This disease with a mortality rate of nearly 100% is hidden around you and me, but many people don’t know about it.

September 28th is Rabies Day, let’s talk about it seriously↓

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Some people may ask: Shouldn’t Rabies Day be about dogs? Why are cute cats also related to rabies?

In fact, when it comes to rabies, we should not only pay attention to dogs and cats, but also various mammals such as bats, raccoons, foxes, etc.

Rabies

Zoonotic diseases with a mortality rate of nearly 100%

Before introducing animal trauma and rabies, we need to first understand the "rabies virus".

Rabies virus is the pathogen of rabies. It is called "Rhabdovirus" because it looks like a bullet. Human infection is usually caused by animal bites and scratches. Rabies virus has an affinity for nerve tissue. After infection, it will move upward at a speed of 12-14 mm/day and reach the spinal ganglia, causing discomfort including local paresthesia, fever, fatigue, etc. (prodromal symptoms); thereafter, it will spread to the central nervous system structure and salivary glands at a speed of 200-400 mm/day, and produce neurological symptoms (rabies onset).

Image source: chinacdc.cn

The mortality rate of rabies is nearly 100%, so this rhabdovirus can be said to be "a bullet that never misses its target." Even if a few cases survive, there have been fewer than 30 cases of rabies patients surviving worldwide over the years (and there may even be insufficient evidence), and compared with the data that about 59,000 rabies patients die each year worldwide, the number of surviving cases can be said to be very insignificant.

Therefore, the threat of rabies must be taken seriously!

Rabies: More Than Just Dogs

So, are cats and rabies related? Of course they are!

When many people hear about rabies, they may immediately think of a vicious dog with drooling mouth and fierce eyes. But in fact, mammals such as cats, bats, raccoons, and foxes can be infected and carry rabies virus, but dogs and cats are the "main causes" of rabies infection in humans.

Data shows that among the animals that cause human rabies cases in China, dogs account for 95%, ranking first; cats rank second, and 4% of all human rabies cases are related to cats, most of which are caused by cat bites or scratches.

How is the virus transmitted? As mentioned earlier, when the rabies virus infects the host, the virus will gradually spread to the salivary glands, resulting in the presence of the virus in the cat's saliva. When a cat bites or scratches a cat's paw that has been licked and stained with virus saliva, the virus will enter the wound and cause infection, which in turn causes the disease.

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Therefore, if you are scratched or bitten by a cat, you should immediately determine the risk of disease and take appropriate measures as soon as possible.

Cat Injuries and Vaccinations

Animals that get rabies are not born with the rabies virus naturally, but are infected in their daily lives.

Therefore, we need to distinguish between two different cats.

1

House cats in enclosure

For cats that are kept in a closed environment and have no chance to come into contact with wild animals outside (such as those kept in a building room), there is no chance of contact with the virus and therefore they will not be infected with rabies. In this case, even if they are bitten or scratched, there is no need to vaccinate against rabies.

2

Free-range or stray cats (stray cats)

Since stray cats and free-range cats may be infected with rabies due to contact with animals infected with rabies in the outside world, if they are injured by free-range or stray cats, the risk of infection needs to be considered, and rabies vaccination is required in this case.

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Some people may ask: If a feral or free-range cat that I shelter or adopt scratches or bites me, is it necessary to vaccinate me? The answer is: vaccination.

Because the average incubation period for cats infected with rabies virus is 2 months, but it may be 2 weeks to several months or even years, any unexplained aggressive behavior or sudden behavioral changes in cats must be considered suspected rabies.

Therefore, we do not need to worry about domestic cats that have been raised at home and kept in a closed environment contracting rabies, but free-range or adopted stray cats and wild cats may be at risk of carrying the rabies virus.

After being bitten by a dog or cat

How to treat wounds?

Once rabies occurs, it is almost 100% fatal, so if there is a risk of infection with the rabies virus, it is necessary to follow the prescribed treatment. Next, we will explain the actions that need to be taken one by one based on official recommendations from home and abroad:

1. Determine the level of wound exposure. Level II and III exposures require the following steps:

(1) Level I exposure: touching or feeding animals, or having intact skin licked (no exposure);

(2) Level II exposure: light biting of exposed skin, scratching or abrasion without bleeding (exposure);

(3) Level III exposure: single or multiple bites or scratches that penetrate the skin, mucous membranes contaminated by saliva (licking), broken skin caused by licking, and direct contact with bats (severe exposure).

2. Wound flushing: Use soapy water (or other weak alkaline detergents, professional flushing fluids) and running water at a certain pressure to thoroughly rinse all bites and scratches for about 15 minutes alternately. If available, a virucide (such as povidone-iodine solution) should be used to flush the wound.

3. Use of vaccines and passive immunization agents: Depending on the wound condition, the use of vaccines or passive immunization agents and related use plans can be found in the figure below:

Photo courtesy of the author

In addition, if special circumstances arise, professional medical personnel are still needed to provide special treatment. For example, when flushing a deep wound, medical personnel can use a syringe or special flushing equipment to infuse and flush the inside of the wound to achieve a comprehensive and thorough cleaning. For HIV-infected people or other immunodeficient patients, they need to be treated separately according to the treatment situation.

Of course, in addition to rabies, cat scratches and bites may also lead to infection with Pasteurella multocida, various aerobic and anaerobic bacteria, and Bartonella henselae that causes cat scratch disease (CSD), so it is very important to treat and disinfect the wound in time!

General approach to rabies management

——10-day observation method

Since cats (as well as dogs and ferrets) will die within 10 days of contracting rabies, there is an international observation method called the "10-day observation method", which means that if the animal remains healthy during the 10-day observation period after the injury, there will be no rabies virus in its saliva when contact is possible, and the injured person does not need to be vaccinated or given passive immunization preparations.

Please note: The 10-day observation method does not mean not to vaccinate after the injury, but to vaccinate and observe for a full 10 days! This method is not suitable for wild cats that are difficult to observe, and other animals besides cats, dogs, and ferrets.

Finally, I would like to remind everyone that rabies is not only prevented by vaccines for humans, but cats and dogs can also reduce the risk by regularly vaccinating against rabies. Kittens can be vaccinated at 12 to 16 weeks of age.

I hope everyone can take scientific precautions, and I wish everyone can always pet cats with peace of mind and stay away from rabies virus!

References

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Planning and production

Author: Shao Yinan, popular science creator

Review丨Zhang Yu, researcher/PhD, Chinese Center for Disease Control and Prevention, national health science expert