Note posted: 2023-01-01
The resurgence of “La Rabia.”
When we talk about anger, it never ceases to surprise us just reading or hearing the word per se; when we read or hear about human cases in the media, it is certainly terrifying. We are not used to being told that a case arose in a certain place because our generation learned that they are diseases that “no longer exist.” But the truth is that they are diseases that have been there, waiting for a little human carelessness to reappear.
Rabies, a word derived from the ancient Indian root: “rabh”, which means violent behavior, is a disease recognized since antiquity, probably older than the human race; It was considered as the action of supernatural forces on man and other mammals, mainly the dog. This violent, irritable behavior of the dog was more frequently observed in the hot season, which is why this seasonal period was known as “heatwave” due to the action exerted by the star Sirius of the constellation Canis Major on the sun. Rabies is one of the oldest known zoonotic diseases, in fact, in the 21st century, rabies continues to be one of the most feared and important threats to public health. There are two epidemiological forms of rabies: the urban one, spread mainly by domestic dogs or cats that can manifest itself in a “furious” or “paralytic” form, and the sylvan form, commonly called “derriengue” as a result of bites by infected bats, as well as coyotes, foxes, skunks, raccoons and possibly other mammals. This zoonosis is maintained at the expense of domestic or wild fauna and the presence of cases in humans is mainly due to transmission by bites; In countries where anti-rabies control is inadequate, the dog is the means of transmission in 90% or more of the cases, in developed countries it represents only 5%, in these wild animals are the most frequent transmitters. The WHO points out that developing countries account for more than 99% of human rabies deaths and that this zoonosis has not been brought under control in most affected countries. Nearly 60,000 people die each year from this infection and 95% of these deaths occur in Asia and Africa, reflecting little access to prevention measures. Worldwide, 99% of all cases of human rabies occur through transmission by dogs, in countries where canine rabies has been eliminated, transmission occurs mainly by bats. In Mexico, after various strategies implemented to control rabies, such as the first massive canine anti-rabies vaccination campaign in 1968, today the results obtained mark an unprecedented drop in the incidence of both human and canine cases, passing from registering 60 cases of rabies by dogs in people in 1990, to 3 cases in 1999 and zero cases since 2006. Due to the achievements made, during the year 2019 this country was recognized as free of human rabies transmitted by dogs as a problem of public health before the Pan American Health Organization/World Health Organization. The Pan American Health Organization (PAHO) attributes the indicated success to the massive canine anti-rabies vaccination campaigns and to the opportune prophylactic treatment carried out on exposed persons.
In the absence of a history of exposure or typical symptoms, the diagnosis of rabies alone can be difficult and often unreliable. Once the disease is established, it has to be treated in an “aggressive” way, one of these ways is with the so-called: “Milwaukee Protocol” where the patient recovers without apparent sequelae. The Recife protocol, developed in Brazil, is another example of treatments. The lack of knowledge that the community in general and medical personnel have about the management and prevention of rabies is unfortunate. During the period from 2000 to 2021, 52 cases of human rabies were registered in Mexico, of which 48 were due to attacks by wild animals (mainly bats and skunks), in addition to an atypical case due to contact with cattle, which occurred in the State of Jalisco. in 2009. The treatment of the established clinical picture is aimed at intensive care for cardiovascular and respiratory support. Today we know of the cases registered in four children from Oaxaca and the death of one, without a doubt something that shocked health again after the issue of covid or Dengue, locally. Let’s hope it’s not due to vaccine shortages or lack of prevention not only at the state level (Oaxaca, Nayarit) but also throughout the country.
Dr. Cesar Alvarez Pacheco