Rabies Transmission by Oral and Other Non-bite Routes
Rabies transmission by oral route is a queer mode of infection. Reports of oral transmission are infrequent and hence need elaborate discussion. Evidences of such transmission have been well documented in men. Transmission of rabies virus to humans by ingestion of milk from a rabid mother has been reported. A woman in early stage of rabies transmitted the disease to her nursing baby.
Transplacental transmission is another unique mode of spread of this disease. Transplacental transmission was observed in an infant born of a Turkish woman who died of rabies following dog bite. Authentic reports of airborne infection are available. In 1956 an entomologist who frequently visited bat infested caves in USA for research studies developed laboratory proven rabies after aerosol inhalation. Out of two instances of rabies transmitted to laboratory workers by aerosol inhalation, one recovered after intensive therapy but the other died.
Rabies virus has been isolated from several body fluids like saliva, tracheal and nasal secretions, tear, CSF, urinary sediment, etc, from laboratory proved case of human rabies. None the less rabies transmission from human patients to healthy contacts is extremely rare.One important mode of non-bite transmission from man to man is by corneal transplantation from unrecognised infected donor. Several cases have been observed since the first case was reported in 1979. Public health importance of oral and other non-bite routes of infection is worth considering. Consumption of infected milk from a rabid cow is not uncommon because consumers become aware of disease in an animal only after using milk for several days. However, reported instances of rabies among cow milk consumers are rare because boiling of milk is a common practice in endemic countries, which is adequate to destroy the virus. None the less under certain circumstances such as wrestlers in the Northern India and for worship purpose in Eastern States only raw milk is used when comsumers are exposed to the risk of infection. In such a situation rabies prophylaxis is mandatory.
Under no circumstances should a cornea be transplanted from a donor, who died of an undiagnosed neurological disorder. Medical, nursing personnels, laboratory workers, and other attendants should use gowns, gloves, goggles for personal protection. In the event of unavoidable exposure immunisation against rabies must not be omitted.