Human Rabies

Presented at the Nigerian Veterinary Medical Association (Oyo State Chapter) symposium titled: The Role of One Health Initiative towards Achieving Rabies Eradication in Nigeria by the Year 2030.
Trenchard Hall, University of Ibadan, Nigeria
2018 World Rabies Day, 28 September 2018

1. Human Rabies by Babalola Ibisola MBChB ( Ogun ), SRH (Geneva), MSC (Fa mily Medicine, Edinburgh ) Department of Family Medicine University College Hospital, At The Nigerian Veterinary Medical Association Symposium Trenchard Hall, University of Ibadan

2. The Role of One Health Initiative towards Achieving Rabies Eradication in Nigeria by the Year 2030 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

3. Outline Introduction Rabies virus Epidemiology Clinical features Prevention Management Take home message 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

4. Introduction Rabies is a zoonotic viral disease with almost 100 percent fatality once infection is established Di- gbo - lu - gi ; due to its similarity to zombie like-display at full clinical manifestation “Rage” or “madness” – in Latin Rabies remains an important yet neglected disease in Africa and Asia It is completely preventable and can be eradicated through massive animal vaccination 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

5. Rabies virus Bullet-shaped single stranded RNA virus Rhabdoviridae family and lyssavirus genus Primary reservoirs are wild mammals and can be transmitted through domestic mammals 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

6. Rabies Virus Structure It has five strucutal proteins – Transcriptase, nucleoprotein and phosphoprotein are associated with the genomic RNA Matrix protein – the inner lining of the bilayed lipid envelop and an outer layer made up of glycoprotein 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

7. Epidemiology of human rabies Rabies is primarily a disease of animals Its epidemiology in human reflects both the distribution in animals and the degree of human interaction/contact with these animals 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

8. Epidemiology 2 In Nigeria and other African and Asian countries, dogs account for over 90% of cases of human rabies – urban rabies In north America (Canada and the US), canine rabies has been eradicated. Wild animals like foxes, bats and jackals are the major causes in these regions – Sylvan (wild) Rabies 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

9. Dog Transmission Distribution of Rabies Nigeria is under the suspected region – good news for us 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

10. ESTIMATED 55,000 mortality Global incidence of Rabies is estimated at around 4 billion per annum. 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

11. Transmission of Rabies Bite by infected dog Contact with saliva of an infected animal 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

12. Susceptibility to infection Concentration of nicotinic acetylcholine receptors in skeletal muscle Size of the inoculums The degree of innervations of the site of bite Proximity of the site of bite to the CNS 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

13. Incubation Minimum Maximum Head and face 12 180 Trunk only 45 45 Upper limbs only 20 1095 Heads only 8 360 Lower limbs only 15 545 Multiple sites 13 96 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI Site of Bite Incubation Period in Days

14. Clinical features Early and non-specific symptoms and signs: - Fever, headache, weakness, muscle pain Agitation, confusion and strange behaviours Painful spasms Excessive salivation Hydrophobia Seizures Death 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

15. Clinical Course of Human Rabies 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

16. Management of Human Rabies First Aid Clean wound site with soap, water and hydrogen peroxide Leave the wound open Suspect every dog bite as potential rabies, especially if the bite was unprovoked Obtain immunization history of the dog /quarantine the dog Treatment Report to the hospital immediately Commence anti-rabies vaccination before the onset of symptoms 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

17. Category of Exposure Risk of Exposure. Definition Treatment Category 1 Touching or feeding animal, licks on intact skin None if reliable history is available Category 2 Nibbling of uncovered skin. Minor scratches or abrasions without bleeding Licks on broken skin Administer vaccine immediately Category 3 Single or multiple trans-dermal bites or scratches Contamination of mucous membrane with saliva Give rabies immunoglobulin and vaccine 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

18. Diagnosis Fluorescent Antibody Test (FAT) Postmortem - Negri bodies 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

19. Anti-Rabies Vaccination Anti-rabies immunoglobulin For Category 3 exposure 20 IU/Kg of human immunoglobulin Half infiltrated in and around the site of bite Remaining half injected into the gluteal region Anti-rabies vaccines For category 2 and 3 Days 0, 3, 7, 14 , 28 and 90 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

20. Take home Message Rabies is still much around It is very preventable It can be eradicated completely Massive education Pre-exposure prophylaxis Post-exposure prophylaxis Massive animal vaccination 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

21. IT IS ONE PLANET. IT IS OUR HOME Let’s join hands to make her healthier 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

22. Appreciation 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI

23. References 1 . World Health Organization. Re-evaluating the burden of rabies in Africa and Asia. Bull. World … 008862, 360–369 (2003). 2. Carroll, R. W., Katz, M. L., Paul, E. & Jüppner , H. Case 17-2017. N. Engl. J. Med. 376, 2266–2275 (2017). 3. Noah, D. L. et al. Epidemiology of human rabies in the United States, 1980 to 1996. Ann. Intern. Med. 128, 922–930 (1998). 4. Fauci , A. S. & Morens , D. M. The Perpetual Challenge of Infectious Diseases. N. Engl. J. Med. 366, 454–461 (2012). 5. Out, B., Into, P. T. & Health, O. Editorial Annals of Internal Medicine Taking the Bite Out of Rabies , Putting Teeth Into “ One Health ”. 132–133 (2017). 6. Song, M. et al. Epidemiological investigations of human rabies in China. BMC Infect. Dis. 9, 210 (2009). 7. Freedman, D. O., Chen, L. H. & Kozarsky , P. E. Medical Considerations before International Travel. N. Engl. J. Med. 375, 247–260 (2016). 9/28/2018 B.A Ibisola Human Rabies Trenchard Hall, UI