iodine or soap and water as the virus hangs around the site of bite for a long time. A “top off” shot or two to boost the immunity will be required even if prior vaccinations have been taken. If prior vaccinations have not been taken and especially if the bite is severe, then immuneglobulin (a kind of “prompt response” medicine) needs to be administered. Again in the Teku Hospital area and in some clinics, this immuneglobulin may be available; but the supply is erratic. Hence “pre exposure” vaccination is best. Luckily after a bite by a potentially rabid animal, the Nepali government does usually administer rabies vaccination for free at Teku Hospital.