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Yes, Cats Can Also Spread Rabies

Introduction

In Greek mythology, Lyssa is referred to as a Goddess of wrath or fury. Legend paints her as a powerful deity with glittering eyes and snakes on her head. While there are many myths surrounding Lyssa&#39;s madness, one that stands out is that related to the hunter Actaeon. It is said that the hunter was caught spying on the Goddess Artemis bathing in a lake and so Lyssa, mad with anger, turned him into a stag. Moreover, she drove his dogs mad and caused them to tear him apart<a href="#reference" target="_blank">1</a>. Soon enough, dogs became synonymous with rabies, which the Greeks began to refer to as &#39;lyssa&#39;.

Since ancient times, rabies has terrified people across the world. In 350 BC, the Geek philosopher Aristotle also wrote about <a href="https://www.merisehat.pk/disease/rabies-89">rabies</a>, stating, &#39;Dogs suffer from the madness. This causes them to become irritable and all animals they bite to become diseased.&#39;

But is man&#39;s best friend really to blame for the terrifying disease? Or is it time we shift the blame to other animals?

&nbsp;

Understanding The Role Of Felines In Rabies

The Greek physician Hippocrates described rabies as&nbsp;&#39;persons in a frenzy drink very little, are disturbed and frightened, tremble at the least noise, or are seized with convulsions.&rsquo;

The medical community has termed rabies as a zoonotic disease that results from an infection with the rabies lyssavirus. The vaccine-preventable disease is currently ranked as the 11th most deadly infectious disease in the world<a href="#accordion">[2]</a>. In Pakistan, rabies results in 5,000 annual deaths, and the country shoulders 10% of the global death burden of this disease<a href="#accordion">[3]</a>.&nbsp;

The causative organism, the rabies virus, is found in both wild and domesticated animals. A bite or a scratch from an infected animal, or exposure to their saliva can transmit the disease to humans. Once the virus enters the body, it begins to replicate within the muscle cells nearby. The virus then travels through the nerves to the brain and causes inflammation of the brain and spinal cord.&nbsp;

Rabies can be present in two forms: encephalitic rabies and paralytic rabies. Also called furious rabies, the encephalitic form is the most common form of rabies, which causes hyperactivity, excitability, and hydrophobia (fear of water) in affected individuals. The other form, paralytic rabies, develops slowly and results in paralysis.&nbsp;

Infection typically occurs in five stages: incubation period, prodromal stage, acute neurological illness, coma, and death. The disease begins with flu-like symptoms (e.g., fever, sore throat, headache, nausea, or vomiting) along with pain or burning sensation at the bite site. As the virus infects the brain, confusion, agitation, insomnia, hyperactivity, hydrophobia, aggression, difficulty swallowing, and convulsions set in. People can go into a coma within 10 days of symptoms and eventually death may occur.

&nbsp;

According to the World Health Organization (WHO), domestic dogs contribute to 99% of all rabies transmission to humans<a href="#accordion">[2]</a>. By targeting the disease reservoir in dogs, the WHO aims to end all dog-mediated human rabies cases by 2030<a href="#accordion">[4]</a>. So far, the widespread dog vaccination campaigns have helped eliminate dog-mediated rabies across the United States, Europe, Canada, and Japan.

However, dogs are not the only reservoirs of the rabies virus. Other domestic animals such as cats, and cattle can also carry the disease. Moreover, exotic mammals like hamsters and guinea pigs that are often kept as pets may also pose a risk of rabies.

Over the years, as the world focused its attention on vaccinating man&#39;s best friend, cat owners seemed to neglect their feline&#39;s rabies vaccination. As a result, the number of rabid cats has disproportionately increased across countries like the United States. In 2019, a rabies surveillance study found cats (5.2%) responsible for a higher proportion of animal rabies cases compared to dogs (1.4%)<a href="#accordion">[5]</a>. According to the CDC, the country reports 60-70 rabid dogs and more than 250 rabid cats every year<a href="#accordion">[6]</a>. Almost all these animals acquired rabies from contact with wildlife, such as raccoons and bats.

&nbsp;

Cats usually contract rabies from the bite of an infected animal, such as bats, foxes, raccoons, or skunks. However, your cat won&#39;t immediately develop the disease. Symptoms can take 3-8 weeks to appear. In some cases, the incubation period can be as long as a year.&nbsp;

Your cat may present with the following symptoms:

<ul>
	<li>Behavioral Changes - This is one of the initial signs of rabies. If your cat is shy, they may become more excitable and outgoing; cats that are extroverted may become shy and less affectionate.</li>
	<li>Aggression - Along with being excitable, cats may show uncharacteristic aggressive behavior towards humans and other animals.&nbsp;</li>
	<li>Neurological Illness - It results from the involvement of the central nervous system (CNS) and is characterized by loss of appetite, convulsions, and an inability to swallow. Thus, the cat may excessively drool or foam at the mouth. Cats with paralytic rabies often don&#39;t appear vicious and instead only present with a loss of muscle control, especially in the throat and jaw.</li>
	<li>Paralysis - The cat may have difficulty breathing and slip into a coma. There&#39;s a possibility of death within 10 days of the onset of symptoms.&nbsp;</li>
</ul>

The rabies virus is present in the saliva of rabid cats. People typically develop rabies from being bitten or scratched by an infected animal. Moreover, contact of the infected saliva with an open wound or scratch can lead to virus entry into humans.&nbsp;

&nbsp;

There is currently no test to check for rabies in living animals. Examination of the brain tissue after the cat&#39;s death is the only way to confirm a diagnosis. Most veterinarians suggest observing the animal for signs and symptoms of rabies. However, once your cat begins showing symptoms, there is nothing you can do as the disease is 100% fatal. A vet may recommend you euthanize your pet to ease its suffering. Therefore, vaccination of cats against rabies remains the best prevention strategy. Boosters might be required a year later, and then every three years.&nbsp;

As per the National Association of State Public Health Veterinarians&#39; recommendation, any unvaccinated cat exposed to rabies should be euthanized immediately<a href="#accordion">[7]</a>. If a healthy domestic cat bites a person or there&#39;s an exposure to saliva with broken skin, the cat should be kept in quarantine for 10 days of observation. The cat will then need to be euthanized if they develop symptoms of rabies. Vaccinated cats are unlikely to become infected with rabies.

If you suspect your cat has rabies or has come in contact with a rabid animal, you should immediately take them to a vet.&nbsp;

&nbsp;

Domestic animals are often the focus of rabies control strategies due to their increased contact with humans. However, wild animals such as raccoons, skunks, and foxes form a larger proportion of rabid animals. In the United States, more than 90% of rabies cases in animals occur in wildlife<a href="#accordion">[8]</a>. Although bats were once the most frequently identified wild rabid animal in the country, raccoons now account for a majority of the cases. In 2019, bats accounted for 57.4% of rabies cases in Canada, followed by skunks (19.1%), dogs (8.7%), and raccoons (7.8%)<a href="#accordion">[5]</a>.&nbsp;

While human contact with wildlife is often less than that with domestic animals, cats and dogs can become exposed to these wild rabid animals. Moreover, a bat scratch or bite is very small and not always easy to find. People who live around wildlife or have bats around should be extra careful of themselves and their pets.

&nbsp;

Conclusion

In Pakistan, the increasing population of stray cats and dogs poses a greater risk of rabies to the population. Moreover, there is a lack of awareness regarding vaccinations of pets against rabies<a href="#accordion">[9]</a>. A combination of these factors contributes to the high disease burden in the country.

Effective rabies control strategies not only reduce the number of rabid animals but also lowers the number of human cases. Therefore, it is important to keep your pet&#39;s vaccinations up to date. Regardless of whether your car is an indoor or outdoor cat, vaccinate them against rabies. Furthermore, try to limit their time outdoors.

At a community level, educating cat owners about the risk of rabies and educating the masses about the risk of rabies from animals other than dogs can play a significant role in improving public health risks.&nbsp;

&nbsp;

Key Points

<ul>
</ul>

<ul>
	<li>Rabies is a zoonotic viral disease that results from an infection with the rabies virus. Although 99% of human rabies cases result from a dog bite, several other animals can also spread the viral disease to humans. Mammals such as cats, cattle, bats, raccoons, skunks, and foxes are all known as reservoirs of the virus.&nbsp;</li>
	<li>A majority of rabies vaccination programs are aimed at the dog population which has decreased the canine rabies reservoir. However, this has led to an increase in rabid cats worldwide. In the United States, cats are the most common rabid domestic animals.&nbsp;</li>
	<li>Cats contract rabies from the bite of an infected animal, mostly a wild mammal such as a raccoon, bat, or fox. Symptoms include a change in behavior&nbsp;(shy to excitable or extroverted to shy), aggressiveness towards other animals or humans, convulsions, excessive drooling, and foaming at the mouth. In paralytic rabies, cats don&rsquo;t appear vicious and instead develop paralysis of the jaw and mouth muscles. The disease is 100% fatal and death can occur within 10 days of symptoms.&nbsp;</li>
	<li>Rabies is a notification priority disease in Pakistan and if you suspect your cat has become exposed to a rabid animal, take them to a vet immediately. The National Association of State Public Health Veterinarians recommends euthanizing all unvaccinated cats exposed to rabies. Therefore, vaccinating your cats is the best way to prevent the disease in both animals and humans.&nbsp;</li>
</ul>

&nbsp;

[1] Lyssavirus. Emerging Infectious Diseases. 2009;15(8):1184. doi:10.3201/eid1508.e11508

[2] WHO, 2021. Rabies. [Online].

[3] Ahmed, T., Asghar, M. W., Khalid, S. & Mushtaq, M. H., 2019. A short report on epidemiological investigation of dog bite cases in association with temperature rise as a part of climate change. ALS, 6(3), pp. 106-109.

[4] World Health Organization, 2018. New global strategic plan to eliminate dog-mediated rabies by 2030. [Online].

[5] Ma, X., Monroe, B. P., Wallace, R. M., Orciari, L. A., Gigante, C. M., Kirby, J. D., Chipman, R. B., Fehlner-Gardiner, C., Cedillo, V. G., Petersen, B. W., Olson, V., & Bonwitt, J. (2021). Rabies surveillance in the United States during 2019, Journal of the American Veterinary Medical Association, 258(11), 1205-1220.

[6] CDC, 2020. Domestic Animal Surveillance. [Online].

[7] Compendium of Animal Rabies Prevention and Control, 2011: National Association of State Public Health Veterinarians, Inc. (NASPHV)

[8] CDC, 2022. Animals and Rabies. [Online].

[9] Ahmed, T. et al., 2020. Knowledge, attitude and practice (KAP) survey of canine rabies in Khyber Pakhtunkhwa and Punjab Province of Pakistan. BMC Public Health, Volume 20.

Nimrah H. Sattar

<a href="https://www.merisehat.pk/disease/rabies-89">Rabies</a>, named after Lyssa (Greek goddess of wrath and fury), is a terrifying disease that can often make the animal or human appear &#39;mad&#39;. In ancient times, not much was known about the causative organism; the physicians just believed the madness was a result of a virus (Latin for poison). Thus, they tried various methods to draw the poison and &#39;madness&#39; out of the person&#39;s body. From cupping to burning the wound, bloodletting, holding the person underwater, and even eating the hair of a rabid dog, they tried it all. Not surprisingly, nothing worked.&nbsp; 
&nbsp;

Later in the 18th century, people turned to mudstones for the treatment of rabies. These calcified hairballs present in the stomachs of cows and goats were thought to have the power to draw out the poison from the body. A lot of the stone&#39;s healing power was of course based on superstition. What they assumed as a cure was just the fact that not everyone that gets bit by a rabid animal develops rabies. Hence, there was never anything to cure. 
&nbsp;

It wasn&#39;t until the 1880s that the first real treatment for rabies came forward. Louis Pasteur&#39;s discovery of the rabies vaccine led to hundreds of people surviving rabid animal bites. Today, vaccines play a significant role in the treatment of the viral disease.

&nbsp;

Rabies is a zoonotic viral disease transmitted via the bite of an infected animal. All mammals can carry the rabies virus, including humans. According to the World Health Organization, 99% of human cases are due to a dog bite<a href="#accordion">[1]</a>. In Pakistan, there is a high incidence of dog bites. In 2010, basic health units across the country reported more than 97,000 cases of dog bites<a href="#accordion">[2]</a>.&nbsp;Moreover, government hospitals in the country receive 50 to 70 new cases per day<a href="#accordion">[3]</a>. Approximately 90% of dog bite cases are from stray dogs rather than pets<a href="#accordion">[3]</a>. As the population of stray dogs increases, this number is expected to rise further, increasing the disease burden.&nbsp; 
&nbsp;

While an animal bite or scratch is the most common mode of transmission, the bullet-shaped rabies virus can also be transmitted via exposure to the animal&#39;s saliva. However, the saliva must come in contact with an open wound, scratch, or cut. Furthermore, inhalation of the aerosolized form of the virus and even organ transplantation can transmit the virus to humans<a href="#accordion">[4]</a>. However, petting a rabid animal or contact with its blood or urine cannot transmit the infection as the virus is stored in the animal&#39;s saliva.&nbsp; 
&nbsp;

The incubation period for rabies can vary between a week to a year. Symptoms typically start as a flu-like illness followed by agitation, hyperactivity, confusion, increased salivation, difficulty swallowing or drinking water, fear of water (hydrophobia), convulsions and eventually death. Some people may not show signs of aggressiveness or hyperactivity; instead, they experience paralysis of the muscles.&nbsp; 
&nbsp;

Understanding Emergency Measures To Treat Rabies

Once symptoms appear, rabies is 100% fatal<a href="#accordion">[1]</a>. In Pakistan, rabies accounts for more than 5,000 human deaths per year<a href="#accordion">[5]</a>. However, timely administration of post exposure prophylaxis vaccine and rabies immunoglobulins can effectively prevent the disease from developing.&nbsp; 
&nbsp;

You will need the rabies vaccine in the following scenarios:

<ul>
	<li>If you got bit, scratched, or had contact with the saliva of a rabid animal</li>
	<li>If the captured animal shows signs of rabies within the 10 days of observation 
	&nbsp;</li>
</ul>

However, if you are unaware of the animal&#39;s rabies status, it is best to assume that the animal was rabid. Especially, if you belong to a rabies endemic region like Pakistan.&nbsp; 
&nbsp;

Emergency treatment for rabies includes immediate washing of the wound with soap and water for at least 15 minutes. If initiated within 3 hours of an animal bite, extensive wound care can be approximately 100% effective at preventing rabies. Moreover, medical care should be sought immediately. In the emergency room, treatment is based on history and exposure.&nbsp; 
&nbsp;

As per the WHO&#39;s guidelines, post exposure prophylaxis (PEP) measures are based on the severity of the contact with the suspected rabid animal<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

Category I - People in this category are defined as having no exposure. They may have a history of touching or feeding animals, or an animal may have licked their intact skin. 
&nbsp;

Treatment: Washing of exposed skin surfaces only. 
&nbsp;

Category II - This is a category of exposure. People will have a history of an animal nibbling their uncovered skin, minor scratches or abrasions without bleeding. 
&nbsp;

Treatment: Wound washing and immediate vaccination. 
&nbsp;

Category III - Severe exposure characterized by single or multiple transdermal bites or scratches; contamination of mucous membrane or broken skin with animal licks; or direct contact with bats. 
&nbsp;

Treatment: Wound washing, vaccination, and administration of rabies immunoglobulin. 
&nbsp;

Both categories II and III require PEP.&nbsp; 
&nbsp;

If you have never received the rabies vaccine, rabies immunoglobulins are immediately injected at the wound site and a distant site. Moreover, four shots of the rabies vaccine are also administered over a course of 2 weeks (days 0, 3, 7, and 14). Immunocompromised people may require a 5th dose, which is typically given on day 28. 
&nbsp;

In previously vaccinated individuals, 1 mL (2 doses) of the rabies vaccine is injected into the deltoid muscle on day 0 and day 3 of infection. No immunoglobulins are administered in previously vaccinated persons.&nbsp; 
&nbsp;

However, a rabies vaccine is not always needed. In certain situations, you might not require any PEP with the vaccine or immunoglobulins. In the following cases, a rabies vaccine is not needed: 
&nbsp;

<ul>
	<li>If the animal does not show any signs of rabies during the 10 days of observation</li>
	<li>If you got bit or scratched by a vaccinated animal 
	&nbsp;</li>
</ul>

While dogs may get all the blame for spreading rabies to humans, cats are the most common rabid domestic animal in developed countries<a href="#accordion">[7]</a>. However, both cats and dogs typically acquire the virus from contact with a wild animal. In developed countries, domesticated animals like cats and dogs account for only 10% of cases while the rest are due to wild animals<a href="#accordion">[6]</a>. These include raccoons, bats, skunks, and foxes. In 2019, bats accounted for 57.4% of rabies cases in Canada, followed by skunks (19.1%), dogs (8.7%), and raccoons (7.8%)<a href="#accordion">[7]</a>.&nbsp;

Therefore, it is important to note that not all dogs are rabid, Moreover, dogs aren&#39;t the only ones you should be wary of.&nbsp; 
&nbsp;

&nbsp;

In 2018, Getz Pharma Private Limited joined hands with Indus Hospital &amp; Health Network (IHHN) to establish &#39;Rabies Free Pakistan&#39;. The project aims to eradicate rabies from Pakistan by 2030. So far, the Rabies Free Pakistan team has vaccinated more than 30,000 dogs and neutered around 7,000 dogs. Through mass vaccinations and controlling the dog population, the program aims to reduce the disease burden.&nbsp; 
&nbsp;

However, rabies is a neglected disease in Pakistan. Despite the high prevalence, a huge majority of people are unaware of the disease, its cause, and ways of prevention<a href="#accordion">[8]</a>.&nbsp;Moreover, many people in Pakistan do not vaccinate their pets against rabies. Another barrier to rabies elimination is the heavy distribution of stray dogs in rural areas. These dogs carry a higher risk of infection as they are unvaccinated. Therefore, implementing canine vaccination programs in rural areas, increasing awareness of first-aid practices, and controlling the dog population can help decrease the incidence of rabies in the country. 
&nbsp;&nbsp; 
&nbsp;

<ul>
	<li>Rabies is a zoonotic viral disease that results from an infection with the rabies virus. Symptoms typically begin 1-3 months after exposure to an infected animal. These include fever, headache, burning sensation at the wound site, anxiety, agitation, hydrophobia, hyperventilation, paralysis, coma, and eventually death.&nbsp;</li>
	<li>Humans can contract rabies via the bite or scratch of a rabid animal. Moreover, exposure to the animal&rsquo;s saliva with an open wound, scratch or cut can also transmit the virus to humans.&nbsp;</li>
	<li>Although dogs account for the greatest number of human rabies cases, cats can also spread the disease.&nbsp;</li>
	<li>Emergency treatment for a rabid animal bite includes extensive wound washing followed by administration of the rabies vaccine and immunoglobulins. In previously vaccinated individuals, only 2 doses of the rabies vaccine are given intramuscularly, at day 0 and day 3.</li>
	<li>Effective rabies control programs, which include mass vaccination of dogs, spreading awareness about rabies among the masses, better distribution of rabies vaccines, and increasing surveillance in rural areas can help reduce the disease burden in the country.&nbsp;</li>
</ul>

&nbsp;

[1].WHO, 2021. Rabies. [Online]

[2].World Health Organization, n.d. Pakistan - Rabies Control Programme.

[3].Ali MI, Jamali S, Ashraf T, Ahmed N. Patterns and Outcomes of dog bite injuries presenting to emergency department in a tertiary care hospital at Karachi. Pak J Med Sci. 2021;37(3):794-799. doi: https://doi.org/10.12669/pjms.37.3.3464

[4].Lu, Xue-Xin et al. “Rabies virus transmission via solid organs or tissue allotransplantation.” Infectious diseases of poverty vol. 7,1 82. 15 Aug. 2018, doi:10.1186/s40249-018-0467-7

[5].Ahmed T, Asghar MW, Mushtaq MH. A short report on epidemiological investigation of dog bite cases in association with temperature rise as a part of climate change. Advancements Life Sci. 2019;6(3):106–9

[6].Koury R, Warrington SJ. Rabies. [Updated 2021 Nov 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-

[7].Ma, X., et al. (2021). Rabies surveillance in the United States during 2019, Journal of the American Veterinary Medical Association, 258(11), 1205-1220.

[8].Ahmed, T., Hussain, S., Zia, UuR. et al. Knowledge, attitude and practice (KAP) survey of canine rabies in Khyber Pakhtunkhwa and Punjab Province of Pakistan. BMC Public Health 20, 1293 (2020).