Rabies in humans: signs, treatment and prevention

Instructions

The incubation period averages 30-50 days. Bites to the head and stings are considered especially dangerous. The disease is divided into: initial, excitation, paralytic. The first stage is characterized by the following: malaise, fever, pain in the neck, loss of appetite, headaches, sore throat, and possibly vomiting or nausea. There is a burning sensation, redness and itching at the site of the bite. There may be insomnia, visual hallucinations, nightmares.

A patient with rabies, on average, enters the agitation stage after 1-3 days. Restlessness, anxiety arises, when trying to drink, a feeling of horror appears, sharp spasms of the muscles of the larynx and pharynx. At this stage, the person becomes excitable, irritable, and aggressive. During an attack, patients with rabies scream, break furniture, and rush at people. Increased salivation is noted, the period usually lasts up to 3 days.

As the disease develops, a paralytic stage occurs: the temperature rises to 40 - 42 degrees, paralysis of the limbs and cranial nerves, impaired consciousness and convulsions occur. Death usually occurs from cardiac arrest or paralysis of the respiratory center.

There are no effective treatments for rabies. Already at the initial stage, as a rule, the outcome is fatal. There is a known way to prevent this disease - this is a method of specific immunoprophylaxis or vaccination against rabies within 2 weeks from the moment of the bite. The most effective specific prevention is the administration of immunoglobulin and/or vaccination.

The vaccine is administered intramuscularly 5 times, 1 ml each, according to a specific scheme: on the day of infection, then on the 3rd, 7th, 14th, 28th day. With this administration regimen, intense immunity is created; according to WHO recommendations, the 6th injection is prescribed 3 months or 90 days after the first administration. The vaccine is injected into the deltoid muscle of the shoulder or thigh. Treatment can be stopped provided that the animal remains healthy within 10 days and the rabies virus is not detected. Persons who are at risk (hunters, dog handlers, veterinarians) are vaccinated in advance. Vaccination is carried out according to a special scheme, the first revaccination after 12 months, and then repeated revaccinations after 5 years.

If you are bitten by an animal, immediately wash the bite area with soap and water for 10 minutes. A deep wound should be washed with a stream of soapy water using a catheter or syringe. And then you need to immediately go to the emergency room. The doctor will prescribe a course of vaccinations consisting of 5-6 injections. If you have complaints about a worsening condition, you should immediately consult a doctor. Only after a complete examination by a neurologist, therapist and radiologist, the commission decides on the continuation of vaccination.

The importance of viruses in medicine can be compared to a mass destructive factor. When they enter the human body, they reduce its protective capabilities, destroy blood cells, and penetrate the nervous system, which is fraught with dangerous consequences. But there are special types of viruses that leave no chance of survival. Rabies is one of them.

What is rabies and how dangerous is it to humans? How does infection occur in people and are there outbreaks of infection in our time? How does the disease manifest itself and how does it end? Is there a cure for this disease and what prevention is needed? Let's find out everything about this dangerous infection.

Description

It is unknown where the rabies virus came from. Since ancient times, it has been called hydrophobia, because one of the common signs of advanced infection is the fear of water.

The first scientific works appeared in 332 BC. e. Aristotle also suggested that a person becomes infected with rabies from sick wild animals. The name itself comes from the word demon, since long before the viral nature of the infection was discovered, a sick person was considered possessed by evil spirits. Aulus Cornelius Celsus (an ancient Roman philosopher and physician) called the infection hydrophobia and proved that wild wolves, dogs and foxes are carriers of the disease.

The foundations for the prevention and treatment of the rabies virus in humans were laid by the French microbiologist Louis Pasteur in the 19th century, who, as a result of many years of research, developed an anti-rabies serum that saved more than one thousand lives.

At the very beginning of the last century, scientists were able to establish the viral nature of the disease. And exactly 100 years later, they found out that rabies can be cured even at the stage of the first signs of the disease, which was not the case before. Therefore, this, as everyone previously believed, was a fatal disease, today it is considered curable, but under certain circumstances.

What is rabies

Rabies is a neurotropic (affecting the nervous system) acute viral infection, which can be transmitted to animals and humans. After the virus enters the body, the symptoms quickly increase in intensity, and the infection ends in death in most cases. This is due to the characteristics of the microorganism.

How dangerous is the rabies virus?

1. It is resistant to low temperatures and does not react to phenol, Lysol solution, sublimate and chloramine.
2. It cannot be killed with a strong antibacterial drug; even viral agents are powerless.
3. At the same time, the rabies virus is unstable in the external environment - it dies when boiled after 2 minutes, and under the influence of temperatures above 50 ºC - in just 15. Ultraviolet light also quickly inactivates it.
4. The virus moves to the nerve cells of the brain, causing inflammation.
5. The microorganism exists on almost all continents and, according to WHO estimates, more than 50 thousand people die from it every year.

The rabies virus can be found not only in African and Asian countries, but also in the post-Soviet space, as it is spread by wild animals.

What is rabies and why is it dangerous?

Rabies (hydrophobia, hydrophobia) is a natural focal viral disease. Epidemic features of the pathological process:

• high mortality;
• spread over a wide area;
• connection with the level of the economy in the state;
• the degree of development of anti-rabies care for the patient.

Hydrophobia is accompanied by the development of a special form of encephalitis if bitten by a rabid cat. Hydrophobia often ends in death.

The causative agent of rabies belongs to the Lyssavirus phylum. The virus cannot be destroyed by disinfectants, freezing, or antibiotic injections (AB).

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It is destroyed by exposure to alkalis, acids, and high temperatures. The outcome of the disease is unfavorable. The pathogen causes the death of brain cells, and the injured person develops swelling, hemorrhage, and tissue necrosis.

Causes of human infection

How is rabies transmitted to humans? This is a typical zoonotic infection, that is, people become infected from a sick animal. The natural reservoir of the virus is carnivores.

1. The carriers of infection are foxes and wolves in our forests. Moreover, the main role in the spread of the rabies virus belongs to foxes.
2. In America, raccoon dogs, skunks, and jackals play a large role in infecting people.
3. In India, bats are involved in the spread of infection.
4. Pets such as cats and dogs can also infect humans.

What are the ways of transmission of the rabies virus? — through wound surfaces or mucous membranes, where the virus found in the animal’s saliva enters.

How does infection occur? The virus is active in the last days of the incubation period and during the development of manifestations of the disease, it is then that it is already present in the saliva of a sick animal. When the rabies pathogen gets on the mucous membranes or on a wound, it enters the human body and begins to multiply.

How can you get rabies from a dog if there was no bite? Contact with the saliva of an infected pet is sufficient. It is almost impossible to suspect the disease during the incubation period, but the virus is already present and actively multiplying inside. This is another dangerous moment in the spread of infection. What are the signs of rabies in a person from a dog bite? - they are no different from those when infected with other animals. The only thing that matters is the size of the animal. The larger the dog, the more harm it can cause and the faster the infection will develop.

There is an assumption about where the virus comes from - scientists have come to the conclusion that there is a reservoir in nature - these are rodents with rabies that did not die immediately after infection.

Nowadays, foci of infection can be found absolutely everywhere, in any country in the world. But outbreaks of the disease were not recorded in those regions where anti-rabies serum is actively used (Japan or on the islands of Malta, Cyprus).

Susceptibility to infection is universal, but children are more likely to get sick in the summer-autumn period due to visiting the forest. Can you get rabies from a person? Throughout the history of studying the disease, doctors have been afraid that a sick person is dangerous to others. But this is almost impossible, because he is closely monitored, including his rigid fixation on the bed or complete isolation from others.

Is rabies transmitted through a scratch? - yes, this is a possible way of contracting an infection, provided that a large amount of saliva gets into the wound. The virus is concentrated in the muscle mass, then reaches the nerve endings. Gradually, the microorganism captures an increasing number of nerve cells and affects all their tissue. When the rabies virus multiplies in cells, special inclusions are formed - Babes-Negri bodies. They serve as an important diagnostic sign of the disease.

The infection reaches the central nervous system and affects important structures of the brain, after which convulsions and muscle paralysis appear. But not only the nervous system suffers; the virus gradually penetrates the adrenal glands, kidneys, lungs, skeletal muscles, heart, salivary glands, skin and liver.

Penetration of the rabies virus into the salivary glands and its reproduction causes further spread of the disease. The infection spreads faster if a person is bitten by an animal in the upper half of the body. A bite to the head and neck will lead to rapid spread of infection and a large number of complications.

Diagnostics

Diagnosis of rabies in humans is carried out quite specifically. First you will need to visit an infectious disease specialist who will prescribe the appropriate examinations. It will be necessary to donate blood, urine, and also a biopsy of tissues on which saliva has entered the wound. If there is rabies, lymphocytic leukocytosis and aneosinophilia will be detected. In the prints that were taken from the cornea of ​​the eyes, the antigen to the virus is determined.

When a person dies of rabies, ammon's horn tissue is taken for analysis to confirm the diagnosis. If there was a rabies virus in the human body, Bebesh-Negri bodies will be detected in the test material.

The manifestations of rabies can be similar to other diseases. For example, similar symptoms may occur in hysteroneurosis, tetanus, delirium tremens, etc. In case of poisoning with atropine or rat poison, similar manifestations are also observed. But there are also a number of differences.

It is worth noting that the analysis will help avoid death in some cases if the pathology is caused by other diseases. But if the diagnosis is confirmed, it will be impossible to help the person.

Periods of disease development

There are several stages in the development of rabies:

• incubation or period without manifestations of the disease;
• the initial or prodromal period of rabies, when there are no visible typical signs of infection, but the person’s well-being significantly deteriorates;
• stage of heightened or excited;
• terminal stage or paralytic.

The most dangerous time is the onset of the disease. The incubation period for rabies in humans ranges from 10 to 90 days. There are cases where the disease developed a year after the animal’s bite. What is the reason for such a big difference?

1. As already noted, the location of the bite plays an important role in this. If an animal infected with the rabies virus bites a person in the upper half of the body, the time frame for the development of the disease is reduced. In case of injury to the foot or lower leg, infection develops more slowly.
2. Depends on the age of the affected person. In children, the incubation period is much shorter than in adults.
3. The type of infected animal also matters. The bite of small carriers of infection is less dangerous, a large animal will cause more damage and the disease will develop faster.
4. Another important aspect is the size and depth of the wound, bite or scratch.
5. The greater the amount of rabies pathogen that gets into the wound, the greater the chances of rapid development of the disease.
6. The reactogenicity of the human body also plays a role, or, in other words, how susceptible its nervous system is to a given pathogen.

Symptoms

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The duration of the incubation period of the disease, which begins from the moment the rabies virus is introduced into the human body and continues until the first symptoms of the disease appear, depends on the location of the bite or contact with the damaged skin or mucous membranes of the saliva of an animal with rabies . For example, the longest incubation period is observed when the lower extremities are affected and ranges from 1 – 3 months to 1 year. The incubation period is significantly shortened (2 weeks - 1 month) in cases where the entrance gates of infection are the head, face, and neck.

There are 3 periods in the clinical picture of the disease:

1. Initial period. This period in most cases is characterized by a blurred clinical picture, which significantly complicates diagnosis. Changes are mainly observed in the human psyche. He becomes withdrawn and less often irritable. A person complains of sleep disturbances (frightening dreams often occur), anxiety and fear, headache, general weakness, and loss of appetite. The appearance of such nonspecific symptoms does not make it possible to correctly diagnose at this stage, especially since a person forgets about the previous animal bite due to the long incubation period. Significantly less often, warning signs of the disease occur in the form of nagging pain, itching and burning in the area of ​​a long-healed wound. It is extremely rare to observe hyperemia (redness) and swelling at the site of the bite. Body temperature at the initial stage of the disease is normal or subfebrile. The initial period of the disease lasts 2–3 days;
2. The period of excitement (stage of the height of the disease). It is characterized by a slight increase in body temperature, general agitation, increased irritability, as well as hydrophobia, aerophobia, acoustophobia and photophobia. Hydrophobia is caused by painful spasms of the muscles of the pharynx and larynx when a person tries to drink water. As the process progresses, an attack of hydrophobia occurs not only at the sight of a glass of water, but even at the sound of flowing water or hearing the word “water.” However, it is worth noting that not all patients have hydrophobia, which can confuse the doctor. Then so-called paroxysms occur, which are accompanied by painful spasms of the facial muscles. At this time, the person throws his head back with a scream, breathing quickens, becomes intermittent, with a deep noisy exhalation. A person becomes aggressive, he can bite or even hit during excitement, he screams, rushes about in despair. The appearance of visual and olfactory hallucinations is not uncommon. The period of excitation lasts from 2 to 4 days, less often the second stage of the disease lasts up to 6 days;

Paralytic period. The previous excitement is replaced by apathy, which may be perceived as a positive prognosis, but this is far from the case. In fact, this period is very dangerous, as paralysis of the limbs and cranial nerves occurs. In addition, body temperature rises to high levels, blood pressure levels decrease, and heart rate increases. Death occurs due to paralysis of the respiratory and cardiovascular centers. The duration of the paralytic period varies from 1 to 3 days.

Symptoms of rabies in humans

What are the first signs of rabies in humans?

But even at this time it is almost impossible to suspect the onset of the disease, because such symptoms accompany many infectious diseases, not only rabies.

Symptoms during periods of height or excitement

After a short prodrome, another period follows - the height. It does not last long, from one to four days.

Additionally, the symptoms of the disease are accompanied by severe attacks of aggression:

• a person scratches, and sometimes even tries to bite himself and others, spits;
• the victim rushes around the room, trying to hurt himself or others;
• people infected with the rabies virus develop abnormal strength, they try to break the surrounding furniture and hit the walls;
• attacks of mental disturbance appear - auditory and visual hallucinations, delusions occur.

Outside of attacks, the person is conscious and feels well, he is in a state of relative peace. During this period, the rabies patient vividly describes his experiences and suffering during the attack.

Symptoms of rabies during paralysis

How does the period of paralysis manifest during the development of rabies?

1. Due to muscle paralysis, a person experiences constant salivation, but he cannot swallow and therefore constantly spits.
2. Movement in the arms is weakened due to paralysis of the shoulder muscles and limbs.
3. The jaw of such patients often hangs due to weakness of the facial muscles.
4. In addition to paralysis, in patients with rabies in the last stage of the disease the body temperature rises.
5. Disturbances in the functioning of the cardiovascular and respiratory systems are increasing, so another attack for a person can end in failure.
6. Further, the symptoms of rabies in people fade away—the person becomes generally calm, fear and anxiety disorders disappear, and attacks are also not observed.
7. The violence of rabies is replaced by apathy and lethargy.

The total duration of all periods of the disease is no more than 10 days, excluding incubation.

Signs of rabies

The incubation period can be as short as twelve days or as long as one year. But on average, this period for rabies is one to three months. The duration of the incubation period is primarily influenced by which part of the body the sick animal bit. Thus, the shortest duration of the incubation period is recorded for bites in the area of ​​the head, neck, upper extremities, and the longest - for a bite localized in the area of ​​the lower extremities. A short incubation period is observed in children. No less important are the state of the body’s immune system, the depth of the wound, and the amount of pathogen that has entered the wound.

There are three stages of the disease:

1. Initial (depression);
2. Excitement;
3. Paralytic.

initial stage

The first signs of the disease are the appearance of twitching, itching, burning, and nagging pain in the bite area, even if the wound has already completely healed.
Sometimes the wound can become inflamed again, and the skin in this area becomes swollen and red. The victim notes general malaise and may experience a headache. The temperature rises to 37-37.5 degrees and remains at this level.

At this time, signs of damage to the nervous system already appear: the person becomes depressed, anxiety, fear, and, less often, irritability appear. Such a person withdraws into himself, refuses communication, food, and does not sleep well. The duration of the initial stage is only one to three days. After this period, apathy gives way to excitability, increased heart rate and breathing, and the appearance of compressive pain in the chest area.

Excitation stage

The patient becomes more and more restless. At this stage, the most characteristic sign of the disease already appears - hydrophobia. When trying to swallow water, a person experiences painful spasms of the swallowing and auxiliary respiratory muscles. Therefore, even at the sound of running water from the tap, a person becomes restless, breathes noisily, taking short breaths.

The central nervous system gradually becomes susceptible to any irritants. Muscle cramps can be triggered by a puff of air (aerophobia), a loud sound (acousticophobia) or a bright light (photophobia).

Noteworthy are the sharply dilated pupils, the patient's gaze is fixed on one point. The pulse is greatly increased, and there is increased salivation and sweating. The patient is not able to swallow such a large amount of saliva, and therefore constantly spits or saliva flows down the chin.

At the height of the attack, psychomotor agitation occurs, the patient becomes aggressive, tears his clothes, rushes around the ward, and attacks people. At the same time, consciousness becomes darkened and the patient suffers from hallucinations of a frightening nature. During periods between attacks, consciousness can clear up and then the patient is even able to react adequately and answer the questions posed. The duration of this period is two to three days.

Paralytic stage

At this stage, convulsions and hydrophobia stop. People around often perceive such changes as an improvement in the patient’s condition, but in fact this indicates imminent death.

During this period, body temperature rises to critical levels: 40-42 degrees. There is a rapid heartbeat and a drop in blood pressure. Death usually occurs within 12-20 hours from paralysis of the respiratory center or heart.

On average, the illness lasts five to eight days. The classic version of the course of the disease is described above, but not in all cases rabies occurs in this way. Thus, sometimes the disease immediately manifests itself as agitation or paralysis, without an initial period. Some patients may have no attacks of psychomotor agitation or hydrophobia at all.

Atypical course of rabies and prognosis

In addition to the familiar classic course of rabies, there are several other variants that are uncharacteristic of this infection.

1. The disease occurs without fear of light or water, and begins immediately with a period of paralysis.
2. Perhaps the course of the disease is with mild symptoms, without any special manifestations.

Doctors even suggest that one of the important factors in the spread of the disease is the latent or atypical course of the infection.

The prognosis of rabies is always difficult to predict. There are probably two main options here - recovery or death from rabies. The later therapy is started, the more difficult it is to cure the patient. The last period of illness is always unfavorable in terms of recovery; at this time a person no longer has a chance.

Treatment

Rabies therapy begins with an important stage - complete isolation of the person in a separate room, in which there are no irritants, so as not to provoke attacks.

Then, treatment of rabies in humans is carried out taking into account the symptoms.

1. First of all, they try to correct the functioning of the nervous system, because the main problems are due to inflammation of the centers of the brain. For this purpose, sleeping pills, drugs to reduce pain, and anticonvulsants are prescribed.
2. Considering that patients with rabies are weakened, they are prescribed parenteral nutrition, that is, glucose, vitamins to maintain the functioning of the nervous system, plasma-substituting substances and simply saline solutions are administered using solutions.
3. Is rabies in humans treated with antiviral drugs or other treatments? In the later stages, the disease is incurable and ends in death. Even the most modern antiviral drugs are ineffective and therefore are not used against rabies.
4. In 2005, a girl was cured in the United States who, during the height of her illness, was put into an artificial coma, and after a week of brain shutdown, she woke up healthy. Therefore, active development of modern methods for treating patients with rabies is currently underway.
5. In addition, they are trying to treat the disease with immunoglobulin for rabies in combination with mechanical ventilation and other methods.

Treatment of rabies during pregnancy

Rabies has an extremely negative impact on pregnancy, and therefore, during the period of preparation for motherhood and during pregnancy, it is recommended to avoid unfavorable contacts in every possible way.

Pregnant women are not included in the category of people for whom a course of preventive vaccinations against rabies is indicated. These are applied only to persons professionally associated with the risk of contracting rabies (workers of veterinary diagnostic laboratories, hunters, etc.), and consist of three intramuscular injections of the vaccine. A single revaccination is recommended after a year and then every 3 years if the person continues to be in a high-risk area.

Prevention

Due to the lack of effective treatments for rabies, prevention remains the most reliable method today.

Nonspecific prevention of rabies begins with the extermination of infection vectors and detection, as well as elimination of the source. In recent times, they carried out so-called sweeps of wild animals and exterminated them. Since in nature the fox and wolf rank first in the spread of rabies, they were destroyed. Nowadays such methods are not used, only in case of changed behavior can special services deal with it.

Since animals can spread the rabies virus in urban environments, much attention is paid to preventive measures for domestic dogs and cats. For this purpose, they are given specific rabies prevention - they are regularly vaccinated.

Non-specific methods of protection against rabies include burning the corpses of dead animals or people so that the virus does not continue to circulate in nature. In addition, doctors strongly recommend that if you are bitten by an unfamiliar animal, immediately wash the wound with large amounts of liquid and go to the nearest medical center for emergency assistance.

Specific prevention of rabies

Emergency prevention of rabies consists of administering a rabies vaccine to the affected person. To begin with, the wound is actively washed and treated with antiseptic drugs. If a person is suspected of being infected with the rabies virus, excision of the edges of the wound and suturing it, as is done under normal conditions, is contraindicated. It is important to follow these rules, because when surgical treatment of a wound is performed, the incubation period of rabies is significantly reduced.

Where are rabies injections given? - anti-infection drugs are administered intramuscularly. Each vaccine has its own characteristics in purpose and administration. The dose of the drug may also vary depending on the conditions. For example, it depends on the location of the bite or on the duration of the injury and contact with animals. The rabies vaccine is given in the deltoid muscle or in the anterolateral thigh. There are vaccines that are injected into the subcutaneous tissue of the abdomen.

How many injections does a person get for rabies? — it all depends on the conditions. It matters who is prescribed the drug - the victim or a person who, due to the nature of his work, may encounter infected animals. The creators recommend administering different types of vaccines according to their own developed schedule. After the bite of an animal with rabies, the method of administering the drug six times can be used.

When vaccinating, it is important to meet several conditions:

• for some time after it and the entire period when a person is vaccinated, you cannot introduce unusual foods into the diet, as allergies often develop;
• if it was possible to observe the dog and it did not die from rabies within 10 days, the vaccination schedule is reduced and the latter are no longer given;
• alcohol and rabies injections are incompatible, the consequences can be unpredictable, and the vaccine simply will not work.

During the entire period of administration of the rabies vaccine, a person must be under the supervision of doctors. Emergency rabies immunoprophylaxis is most often carried out in an emergency room, which is equipped with everything necessary for this.

What side effects can a person have after receiving rabies injections? In the past, vaccines made from animal nerve tissue were widely used. Therefore, several years ago, after the use of rabies vaccination, brain diseases such as encephalitis and encephalomyelitis developed. Now the composition and methods of manufacturing the drugs have changed slightly. Modern vaccines are much easier to tolerate; after their use, only sometimes an allergic reaction occurs or individual intolerance appears.

Effective anti-rabies drugs have not yet been invented that could save a person’s life during the developing disease. Its most common complication is death. For this reason, rabies is one of the most dangerous infections. Therefore, after an animal bite, there is no need for heroism - it is important to promptly seek help at the emergency room.

Rabies is a viral disease. A person becomes infected with it from a sick animal, most often after a bite. The virus is contained in the saliva of a sick animal. The worst thing is that this disease is not curable, you can only prevent it with a vaccine that is administered to the person bitten. If symptoms of rabies appear in a person, then it is no longer possible to save the patient. Let's talk about this in more detail to find out how rabies manifests itself in humans.

How do you get rabies?

Multiple and deep animal bites are considered very serious. You can also become infected through any damage that violates the integrity of the skin: abrasions, abrasions, scratches, mucous membranes of the eyes or oral cavity. The fact that a person is infected by a person has not been proven, but it is probable, and it is better to take all precautions when communicating with a sick person.

Rabies in humans - symptoms

Some time must pass from the moment of infection until the first signs of rabies appear in a person. Typically this period ranges from 10 to 60 days. But in some cases it can increase to 1 year or decrease to 5 days.

Manifestations of rabies in humans are divided into three phases:

First symptoms

Acute neurological disorders

Paralytic condition

First symptom phase

last for several days. The patient experiences pain and itching at the site of the bite, and the healed wound or scar swells and turns red again. Among the general signs, an increase in body temperature comes to the fore, but the numbers are not high.

There is a headache, general poor health, lethargy, nausea, diarrhea, lethargy, pain when swallowing and a feeling of shortness of breath. Auditory and visual sensitivity increases. Sleep disturbances appear in the form of insomnia or nightmares. Agree, all these signs can indicate any other disease.

Very often this happens, the patient is diagnosed with ARVI or acute intestinal infection, and treatment is prescribed. To prevent signs of rabies infection in a person from appearing, he must be vaccinated within the first 12 hours after possible infection.

Neurological impairment phase

characterized by symptoms of damage to the nervous system - this is the height of the period. The condition of a person with rabies is very serious, lethargy is replaced by aggressive behavior. Patients are poorly oriented in space, their psyche is disturbed, they attack others with their fists, and try to bite them.

Patients are very excited and emotionally active, making attempts to escape. Convulsions and hallucinations appear. Patients have various attacks of fear (). They are provoked by a blow of wind, the sight of water or the thought of it, bright light, loud sound.

During such attacks, the face of a sick person is distorted, spasm of the muscles of the larynx and pharynx occurs, there is hiccups and vomiting. Body temperature rises to 40 C. Typically, between such changes in general well-being, patients are calm and adequate, and are fully conscious.

Paralytic or final

. It develops after 2-3 days if the patient did not die from a prolonged spasm of the respiratory muscles earlier. During this phase, symptoms of paralysis of all muscles increase.

Double vision appears, dysfunction of the pelvic organs appears, and the face is distorted. Excitement subsides, patients calm down. There are no cramps, patients can even eat and drink water. But all this is “false prosperity” and after 12-20 hours death occurs from cardiac and respiratory arrest, and this happens suddenly.

Rabies in humans - treatment

Rabies is not curable; it leaves no chance for a person to live, especially if its symptoms have already developed. Therefore, it is better to prevent the disease than to treat it. Therefore, avoid contact with animals whose behavior has changed or is not adequate. But if there has already been a bite, then the wound should be washed thoroughly with soapy water and immediately consult a doctor. A rabies vaccination for a person bitten by any animal in this situation is the only way to save his life!

Rabies is an acute infectious disease of humans and animals that affects the central nervous system. Its cause is viruses that have a tropism for the tissues of the nervous system, where, after biting a sick animal, they move at a speed of 3 mm per hour. After replication and accumulation in the tissues of the central nervous system, viruses spread through neurogenic pathways to other organs, most often to the salivary glands.

The incidence of the disease depends on the location and severity of the bite. In 90% of cases, the disease develops with bites on the neck and face, in 63% - in the hands, in 23% - in the shoulder. The signs and symptoms of rabies at all stages of the disease are highly specific. There are no effective treatments for the disease. The disease is usually fatal. Timely vaccination against rabies is the most effective prevention of the disease. The rabies vaccine was first obtained in 1885 by the French microbiologist Louis Pasteur. And in 1892, Victor Babes and in 1903 A. Negri described specific inclusions in the neurons of the brain of animals that died from rabies (Babes-Negri bodies).

Rice. 1. The photo shows rabies viruses.

Causes of rabies

Rabies (hydrophobia) is an acute contact zoonotic infectious disease caused by a neurotropic virus and characterized by the development of a kind of encephalitis with fatal damage to the central nervous system.
In the medical literature of other countries, the disease is known as rabies when it develops in animals, and hydrophobia when it comes to human diseases. The names come from Lat. rabies (derived from the Sanskrit words rabas - riot; rabere - dream) and hydrophobia - fear of water. To determine the genus to which the rabies virus belongs, the name Lyssavirus is used (from the Greek Lyssa - the name of the goddess of madness, rage and fury).

Since the late 1990s, due to the high level of immunization of wild animals in Western and Central Europe, the epicenter of rabies has moved east to Poland, Croatia, Russia, Belarus, Ukraine, and Latvia. In recent years, the epizootic situation in Ukraine has worsened significantly. Active foci of natural rabies exist throughout Ukraine, most of them are registered in Chernigov, Sumy, Poltava, Kharkov, Khmelnytsky and Lugansk regions. The increased incidence of rabies among dogs, cats and farm animals is, first of all, an indicator of epizootic troubles among wild animals. The situation is complicated by the increase in the number of stray dogs and cats in populated areas, incomplete coverage of preventive vaccinations for domestic animals, and violation of the rules of keeping their owners. All this is a prerequisite for the formation of urban-type rabies cells, which in turn increases the threat of the emergence and spread of this infection among the population.

Thus, in Ukraine, about 110 thousand people annually seek medical help for animal bites, of which almost 20 thousand receive rabies vaccinations. In recent years, isolated cases of rabies in humans have been recorded, due to the delay in seeking medical help from victims of animal bites.

RNA genomic virus Rabies virus from the group of myxoviruses of the Rhabdoviridae family, genus Lissavirus. The virion is spherical in shape and contains single-stranded RNA. A characteristic feature of the morphology of the rabies virus is the presence of glycoprotein spikes on the lipoprotein envelope. The nucleocapsid has an RNA polymerase. The virus contains 5 main proteins:

• a stable outer envelope glycoprotein consisting of more than 300 different trimmers; helps the virus penetrate the target cell, induces the formation of virus-neutralizing antibodies and determines a single antigenic variant of the virus;
• intraenvelope matrix protein;
• nuclear protein that stimulates the formation of complement-fixing antibodies;
• internal large protein - transcriptase;
• internal small protein - phosphoprotein.

The complete antigenic homogeneity of rabies viruses has been established, which made it possible to create a highly effective rabies vaccine. The rabies virus is exclusively tropic to neurons of the brain and spinal cord, as well as tissues of the salivary glands. It is capable of active replication in the brain matter of warm-blooded animals, which is why intracerebral infection of mice or rabbits has recently been used in virological studies. The virus is now usually cultivated in primary and continuous cell cultures or in chicken embryos.

There are two known variants of the virus:

• street (wild), circulating in natural conditions among wild animals,
• fixed, obtained during laboratory tests.

The fixed rabies virus after parenteral administration causes an experimental disease with a short (7-day) incubation period, has a 20-30 times lower infectious dose, does not form Negri bodies in the brain, and is not detected in saliva; and due to its preserved immunogenicity, it is used to obtain rabies vaccines.

The rabies virus is unstable in the environment:

• inactivated by heat (boiling destroys it in less than 2 minutes),
• under the influence of the Ural Federal District,
• under the influence of alcohol, commonly used disinfectants,
• Once frozen, it can be preserved for several years.

In addition to the rabies virus, the genus of Lyssaviruses includes 10 more species, grouped into 7 main genotypes according to phylogenetic origin. All other viruses of this genus are capable of causing diseases in humans with damage to the central nervous system, which sometimes closely resemble the symptoms of classical rabies. For most of these viruses, bats are the main source.

The source and reservoir of the rabies pathogen are wild and domestic predatory animals belonging to the class of mammals. There are natural foci of rabies that form wild animals (wolves, foxes, badgers, raccoon dogs, mongooses, mice, rats, bats, hedgehogs, jackals, arctic foxes, skunks, and also vampire bats in Central and South America), and anthropurgic cells supported by dogs, cats, and farm animals.

The greatest danger comes from stray animals. Animals for which a bite is an instinctive reaction of everyday life (predators) are the most dangerous representatives of the fauna in terms of transmission of infection. Some small mammals (bats, mice, rats, etc.) do not show signs of severe illness and can excrete the virus in their saliva throughout their lives.

The mechanism of infection is contact, the route of transmission is wound. A person becomes infected when bitten by a rabid animal or if its saliva gets on damaged skin and/or mucous membranes, less often when skinning the corpses of rabid animals, especially foxes.

The animal's saliva becomes contaminated in the last 7-10 days of the incubation period and remains so throughout the entire illness. The possibility of aerogenic infection has been proven (in laboratory conditions, when visiting caves inhabited by bats), when the virus enters through damaged areas of the conjunctiva and mucous membranes of the mouth and throat.

In recent years, isolated cases of iatrogenic contact infection of people due to corneal, kidney or liver transplants from deceased donors in whom rabies as the cause of death was not established have been described. Rabies occurs on all continents except Antarctica. The disease is not registered in some island countries: Japan, New Zealand, Cyprus and Malta, as well as in the Scandinavian countries (Norway, Sweden, Finland) and on the Iberian Peninsula (Spain, Portugal). Natural foci of rabies have been eliminated on the islands of Great Britain, Ireland, and Iceland.

Susceptibility to rabies is general, but mainly rural residents are affected; the urban population accounts for up to 20-25% of cases. Men get sick more often. Not all people bitten by a rabid animal develop the disease. The development of the disease depends on the location, size of the wound and the dose of the virus that has entered the body. Thus, when a virus enters the conjunctiva of the eyeball, it causes disease in the absence of immediate preventive measures in almost 100% of people; when bitten on the face, rabies occurs in 99%, on the hand in 63%, on the proximal limbs in 23% of people, so a false impression is created, that some people are relatively resistant to this infection. In total, about 15-30% of those bitten get sick, but every sick person dies.

Thanks to widespread vaccination of people at risk of developing rabies, the incidence continues to decrease. A person with rabies is a biological dead end of the natural epidemic process.

As a result of post-traumatic penetration of the virus into muscle and connective tissue, its primary replication occurs at the site of inoculation (mainly striatal muscle cells), which is usually associated with the so-called viral latency, since this process can drag on for several months. Much faster, the virus accumulates directly in the peripheral nerves that innervate damaged tissue, especially when infected through the conjunctiva and mucous membranes. In this case, the duration of the incubation period is significantly reduced (up to 7 days) if a larger number of nerve fibers and receptors are damaged.

A shorter incubation period is observed with deep bites of the most innervated areas of the body: head, face, neck, fingers, genitals. When areas that are poorly innervated are affected, it can lengthen significantly. Due to the likelihood of such a long incubation period (1 year or more) and the always fatal consequence of rabies in humans, it is classified as a group of so-called slow infections.

It is important that during the incubation period of the pathogen, the body’s protective immune reactions are not yet triggered. At the site of primary reproduction of the virus, degenerative changes in nerve receptors develop, accompanied by hyperesthesia in the wound area. Due to its neurotropism, the pathogen first penetrates the perineural cavity of the afferent nerves, and then moves along their axons at a speed of 12-24 mm/day until it enters the dorsal ganglion. Its reproduction in the ganglion is accompanied by the appearance of pain or paresthesia at the site of inoculation; these are the first clinical symptoms to which patients usually do not pay much attention.

Only this process begins the synthesis of antibodies against the rabies virus, so they can be detected in the blood and cerebrospinal fluid only after the first symptoms of the disease appear. However, under such conditions, the death of the patient occurs before the titers of virus-neutralizing antibodies reach a protective level. Damage to the neurons of the corresponding structures leads to an increase in reflex excitability, and consequently to the development of paralysis.

Damage to the nuclei of the vagus, glossopharyngeal and hypoglossal nerves causes spasms of the respiratory and pharyngeal muscles, which are very characteristic of rabies: when trying to swallow saliva or water, extremely painful, uncoordinated contractions of the throat muscles occur. In turn, this leads to the rapid formation of a conditioned reflex - any mention of water is associated with severe pain. This is how the “calling card” of rabies is formed - hydrophobia.

Increased excitability of the autonomic centers subsequently leads to paroxysmal contraction of the throat muscles in response to any external stimuli. Typical hydrophobia is often accompanied by aero-, photo-, and acoustic phobia. Irritation of the sympathetic nervous system causes increased salivation, sweating and lacrimation, and damage to the vagus nerve causes disruption of the cardiovascular system.

The virus spreads centrifugally along the efferent fibers of the peripheral nerves to various organs and tissues, accumulating primarily in the salivary, lacrimal glands and cornea. The pathogen also penetrates the lungs, adrenal glands, kidneys, skeletal muscles, pancreas, and mammary glands (excreted in milk).

The inability to swallow saliva leads to its spitting, widespread splashing during periods of excitement during paroxysms, and can, under certain conditions, lead to hypothetical infection of others. Subsequently, degenerative degeneration of peripheral motor neurons causes flaccid paresis and paralysis, cerebral edema (progressive encephalomyelitis) predetermines the patient's fall into a coma and inevitable death due to respiratory arrest and/or acute heart failure.

In the deceased, changes are found primarily in the brain and spinal cord. By multiplying in the nervous tissue, the virus causes characteristic changes in it - swelling, hemorrhages, degenerative and necrotic processes. The histological picture indicates focal encephalitis with proliferation of neuroglia, forming miliary granulomas (which can sometimes be observed in other diseases) - “rabies nodules”.

The incubation period for rabies ranges from 7 days to more than 1 year, with an average of 30-90 days. Clinically, typical and atypical forms of rabies are distinguished.

The typical form goes through three successive stages: precursor, excitation, paralytic. The first signs of the disease in the precursor stage almost always appear at the site of the bite. The scar often swells, turns red, becomes painful, and itches. The pain often spreads along the corresponding nerves innervating the muscles near the scar. Patients experience causeless fear, melancholy, anxiety, increased sensitivity to sound and light stimuli, and a slight increase in body temperature. Sleep is disturbed, nightmares disturb, and later insomnia. Patients are reluctant to come into contact, complain of general weakness, loss of appetite, dry mouth, increased sweating, palpitations, moderate sore throat when swallowing, and sometimes nausea and vomiting.

Those around them pay attention to the change in the character of patients, as they become gloomy, picky, rude in relationships, with alternating periods of unmotivated excitement and depression; during this phase they often wander alone. On examination, a certain expansion of the pupils, moderate symptoms in the throat, a frequent labile pulse, and increased heart sounds are detected. After 2-3 days, the stage of excitement begins. Anxiety increases, symptoms of excessive reflex excitability of the breathing and swallowing centers appear. Severe tachycardia is also characteristic. The face is cyanotic, the eyes are fixed on one point; exophthalmos appears, the pupils are significantly dilated. The patient is thirsty, but when trying to get drunk, extremely painful spasms of the muscles of the throat and larynx suddenly occur; such symptoms are subsequently caused by the very sight of water, its murmur, and verbal reminders of it (typical hydrophobia). At this time, the respiratory muscles also contract spasmodically, which causes difficulty breathing. Inhalation is significantly difficult, with the participation of all auxiliary muscles, accompanied by a kind of whistling or snoring, exhalation is superficial and imperceptible. After a few seconds, muscle spasms disappear and breathing is restored. The patient complains that he “doesn’t have enough air” and cannot swallow. Over time, spasms develop more often and last longer (sometimes up to 1-2 minutes), occur not only from water, but also from the movement of air, previously cold (aerophobia), bright light (photophobia), loud speech or strong sound (acousticophobia) .

Patients sometimes rush about, often jump out of bed, tear their clothes, try to run somewhere due to suffocation, and occasionally become aggressive; visual and auditory hallucinations are added. There is an expression of horror on the face, the voice is hoarse, profuse sweating. Due to difficulty swallowing and increased salivary secretion, significant drooling is often observed. Body temperature rises to 40-41 °C. The excitation stage lasts 2-3 days, rarely up to 6 days, and can result in death due to prolonged cessation of breathing or cardiac arrest. But more often the disease passes into the paralytic stage, which lasts up to 10 days.

The attacks of excitement stop and an “ominous” calm sets in; Sensitivity and motor function are sharply weakened. Paralysis, as a rule, is flaccid, starting from the legs (characteristic ascending paralysis of the Landry type). At this stage, the patient lies motionless, his face is cyanotic, his features are pointed, and beads of sweat cover his entire body. Due to paralysis of the oculomotor nerves, the pupils dilate significantly and stop responding to light. The function of the pelvic organs is impaired, accompanied by urinary retention or incontinence. Due to the disappearance of excitement and convulsions, breathing becomes easier. Often patients can swallow and drink, but the body temperature rises to 42 ° C and death soon occurs due to paralysis of the heart or respiratory center.

Atypical forms include bulbar, paralytic (“silent” rabies), meningo-encephalitic, cerebellar. Accordingly, the disease begins without warning, with excitement or immediately with paralysis, and can occur with pronounced signs of damage to the medulla oblongata (breathing disorders, dysphagia) and the cerebellum (dizziness, ataxic gait), and the psyche (delirium, manic-depressive psychosis). The disease always ends in death.

Rabies virus

Filterable rabies virus is a member of the genus Lyssavirus

(from the Greek lyssa, which means rabies, demon) of the family
Rhabdoviridae
.

The rabies virus has a tropism for nervous tissue.

• Rabies viruses are heat sensitive. They are quickly inactivated when exposed to solutions of alkalis, iodine, detergents (surfactant synthetic substances), and disinfectants (Lysol, chloramine, carbolic and hydrochloric acids).
• Viruses are sensitive to ultraviolet irradiation, die quickly when dried, and die within 2 minutes when boiled.
• At low temperatures and freezing, rabies viruses persist for a long time. They can be stored in animal corpses for up to 4 months.

Viruses are transmitted to humans through bites with saliva or through damaged skin that contains saliva from a sick animal. Damage to the central nervous system inevitably leads to the death of the patient. The presence of viruses in the central nervous system is indicated by the detection of “Babes-Negri bodies” in ganglion cells.

Rice. 2. The photo shows rabies viruses that resemble a bullet in appearance. One end is rounded, the other is flat. The synthesis of viral particles occurs in the cytoplasm of neurons.

Rice. 3. The photo shows the rabies virus. The virion is surrounded by a double shell. On the outer shell of viral particles there are spikes (protrusions) with knobby swellings at the ends. Inside the virions there is an internal component, which is a thread-like formation. The photo clearly shows transverse stripes representing a nucleoprotein.

Taurus Babesha-Negri

In 1892, V. Babes and in 1903, A. Negri, described specific inclusions in the cytoplasm of neurons in the brains of animals that died from rabies. They are called Babesh-Negri bodies. Large neurons of the ammon's horn, pyramidal cells of the cerebral hemispheres, Purkinje cells of the cerebellum, neurons of the thalamus optic, cells of the medulla oblongata and ganglia of the spinal cord are areas of the nervous system where Babes-Negri bodies are most often found.

Cytoplasmic inclusions are strictly specific for rabies disease

Babes Negri bodies are detected in the neurons of the brain of dogs that died from rabies in 90 - 95% of cases, in humans - in 70% of cases.

According to a number of researchers, Babes Negri bodies are:

• places where virions replicate
• places where the production and accumulation of the specific antigen of the rabies pathogen occurs,
• The internal granularity of Babes-Negri bodies represents viral particles associated with cellular elements.

Rice. 4. The photo shows nerve cells with cytoplasmic inclusions. Babes Negri bodies have different shapes - round, oval, spherical, amoeboid and fusiform.

Rice. 5. The photo shows the Babesh-Negri body. The internal granularity of the inclusions represents viral particles associated with cellular elements.

Rice. 6. The photo shows the Babes-Negri body in the light of a conventional microscope. They are surrounded by a light rim.

Replication of viral particles in rabies is always accompanied by the formation of specific inclusions - Babes-Negri bodies.

Epidemiology

Articles in the “Rabies” section The most popular
Rabies is considered one of the most terrible and dangerous diseases for humans. Unfortunately, after being bitten by an animal whose saliva contains a virus that is fatal to humans, death occurs. It is important to note that symptoms from an animal bite do not appear immediately, since the virus does not multiply in the human body immediately.

If a person is not given first aid on time, the virus subsequently gradually multiplies in the body, which leads to irreversible consequences: disturbances in the functioning of the musculoskeletal system, brain damage and, as a result, death. Unfortunately, rabies does not leave a person a chance to live.

The disease, after the appearance of the first symptoms, lasts for 5-7 days, and already at the middle stage of the disease, when serious changes appear in the human body, the death of the patient is possible.

In addition, rabies is a very insidious disease, as it can occur in a “silent” form, that is, without pronounced symptoms. For example, when a bat bites you hardly feel any pain, so a person can simply miss the bite.

All symptoms of an infected person are divided into 3 stages:

First symptoms

The bite site begins to hurt: the wound itches, turns red, and swelling appears even if the wound itself has already healed.

The temperature rises to 37 degrees, a nagging headache and nausea appear. A person feels anxiety, a growing internal panic, which turns into a depressed state and depression.

Insomnia may occur.

Excitation stage

At the stage of excitement, a person begins to suffer from convulsions and spasms, and this symptom is a reaction to light, noise or any other irritants.

Hallucinations and an unreasonable feeling of fear appear, turning into persecution mania. An infected person becomes aggressive, goes on a rampage, breaks furniture and tears clothes.

The temperature continues to rise to 40-41 degrees, and tachycardia begins.

The patient experiences profuse salivation and foam at the mouth. The swallowing reflex disappears.

Already at this stage, death is possible.

Final phase

In the final phase, complete paralysis occurs. In this case, the patient begins to breathe more smoothly, can eat and drink, but after 14 (maximum 20) hours death occurs from paralysis of the respiratory tract or from cardiac arrest.

Treatment after a bite

Step 1: Don't panic. The vaccine helps in the first 14 days of treatment after the bite. Therefore, the count still goes not by hours, but by days. But this is not a reason to put off seeing a doctor!

Step 2. Immediately wash the wound with a regular soap solution and generously fill it with hydrogen peroxide or medical alcohol.

Step 3: Visit your nearest emergency room, where you will receive a rabies vaccine immediately. Next, the doctor will tell you the treatment plan. You must be prepared for the fact that you will now need treatment for at least six months, during which it is strictly forbidden to drink alcohol!

1. The sooner after a bite a person seeks help, the more effective the vaccine is.
2. If possible, it is necessary to track the animal that bit the victim. If the animal dies within 10 days, it means that it actually transmitted the rabies virus to the patient. If the animal remains alive, then most likely the vaccines will be canceled.
3. In the first six months after the bite, you should avoid hypothermia or overheating so as not to reduce the protective function of the immune system.

How to treat rabies?

If a person is bitten or licked by a rabid or suspicious animal, first aid procedures are recommended, which include immediately and thoroughly washing the wound for at least 15 minutes with soap and water, detergent, povidone-iodine or other substances that kill the rabies virus, applying sterile bandages. All further activities are carried out under the supervision of a radiobiologist in trauma centers or rooms where there are appropriate vaccines and specific immunoglobulin.

The edges of the wound are not cut out or sutured for 3 days, with the exception of injuries that require special surgical interventions for health reasons. At the same time, emergency tetanus prophylaxis must be carried out. A course of rabies vaccinations is prescribed in case of probable or existing infection of a person in accordance with the determination of whether bite cases belong to certain categories of contact according to WHO recommendations. Category II includes cases where the bite caused compression of open areas of the skin, minor scratches or abrasions without bleeding. In this case, it is necessary to carry out local treatment and immediately administer the vaccine.

If the case belongs to category III - single or multiple transdermal bites or scratches, licking damaged skin, contamination of mucous membranes with saliva during licking, contact with bats - the measures shown are the same as for category II, but with the mandatory additional immediate administration of specific immunoglobulin .

In our country, in accordance with current orders, vaccinations are distinguished according to unconditional and conditional indications. Vaccinations according to unconditional indications are prescribed for bites inflicted by clearly rabid, wild and unknown animals, as well as when the diagnosis of rabies in an animal remains unclear. To determine the dose and duration of the vaccination course, the nature of the contact (licks, bites of varying severity) and the location of the wound are taken into account.

Vaccinations are carried out according to the following scheme: 1.0 ml of rabies vaccine on the 0th (the day of administration of the first dose of the vaccine is designated as the 0th day), 3rd, 7th, 14th, 30th and 90th days intramuscularly only into the deltoid muscle of the shoulder (for children under 5 years old - into the upper part of the anterolateral surface of the thigh). In 100% of cases, a course of the first five vaccinations ensures that the body produces specific antibodies above the protective level (1:80) up to 45 days from the start of vaccinations.

A distant (booster) dose of the vaccine is administered to the victim on the 90th day to maintain the antibody titer throughout the year. Vaccinations are effective if they are prescribed no later than the 14th day from the moment of contact with the animal. In severe cases, as well as in the case of dangerous localization of bites (the most innervated areas of the body - face, head, hands and fingertips, perineum), vaccination is combined with the administration of rabies immunoglobulin. This is due to the possibility of reducing the incubation period to 7 days - less than when developing post-vaccination immunity. The victim is administered human rabies immunoglobulin at a dose of 20 IU per 1 kg of body weight (heterologous - 40 IU/kg) and rabies vaccine according to the above scheme.

Conditional indications occur with severe bites inflicted by healthy animals. They are distinguished by localization (the previously listed maximally innervated areas of the body), as well as by prevalence (multiple) and depth. If during the 10-day observation period the animal does not develop signs of disease, vaccinations are stopped. If the animal gets sick or dies (disappears) for any reason, they switch to an unconditional (6 injections) course of vaccinations, which creates the basis for long-term immunity.

In the case of single bites in the limb or body caused by healthy animals under veterinary supervision, and in the absence of epidemiological data on rabies, vaccinations are not carried out according to conditional indications.

If rabies is suspected, immediate hospitalization is indicated, and treatment of rabies must take place in a hospital setting. Therapeutic measures are aimed at eliminating painful symptoms.

The patient is provided with a separate room, maximum peace and absolute silence are ensured. To reduce excitability, it is necessary to prescribe various drugs - morphine, sodium thiopental, sedatives. Fluid loss is replenished by parenteral administration of saline solutions, plasma expanders, and glucose. Perform artificial ventilation. Minor temporary relief can be achieved by administering rabies immunoglobulin.

In recent years, the effectiveness of the so-called Milwaukee treatment protocol has been discussed, the use of which contributed to the recovery of two patients in the USA and one patient in Brazil. However, in these cases, the infection occurred through the bite of bats; the classical rabies virus was not identified, which raises certain doubts about its etiology - whether it was a disease caused by other lyssaviruses, for which spontaneous recovery has also been described.

However, despite all the doubts, when treating rabies, it is recommended to carry out the measures of this protocol - putting the patient into an artificial coma in order to provide time for the production of protective virus-neutralizing antibodies, the use of ribavirin, interferons and rabies immunoglobulin in order to influence the virus.

Medical personnel should work in protective clothing to prevent saliva from coming into contact with the skin and mucous membranes.