What a doctor who diagnosed an imported rabies case wants you to know about rabies
In 2006, I diagnosed the first imported case of rabies in 36 years.
Since rabies is a topic of discussion, I will summarize some points from my past tweets for the general public.
It has been over 60 years since Japan became a rabies-free country, but it is estimated that approximately 59,000 people die from rabies worldwide every year, and countries without rabies are actually the exception.
Rabies can infect not only dogs but all mammals. In North America, bats and raccoons carry the virus. Please be careful not to touch animals carelessly when abroad.
(Although it can affect all mammals, post-exposure prophylaxis is rarely needed if exposure occurs from rodents, rabbits, or hares. As for birds, while they may be able to be infected at an experimental level, they do not typically transmit rabies.)
Once rabies symptoms appear, there is no established effective treatment. It is almost 100% fatal (a treatment called the Milwaukee Protocol, which uses a combination of antiviral drugs and sedatives, has been proposed, but it is not yet sufficient).
However, if properly prevented, it can be prevented almost 100% of the time.
The WHO recommends preventive measures based on the degree of contact with an animal suspected or confirmed to have rabies as follows.
If you have not been vaccinated before being bitten, it is possible to prevent it by starting vaccination after being bitten. However, it takes 7 to 10 days for the vaccine to produce antibodies that protect against infection. To protect against infection during this period, it is necessary to administer globulin (antibodies) against the rabies virus.
However, this anti-rabies immunoglobulin is not sold domestically and cannot be obtained. If you are bitten abroad, be sure to visit a local medical institution. Also, you need to wash the wound thoroughly with soap and running water as soon as possible.
Even abroad, this immunoglobulin may be in short supply and not immediately available.
If you are staying in an endemic country for a long period, it is better to get vaccinated before traveling. Please refer to the Quarantine Station website (FORTH) to see where you can get vaccinated. You need to receive 3 doses (can be administered in as little as 3 weeks), so please visit with plenty of time. If you have already received 3 doses in advance, the administration of immunoglobulin after being bitten will not be necessary.
The incubation period for rabies is 1 to 3 months on average (as short as 10 days and as long as 7 years). The speed of progression varies depending on the site of the bite and the amount of virus injected at the time of the bite. It is said that the closer the bite is to the brain, the faster the onset.
The patient in the 2020 imported case said they were bitten on the ankle 8 months before the onset of symptoms, so it may have taken a long time until onset.
The following is the case report I diagnosed in 2006.
Below are the answers to questions I received previously.
Q.1 Can rabies be transmitted from person to person?
A.1 Theoretically, it is possible, but such cases have hardly been reported. There is only a report that there might have been 2 cases in Ethiopia (1 case from a bite, 1 case from a kiss), and I have never seen any other reports except for organ transplants.
Q.2 If I am bitten by a domestic dog that has not been vaccinated against rabies, is there a risk of contracting rabies?
A.2 If it is a domestic dog, there is no need to worry. The rabies virus is not a virus that dogs naturally carry, nor does it occur spontaneously. Dogs do not carry the rabies virus unless they are infected by being bitten by an infected animal.
Rabies was eradicated in Japan in 1957, and since then, there have only been imported cases where people were infected abroad and developed symptoms after coming to Japan. Japan is one of the few rabies-free countries in the world.
Only the blue countries in the link below are rabies-free.
Taiwan was also a rabies-free country for many years, but in 2013, rabies infection was confirmed in a ferret-badger for the first time in 52 years, and it is no longer a rabies-free country.
In Japan, before 1950, dozens of patients contracted rabies and died every year. The Rabies Prevention Act was enacted in 1950.
Dog registration, vaccinations, and the detention of stray dogs were thoroughly implemented, and rabies was eradicated in a short period of just 7 years.
It would be very troublesome if rabies, which was successfully eradicated domestically, were to become prevalent again. I mentioned earlier that there is no need to worry about rabies when bitten by a domestic animal, but that premise would collapse.
This special measure,
This time, for dogs accompanying evacuees, if a history of two vaccinations and antibody titers above the standard value are confirmed through blood tests, they will be allowed to accompany their owners to their place of stay. However, until the waiting period has passed, owners are required to perform health observations twice a day and report to the Animal Quarantine Service once a week.
It seems that this is not an unconditional relaxation, but rather comes with certain conditions. As I am not a veterinarian, I will refrain from commenting on the effectiveness of this measure.
By the way, the reason I was able to suspect rabies back in 2006 was because I had read Black Jack. In the Shonen Champion Comics edition, it is included in Volume 9, Chapter 78, 'Something in the Mountains'.