Greater public awareness needed after death of woman from rabies

Sep 5 2005

Scientists in the UK who have been looking into the death of a British woman from rabies are now demanding greater public awareness of the very real dangers posed by the infection.

The woman Alison Dwerryhouse, 39, from Bury, near Manchester, caught the virus when she was grazed on the leg by a pet puppy, while on holiday in India.

She died in July, more than three months after returning home.

According to Derrick Pounder, Professor of Forensic Medicine at the University of Dundee, the growth in the travel industry means there is a risk of further deaths. Pounder says most travellers are unaware of the need for vaccinations when visiting areas in Africa, Asia, Latin America, and the Middle East.

Rabies is an acute viral infection of the central nervous system that causes an increase in saliva, extreme thirst, abnormal behaviour, hallucinations, eventual paralysis and possibly death.

The virus is usually transmitted through a dog bite and results in at least 40,000 deaths every year.

The researchers say Ms Dwerryhouse visited a doctor in July, 3½ months after returning home, suffering from shooting pain in her lower back and left leg, and was admitted to hospital four days later unable to walk.

Within 18 days she was dead.

The study revealed that her death was the result of a slight graze caused by contact with a puppy, which was on a lead.

At the time Ms Dwerryhouse, who had not been vaccinated against rabies, did not seek medical help but had cleaned the wound with a tissue.

The study’s authors say the circumstances surrounding her death are a stark warning to anyone travelling to affected areas.

Apparently about 90 per cent of deaths from rabies occur in the developing world, in particular in India, where stray dogs roam freely.

At present rabies is rare in Britain, and only 12 cases have been reported since 1977.

Of those, 11 were contracted abroad and one acquired from a bat in Scotland.

Rabies can also be spread from other animals including foxes, wolves, racoons and skunks.

Professor Pounder, in an editorial accompanying the study, said that by the time people became aware of the disease and had symptoms, they were beyond help.

Apparently the interval between an animal bite and the onset of symptoms can vary from a few days to months or years, with the longest gap recorded being 19 years.

Professor Pounder says that part of the problem is that most people live and are brought up in a rabies-free country, and are not confronted with the reality of the disease.

The very ease of travel to exotic places may possibly affect people’s perception of the risks involved.

It is clear that travellers need to be advised of the rabies vaccination, which provides effective protection against the disease.

It is also vital that people know whether they are visiting a country where rabies is endemic, and that any animal bite must be taken seriously.

The risk in these countries can also be reduced by avoiding contact with animals susceptible to rabies.

The professor says that though ignoring freely roaming dogs and cats may go against the instincts of animal-loving travellers in developing countries, it is a necessary precaution,and wildlife should be appreciated at a distance.

Rabies is a disease transmitted from animals to human beings and affects the nervous system and the brain, which then becomes inflamed.

It is advised that travellers to high-risk areas should consider a vaccination, a course of three injections.

Once a person has been bitten or scratched by a suspect animal, immunisation is essential within 24 hours.

The post-exposure immunisation is painful and depends on a scarce and expensive anti-serum unavailable in many places where rabies poses most risk, but it is effective.

As a point of interest a study in Thailand found that 8 per cent of visitors were licked and 1 per cent bitten, and that 7 per cent of street dogs had rabies.

Obviously children are at particular risk as they are less likely to be afraid of infected animals and may be unable to tell their parents that they have been bitten

The study is published in the current edition of the British Medical Journal.