When dog was man’s enemy

Rabies is a zoonotic disease that, despite its rarity, claims around 50,000 lives annually, primarily in underdeveloped countries in Africa and Asia. Its fatality, coupled with painful symptoms, has prompted countries to vaccinate both wild and domestic animals to minimize the potential for human infection. In 2014, Croatia recorded its last case of a rabies-infected fox, a milestone that could soon grant the country rabies-free status.

What is rabies, and why is it so terrifying?

Rabies is a zoonotic disease caused by the Rabies virus (Lyssa), which belongs to the Rhabdoviridae family. Depending on the host, there are two types of rabies: urban, transmitted by cats and dogs, and sylvatic, transmitted by foxes, raccoons, and other wild animals. Some bat species are also infected with different types of rabies virus, which can be pathogenic. Stray dogs are the most common carriers of this disease in modern times.

The virus enters the body through a bite or direct contact with saliva on an open wound or mucous membranes, spreading from the peripheral nervous system to the central nervous system, causing encephalomyelitis and nerve cell degeneration. The incubation period ranges from 20 to 90 days, but there have been cases where the disease manifested months or even years later. Many factors influence this time gap, such as virus concentration and the site of entry. The period from symptom development to death is a few days, and rabies ends fatally in 99% of cases.

There are two types of symptom manifestations. The first, furious rabies, includes hallucinations, hypersalivation, and hydrophobia (fear of water), with affected individuals often producing animal-like sounds. The second, paralytic rabies, is less extreme but involves muscle paralysis. However, death is an inevitable outcome.

Despite the absence of a definitive cure, there are a few cases where infected individuals have survived. The Milwaukee protocol, an experimental clinical practice involving deep sedation with drugs like ketamine or midazolam and antiviral treatment with ribavirin, was documented in 2004 after a patient survived rabies. However, due to its questionable and inconsistent efficacy, it is not the primary treatment for rabies and is rarely used today.

How do we protect ourselves?

Fortunately, there is a vaccine. Vaccination of pets and oral vaccination of wild animals are crucial preventive measures against this disease. The rabies vaccine is intended for animals, but it is also administered to humans in cases of exposure or for prevention. Pre-exposure vaccination is given in multiple doses to vulnerable groups, such as veterinarians and hunters with frequent animal contact, followed by a booster dose after a year. In case of a bite or contact with the saliva of an infected animal, thorough wound cleaning is recommended, accompanied by vaccination and rabies immune globulin for passive immunization.

Rabies in Croatia

Some of the first cases of rabies in Croatia occurred in the Šibenik area in 1783, where two people were infected through bites from a cat and a dog. Stray dogs became a significant public health problem in the 19th century. During that time, a dog tax existed in Croatia to reduce their numbers, and any unmarked dog on the street had to be removed. In the 20th century, dog vaccination campaigns began, leading to the eradication of urban rabies in 1967. However, sylvatic rabies spread afterward. In 2011, an intensive campaign for the oral vaccination of foxes and wild animals commenced, and in 2014, the last case of rabid fox was recorded.