Rabies in babies and children

Rabies is a serious disease transmitted to humans through the saliva of an infected animal. It affects the central nervous system, and without treatment, is nearly always fatal. Rabies starts with flu-like symptoms and then progresses to neurological problems, including confusion, partial paralysis and a fear of water and light. Seek immediate medical care, even if you're unsure about an animal bite. Your doctor can assess the bite and offer a series of anti-rabies injections for protection.

What is rabies?

Rabies is a serious though preventable disease caused by a virus from an infected (rabid) animal. It can be fatal if a person doesn't get prompt treatment and develops rabies.

The rabies infection kills thousands each year, especially in developing countries in Africa and Asia.

Rabies is endemic in India and is said to cause around 18,000-20,000 deaths each year. About 30-60 per cent of reported rabies cases and deaths in India occur in children under the age of 15 years.

What are the different types of rabies infections?

There are two classic forms of rabies:

• Furious rabies. In this type of rabies, people show signs of hyperactivity, excited behaviour, fear of water (hydrophobia) and sometimes fear of drafts of air, or air being blown on the face (aerophobia). After a few days, death occurs due to cardio-respiratory arrest.
• Paralytic rabies. This type of rabies runs a less dramatic and usually longer course than the furious form. The muscles gradually become paralysed, starting at the site of the bite or scratch. A coma slowly develops, and eventually, death occurs. The paralytic form of rabies accounts for fewer cases. It is, however, often misdiagnosed.

How is rabies transmitted?

The rabies virus is transmitted through direct contact with a rabid animal.

Infected animals can spread the virus by biting another animal or a person. The virus (present in the animal's saliva) enters a person's body, usually from a bite.

Or, when an infected animal scratches a person or licks a person's broken skin or an open wound. The rabies virus can also enter the body through the mouth, nose and eyes.

The virus does not enter the bloodstream, but moves into the nerves and travels to the brain, where it multiples and causes damage.

Rabies is not contagious and does not spread from person to person.

Which animals cause rabies?

Dogs are the main source of rabies deaths in humans. They contribute to up to 99 per cent of all rabies transmissions. The majority of bites come from stray dogs, and the rest from pets.

Other animals that can cause rabies include cats, cows, buffaloes, sheep, goats, pigs, donkeys, horses and camels.

Wild animals such as monkeys, mongooses, jackals, foxes and bears. Bats and rodents can also cause rabies.

How can you tell that an animal has rabies?

It's not possible to tell if an animal has rabies by just looking at it. The animal might act strangely (too hostile or timid), or may be drooling a lot, but this isn’t common in all cases.

The only way to be sure is to get lab tests.

So, for your health and safety, it's best to leave stray and wild animals alone and treat any attack on priority.

What are the signs and symptoms of a rabies infection in children?

Following a bite, the time it takes for the first symptoms to appear (incubation period) can vary. It could be a few days or in some cases, more than a year after a bite.

Initially, there may be pain or a tingling, pricking or burning sensation at the site of the bite. There may also be flu-like symptoms such as:

• fever
• headache
• sore throat
• fatigue
• coughing
• muscle ache
• loss of appetite

As the virus spreads through the nervous system, a progressive, fatal inflammation of the brain and spinal cord develops. Some of the symptoms that show up include:

• muscle spasms and odd, unusual postures
• aggressive and irritable behaviour
• extreme sensitivity to sounds, light and touch
• excessive movements
• seizures or convulsions
• confusion and hallucinations
• difficulty swallowing
• excessive salivation
• insomnia
• weakness or partial paralysis

What should I do if my child gets bitten by an animal?

If your child gets bitten by an animal, speak to your paediatrician right away. Your doctor will suggest some initial first-aid steps to take at home, and advise you to get to the nearest hospital as quickly as possible.

You may be advised to:

• Flush the wound immediately with plenty of running water. Flushing with water removes the saliva, and therefore, the source of the virus.
• Use soap and water to clean the area thoroughly, and apply an antiseptic such as povidone-iodine, or any other antiseptic recommended by your doctor.
• Go to your doctor or the nearest hospital at the earliest.

Don't cover the bite with a bandage or dressing unless specified by your doctor. If the wound is bleeding profusely, your doctor is likely to suggest you cover it as you make your way to the hospital.

Also, don't be tempted to try home remedies such as putting soil, chillies (mirch), crushed garlic (lehsun) oil, lime (nimbu), turmeric (haldi), herbs or spices, chalk, or betel paan leaves on the wound. These are irritants and can make the injury worse. If they have been applied, wash them away gently with soap and water.

Don't touch the wound directly with your bare hands.

Remember, even if you're unsure if your child has been bitten or exposed to the rabies virus you must get prompt medical care.

How is rabies diagnosed?

There is no way to be sure if an animal has rabies so doctors don’t wait for a confirmed diagnosis. Lab tests can be done to check for infection, but doctors start treatment right away before the results come in.

When you get to the hospital, the doctor may ask the following questions:

• What animal was involved?
• What were the circumstances around the biting incident?
• Was the bite unprovoked?
• Are your child's vaccinations up-to-date, especially the tetanus vaccine?
  
• Who owns the animal?
• What are the conditions in which the animal lives?
• Is the animal vaccinated? Are his vaccinations up-to-date?

The doctor will also want to know how the animal behaved before and after the biting incident. Dogs are usually observed for 10 days after the biting incident for any signs of "getting sick", behavioural changes, listlessness and so on.

If the biting animal is a stray, or a wild animal the local authorities can step in and decide what to do next.

What is the treatment for rabies in children?

Your baby's doctor won’t wait for symptoms to appear, as it would be too late. Even if there is a doubt, he will recommend a series of anti-rabies immunisations to be on the safe side. This is called post-exposure prophylaxis (PEP). Your child will get the following shots:

• Rabies immunoglobulin: this gives immunity in the form of ready-made antibodies, to tide over the initial phase of the infection, until your baby produces his own antibodies and the vaccine starts working.
• Rabies vaccine: a series of four doses will be given. Day 0, the first dose on the day of the bite. Followed by a dose on days 3, 7, and 14. Those with a weak immune system may need to get an extra dose on day 28.

Your child may also need a tetanus injection and an antibiotics injection, if his tetanus toxoid (TT) immunisation is not up-to-date or if the state of the wound is uncertain.

Your doctor is likely to recommend your child stays at the hospital or clinic for at least half an hour after having the shots for observation.

Are anti-rabies vaccines effective and safe for my child?

When given promptly and correctly, the rabies treatment is 100 per cent effective. Rabies immunisations are safe for everyone, including babies and children.

Side-effects are rare, but let your doctor know right away if you spot symptoms such as:

• fever
• redness, swelling and itching at the injection site
• chills, weakness or vomiting

Even if you're unsure about anything, it's best to check with your doctor.

How should I take care of my child after he gets the anti-rabies shot?

Your child's doctor will give you a list of dos and don’ts to help him recover well.

Try to keep your child comfortable and follow your doctor's advice on wound care, diet, daily routines and physical activities.

Your child must receive all the shots for the vaccine to be effective. So, it's very important that you follow the vaccination schedule and get the required dose on the specified day.

Never give any other medicines or try any alternate treatments unless they have been discussed with your doctor. Some of these could cause interactions and have a negative impact on your child's recovery.

How can I protect my child from rabies?

Rabies can be prevented with vaccines. Rabies vaccines are not currently included in the routine vaccinations for children in India. However, the Indian Academy of Pediatrics (IAP) recommends preventative rabies vaccines for "practically all" children. This includes children who have pets at home, and those who live in areas where the risk of being bitten by stray or wild animals is higher.

The vaccine is also recommended for children with chronic health conditions, such as heart, lung or immune system conditions, and asthma, as they are at higher risk for complications.

Vaccinating animals is another way of preventing the spread of disease, though this is challenging.

Children are more likely to catch rabies than adults, as they are:

• more likely to pat and play with animals
• less likely to let an adult know if an animal has bitten them
• more likely to get severe bites to their heads, faces and hands

Here are some things to keep in mind:

Keep away from stray and other animals to prevent bites

Teach your child about the importance of staying away from all stray dogs and other animals. Cats can be occasionally dangerous too. He should also keep away from pets of other people, especially those he's not familiar with.

It's best for child to not pet or hand out food items to stray dogs. Even if it is the friendly "neighbourhood" stray.

Litters of stray dogs are very attractive to little children. Try to keep your child away, as the mother of the pups can attack if she senses danger.

Be careful when you are in common areas of housing complexes or public areas such as markets, roadside eateries, tourist spots, parks, bus stops or railway stations. These places often have stray animals lurking around, looking for food and shelter.

Never scream or run if an animal starts to growl. Walk away slowly without making eye contact.

If you live in an area infested by monkeys, ensure your little one doesn't venture out without supervision, even if it's for a short time. Children should avoid carrying or eating food in the presence of monkeys and strays.

Immunise your pet dog or cat

Regularly consult your veterinarian about your pet's health and the required vaccinations.
If you are about to acquire a pet, check with the breeder or seller about the following:

• Where the pet comes from. It should be from a legitimate source.
• Medical history and background check of the animal and its parents.
• Health and immunisation status of the animal. Always ask for a medical certificate.
  

Keep your child's vaccinations up-to-date

Make sure your child has all the recommended vaccines at the right time.

It's best to be prepared for any eventuality. Find out which hospital or clinic is equipped to handle and treat rabies cases if the need arises.

Include the contact information in your emergency numbers list and first-aid kit.


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