Rabies in community health education and prevention
eusiviapasi
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Jun 05, 2024
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About This Presentation
Rabies community health
Educating about rabies and prevention
Slide Content
RABIES
Rabies
Definition
“Also known as Hydrophobia.
・H is the only communicable disease of
man that is always FATAL.
*Rabies is zoonotic disease. It affects
Carnivorous, warm blooded animals, like
Dogs, Cats, Jackals, Wolves, Bats,
Raccoons, Skunks etc.
“Also known as Hydrophobia.
・H is the only communicable disease of
man that is always FATAL.
*Rabies is zoonotic disease. It affects
Carnivorous, warm blooded animals, like
Dogs, Cats, Jackals, Wolves, Bats,
Raccoons, Skunks etc.
- Rabies is transmitted to man by,
1. Bites,
2. Scratches or
3. Licks of rabid animals.
* Rabies is caused by Lyssavirus type 1.
- This virus affects CNS.
1. Bites,
2. Scratches or
3. Licks of rabid animals.
* Rabies is caused by Lyssavirus type 1.
- This virus affects CNS.
* Rabies is transmitted to man by,
1. Bites,
2. Scratches or
3. Licks of rabid animals.
* Rabies is caused by Lyssavirus type 1.
* This virus affects CNS.
1. Bites,
2. Scratches or
3. Licks of rabid animals.
* Rabies is caused by Lyssavirus type 1.
* This virus affects CNS.
ㆍ Clinical characteristics of Rabies.
1. Incubation Period is long and variable.
2. Duration of illness is short.
3. Encephalitis and myelitis.
4. Highly fatal illness.
5. Preventable disease.
1. Incubation Period is long and variable.
2. Duration of illness is short.
3. Encephalitis and myelitis.
4. Highly fatal illness.
5. Preventable disease.
Problem Statement
* Geographic Distribution.
* In some countries disease have never been
introduced.
* Some countries achieved Rabies Free Status.
Australia, China ( Taiwan), Ireland, Japan,
New Zealand, Malta, Finland, Norway, Sweden
UK etc.
* These countries achieved Rabies free status by
vigorous campaigns of elimination.
* Geographic Distribution.
* In some countries disease have never been
introduced.
* Some countries achieved Rabies Free Status.
Australia, China ( Taiwan), Ireland, Japan,
New Zealand, Malta, Finland, Norway, Sweden
UK etc.
* These countries achieved Rabies free status by
vigorous campaigns of elimination.
* In India Union Territories of
Lakshadweep and Andman, Nicobar
Islands are free from Rabies.
*- Rabies Free Area - Definition
- No indigenous case of rabies occurred in
1. Manor
2. Any animal species, for 2 years.
Lakshadweep and Andman, Nicobar
Islands are free from Rabies.
*- Rabies Free Area - Definition
- No indigenous case of rabies occurred in
1. Manor
2. Any animal species, for 2 years.
* Rabies occurs in > 150 countries and
territories.
* Natural reservoirs of rabies includes
number of Carnivorous animals and bats.
- But most important source of infection
for man includes rabid dogs. [excluding
USA ( Bats, Raccoons, Skunks)]
- 99% human cases of rabies are caused
by rabid dogs.
* Rabid dogs affects > 3.3 billion people.
territories.
* Natural reservoirs of rabies includes
number of Carnivorous animals and bats.
- But most important source of infection
for man includes rabid dogs. [excluding
USA ( Bats, Raccoons, Skunks)]
- 99% human cases of rabies are caused
by rabid dogs.
* Rabid dogs affects > 3.3 billion people.
- In rural areas of Asia and Africa, annual
estimated deaths = 55000.
- In India, annual estimated deaths =
20000.
- At risk population in India --- 2/ lac.
- At risk population in Africa -- 4 / lac.
estimated deaths = 55000.
- In India, annual estimated deaths =
20000.
- At risk population in India --- 2/ lac.
- At risk population in Africa -- 4 / lac.
- Rabies is most commonly seen in
children in < 15 years of age.
- In this age group 5 times higher
incidence is seen in North - Western part
of the United Republic of Tanzania.
children in < 15 years of age.
- In this age group 5 times higher
incidence is seen in North - Western part
of the United Republic of Tanzania.
Global Rabies Prophylaxis
ㆍ >15 million people receive Rabies
Prophylaxis annually.
* About 40% Children between 5 to 14 years age
group requires post - exposure immunization.
* In absence of post exposure immunization /
prophylaxis, 327000 deaths may occur
annually in Asia and Africa alone.
ㆍ >15 million people receive Rabies
Prophylaxis annually.
* About 40% Children between 5 to 14 years age
group requires post - exposure immunization.
* In absence of post exposure immunization /
prophylaxis, 327000 deaths may occur
annually in Asia and Africa alone.
Epidemiological Determinants
Agent Factors
Causative agent is Lyssavirus type 1. It is bullet
shaped virus.
Neurotropic virus.
RNA virus.
Family - Rhabdoviridae
Serotype 1 causes Rabies.
Serotypes 2,3 & 4 are Rabies related viruses.
These Serotypes are antigenically different viruses.
These viruses produces rabies like disease in man
and animals.
Currently available antirabies vacancies do not
provide protection against these rabies related
viruses.
Causative agent is Lyssavirus type 1. It is bullet
shaped virus.
Neurotropic virus.
RNA virus.
Family - Rhabdoviridae
Serotype 1 causes Rabies.
Serotypes 2,3 & 4 are Rabies related viruses.
These Serotypes are antigenically different viruses.
These viruses produces rabies like disease in man
and animals.
Currently available antirabies vacancies do not
provide protection against these rabies related
viruses.
Rabies virus
Envelope
(Membrane) Matrix Protein Glycoprotein
Ribonucleoprotein
(Membrane) Matrix Protein Glycoprotein
Ribonucleoprotein
Viral Antigens
Membrane Antigen Internal Antigen
ㆍ G protein. に Nucleoprotein
・ Glycoprotein antigen. antigen.
ㆍ Capable of inducing
formation of virus
neutralizing
antibodies.
Membrane Antigen Internal Antigen
ㆍ G protein. に Nucleoprotein
・ Glycoprotein antigen. antigen.
ㆍ Capable of inducing
formation of virus
neutralizing
antibodies.
* Presence of neutralizing antibodies in
the blood of man and animals is
considered as an index of protection
against infection with Rabies virus.
- Rabies virus is excreted in the saliva of
infected animals
the blood of man and animals is
considered as an index of protection
against infection with Rabies virus.
- Rabies virus is excreted in the saliva of
infected animals
Rabies virus
Street virus Fixed virus
ㆍ The virus recovered ・The virus recovered
from naturally from serial brain to
occurring cases of brain passage of
rabies is called as street virus is called
street virus. as fixed virus
Street virus Fixed virus
ㆍ The virus recovered ・The virus recovered
from naturally from serial brain to
occurring cases of brain passage of
rabies is called as street virus is called
street virus. as fixed virus
Street virus
- Street virus is pathogenic for all mammals.
- It shows long and variable incubation
period.
・20 to 60 days in dogs.
- Street virus is pathogenic for all mammals.
- It shows long and variable incubation
period.
・20 to 60 days in dogs.
Fixed virus
・ Under certain conditions, (example - parenteral
administration of antirabies vacancie, which is
inadequately Inactivated) fixed virus is
pathogenic to for humans and mammals.
・ Fixed virus is modified virus. It's incubation
period is progressively reduced.
* Incubation Period is 4 to 6 days
・ Under certain conditions, (example - parenteral
administration of antirabies vacancie, which is
inadequately Inactivated) fixed virus is
pathogenic to for humans and mammals.
・ Fixed virus is modified virus. It's incubation
period is progressively reduced.
* Incubation Period is 4 to 6 days
Source of Infection
* Source of Infection to man is Saliva of
rabid animals.
・In dogs and cats, the virus may be
present in the saliva for 3to 4 days.
Occasionally virus may remain present
for 5to 6 days before the onset of
clinical symptoms. The virus remains
present during the course of the illness
till death.
* Source of Infection to man is Saliva of
rabid animals.
・In dogs and cats, the virus may be
present in the saliva for 3to 4 days.
Occasionally virus may remain present
for 5to 6 days before the onset of
clinical symptoms. The virus remains
present during the course of the illness
till death.
Host Factors
- All warm blooded animals are
susceptible to rabies.
"In India, 1 to 14 years age group is
commonly affected.
+ In man rabies is dead end infection.
- All warm blooded animals are
susceptible to rabies.
"In India, 1 to 14 years age group is
commonly affected.
+ In man rabies is dead end infection.
High risk groups
* Laboratory workers, working with Rabies
virus.
" Veterinary staff.
- Dog handlers.
* Hunters
* Laboratory workers, working with Rabies
virus.
" Veterinary staff.
- Dog handlers.
* Hunters
Mode of Transmission
* Bite of a rabid animals. Most commonly
involved animals are rabid dogs, in most parts
of the world.
* In USA and Canada Rabies is transmitted by
bats.
* Scratches and Licks of rabid animals can
transmit infection.
* Bite of a rabid animals. Most commonly
involved animals are rabid dogs, in most parts
of the world.
* In USA and Canada Rabies is transmitted by
bats.
* Scratches and Licks of rabid animals can
transmit infection.
- Inhalation of aerosolized rabies virus is
one potential non-bite route of exposure,
but except for laboratory workers, most
people won't encounter an aerosol of
rabies virus.
* Rabies transmission through corneal and
solid organ transplants have been
recorded, but they are also very rare.
one potential non-bite route of exposure,
but except for laboratory workers, most
people won't encounter an aerosol of
rabies virus.
* Rabies transmission through corneal and
solid organ transplants have been
recorded, but they are also very rare.
Factors affecting incubation period
ape
Sa
Site of the bite. ( Bites on face, head, neck,
and upper extremities - shorter incubation
period)
Severity of the bite. ( More severe bites -
shorter incubation period)
Number of wounds.
Amount of virus injected.
Species of biting animal. ( Bites by wild
animals - shorter incubation period)
Protection provided by clothing.
Treatment undertaken.
ape
Sa
Site of the bite. ( Bites on face, head, neck,
and upper extremities - shorter incubation
period)
Severity of the bite. ( More severe bites -
shorter incubation period)
Number of wounds.
Amount of virus injected.
Species of biting animal. ( Bites by wild
animals - shorter incubation period)
Protection provided by clothing.
Treatment undertaken.
Pathogenesis
- At the site of introduction or near the site
of introduction ( bite), rabies virus
replicates in the muscle cells or
connective tissue cells.
- After replication virus enters peripheral
nerves.
- Virus spreads centripetally.
- That is virus spreads from the site of bite
or infection to the central nervous
system.
- At the site of introduction or near the site
of introduction ( bite), rabies virus
replicates in the muscle cells or
connective tissue cells.
- After replication virus enters peripheral
nerves.
- Virus spreads centripetally.
- That is virus spreads from the site of bite
or infection to the central nervous
system.
- Virus spreads via peripheral nerves to
the CNS.
- Most likely spread of the virus is, it
ascends passively through the peripheral
nerves.
- Rabies virus infects CNS.
- Following CNS infection, virus spreads
centrifugally.
the CNS.
- Most likely spread of the virus is, it
ascends passively through the peripheral
nerves.
- Rabies virus infects CNS.
- Following CNS infection, virus spreads
centrifugally.
- By centrifugal spread, rabies virus is
carried to,
1. Skeletal muscles.
2. Myocardium.
3. Adrenal glands.
4. Skin.
5. Salivary glands
carried to,
1. Skeletal muscles.
2. Myocardium.
3. Adrenal glands.
4. Skin.
5. Salivary glands
* On reaching the brain, virus causes
inflammation of the brain.
* Virus replicates in the brain.
* Rabies virus causes damage to the brain.
inflammation of the brain.
* Virus replicates in the brain.
* Rabies virus causes damage to the brain.
Clinical Picture
* Duration of illness is short.
* Usually itis 2- 3 days.
* In exceptional cases it may be prolonged
to 5-6 days.
* Usually itis 2- 3 days.
* In exceptional cases it may be prolonged
to 5-6 days.
There may be discomfort or
a prickling or
itching sensation or
pain and
tingling at the site of the bite.
Prodromal symptoms -
Headache
Fever (lasting for 3- 4 days)
Malaise
Sore throat
a prickling or
itching sensation or
pain and
tingling at the site of the bite.
Prodromal symptoms -
Headache
Fever (lasting for 3- 4 days)
Malaise
Sore throat
* Excitation and stimulation of almost all
parts of CNS.
* Involves
1. The sensory system.
2. The motor system.
3. The sympathetic nervous system.
4. Mental system
parts of CNS.
* Involves
1. The sensory system.
2. The motor system.
3. The sympathetic nervous system.
4. Mental system
Sensory changes
- Intolerance to,
1. Noise
2. Bright light
3. Cold draught of air.
- Patient may develop pathognomonic
manifestation
* AEROPHOBIA (Fear of air)
- Intolerance to,
1. Noise
2. Bright light
3. Cold draught of air.
- Patient may develop pathognomonic
manifestation
* AEROPHOBIA (Fear of air)
How to elicit AEROPHOBIA?
"It can be elicited by fanning current of
air across the face.
* It causes violent spasms of pharyngeal
muscles and neck muscles.
"It can be elicited by fanning current of
air across the face.
* It causes violent spasms of pharyngeal
muscles and neck muscles.
Motor and Sympathetic
Manifestations
- Increasd reflexes.
- Muscle spasms
- Dialatation of pupils.
- Increased
1. Salivation
2. Lacrymation
3. Perspiration
Manifestations
- Increasd reflexes.
- Muscle spasms
- Dialatation of pupils.
- Increased
1. Salivation
2. Lacrymation
3. Perspiration
Mental Changes
+ Irritability
+ Anxiety
* Confusion
" Hallucinations
- Anger
* Depression
- Abnormal behaviour
- Fear of death
+ Irritability
+ Anxiety
* Confusion
" Hallucinations
- Anger
* Depression
- Abnormal behaviour
- Fear of death
Pathognomonic feature of rabies
- Hydrophobia
Hydrophobia means fear of water.
When patient attempts to swallow liquids, the
attempts becomes unsuccessful.
Because attempts of swallowing causes severe
spasms of muscles of deglutition.
Hydrophobia is not seen in animals.
- Hydrophobia
Hydrophobia means fear of water.
When patient attempts to swallow liquids, the
attempts becomes unsuccessful.
Because attempts of swallowing causes severe
spasms of muscles of deglutition.
Hydrophobia is not seen in animals.
In later stages of illness,
the mere sight of water or
the mere sound of water may
provoke spasm of muscles of
deglutition.
the mere sight of water or
the mere sound of water may
provoke spasm of muscles of
deglutition.
- Following Manifestations may be seen in severe
cases
1. Paralysis
2. Convulsions
3. Coma
* Death is seen in nearly all patients.
- Till- date only 3 patients with Rabies have survived.
cases
1. Paralysis
2. Convulsions
3. Coma
* Death is seen in nearly all patients.
- Till- date only 3 patients with Rabies have survived.
- Following Manifestations may be seen in severe
cases
1. Paralysis
2. Convulsions
3. Coma
- Death is seen in nearly all patients.
- Till- date only 3 patients with Rabies have survived.
cases
1. Paralysis
2. Convulsions
3. Coma
- Death is seen in nearly all patients.
- Till- date only 3 patients with Rabies have survived.
Diagnosis of Rabies
* Rapid and accurate laboratory diagnosis of
rabies in humans and other animals is essential
for timely administration of postexposure
prophylaxis.
Before current diagnostic methods were
available, rabies diagnosis was made using this
method and the clinical case history.
* Rapid and accurate laboratory diagnosis of
rabies in humans and other animals is essential
for timely administration of postexposure
prophylaxis.
Before current diagnostic methods were
available, rabies diagnosis was made using this
method and the clinical case history.
Bite and non-bite exposures,
from an infected person (human to
human transmission)
could theoretically transmit rabies,
but no such cases have been
documented.
from an infected person (human to
human transmission)
could theoretically transmit rabies,
but no such cases have been
documented.
* Rabies is not transmitted by
1. Ingestion of raw meat or other tissues
infected with Rabies.
2. Casual contact, such as touching a
person with rabies or contact with non-
infectious fluid or tissue (urine, blood,
feces), is not associated with risk for
infection.
1. Ingestion of raw meat or other tissues
infected with Rabies.
2. Casual contact, such as touching a
person with rabies or contact with non-
infectious fluid or tissue (urine, blood,
feces), is not associated with risk for
infection.
Several tests are necessary to diagnose
rabies ante-mortem in humans;
no single test is
sufficient.
Tests are performed on samples of
saliva, serum, spinal fluid, and skin biopsies of
hair follicles at the nape of the neck.
Saliva can be tested by virus isolation or
reverse transcription followed by polymerase
chain reaction (RT-PCR).
Serum and spinal fluid are tested for
antibodies to rabies virus.
Skin biopsy specimens are examined for
rabies antigen in the cutaneous nerves at the
base of hair follicles.
rabies ante-mortem in humans;
no single test is
sufficient.
Tests are performed on samples of
saliva, serum, spinal fluid, and skin biopsies of
hair follicles at the nape of the neck.
Saliva can be tested by virus isolation or
reverse transcription followed by polymerase
chain reaction (RT-PCR).
Serum and spinal fluid are tested for
antibodies to rabies virus.
Skin biopsy specimens are examined for
rabies antigen in the cutaneous nerves at the
base of hair follicles.
Antigen detection by dFA
The rabies antibody used for the dFA test is
primarily directed against the nucleoprotein (antigen)
of the virus.
Rabies virus replicates in the cytoplasm of cells,
and infected cells may contain large round or oval
inclusions containing collections of nucleoprotein
(N) or smaller collections of antigen that appear as
dust-like fluorescent particles if stained by the dFA
procedure.
The rabies antibody used for the dFA test is
primarily directed against the nucleoprotein (antigen)
of the virus.
Rabies virus replicates in the cytoplasm of cells,
and infected cells may contain large round or oval
inclusions containing collections of nucleoprotein
(N) or smaller collections of antigen that appear as
dust-like fluorescent particles if stained by the dFA
procedure.
Histologic examination of biopsy or
autopsy tissues is occasionally useful in
diagnosing unsuspected cases of rabies that
have not been tested by routine methods.
When brain tissue from rabies virus-
infected animals are stained with a histologic
stain, such as hematoxylin and eosin,
evidence of encephalomyelitis may be
recognized
This method is nonspecific and not
considered diagnostic for rabies.
autopsy tissues is occasionally useful in
diagnosing unsuspected cases of rabies that
have not been tested by routine methods.
When brain tissue from rabies virus-
infected animals are stained with a histologic
stain, such as hematoxylin and eosin,
evidence of encephalomyelitis may be
recognized
This method is nonspecific and not
considered diagnostic for rabies.
Histopathologic evidence of rabies
encephalomyelitis (inflammation) in brain tissue and
meninges includes the following:
Mononuclear infiltration
Perivascular cuffing of lymphocytes or
polymorphonuclear cells
Lymphocytic foci
Negri bodies
encephalomyelitis (inflammation) in brain tissue and
meninges includes the following:
Mononuclear infiltration
Perivascular cuffing of lymphocytes or
polymorphonuclear cells
Lymphocytic foci
Negri bodies
Electron Microscopy
The ultrastructure of viruses can be
examined by electron microscopy.
Using this method, the structural
components of viruses and their inclusions
can be observed in detail.
Rabies virus is in the family of
Rhabdoviruses. When viewed with an
electron microscope Rhabdoviruses are seen
as bullet-shaped particles.
The ultrastructure of viruses can be
examined by electron microscopy.
Using this method, the structural
components of viruses and their inclusions
can be observed in detail.
Rabies virus is in the family of
Rhabdoviruses. When viewed with an
electron microscope Rhabdoviruses are seen
as bullet-shaped particles.
Amplification Methods
Samples containing small amounts of
rabies virus may be difficult to confirm as rabies-
positive by routine methods.
Virus isolation in cell cultures increases the
virus concentration because the virus replicates in
cell cultures.
Mouse neuroblastoma cells (MNA) and
baby hamster kidney (BHK) cells provide an
excellent environment for amplification of rabies
virus without the use of animals.
Samples containing small amounts of
rabies virus may be difficult to confirm as rabies-
positive by routine methods.
Virus isolation in cell cultures increases the
virus concentration because the virus replicates in
cell cultures.
Mouse neuroblastoma cells (MNA) and
baby hamster kidney (BHK) cells provide an
excellent environment for amplification of rabies
virus without the use of animals.
Another method for amplifying the
nucleic acid portion of rabies virus uses
biochemical methods.
With this procedure, rabies virus RNA can
be enzymatically amplified as DNA copies.
Rabies RNA can be copied into a DNA
molecule using reverse transcriptase (RT).
The DNA copy of rabies can then be
amplified using polymerase chain reaction
(PCR).
This technique can confirm dFA results
and can detect rabies virus in saliva and skin
nucleic acid portion of rabies virus uses
biochemical methods.
With this procedure, rabies virus RNA can
be enzymatically amplified as DNA copies.
Rabies RNA can be copied into a DNA
molecule using reverse transcriptase (RT).
The DNA copy of rabies can then be
amplified using polymerase chain reaction
(PCR).
This technique can confirm dFA results
and can detect rabies virus in saliva and skin
PCR test results for rabies virus. The arrows
indicate positions of positive bands.
indicate positions of positive bands.
Direct Fluorescent Antibody test
DFA test is the “gold standard” diagnostic
method for rabies and has been rigorously
evaluated by international, national, and state
health laboratories.
The DFA test is currently the only
recommended diagnostic method for routine
rabies determination in animals.
DFA test is the “gold standard” diagnostic
method for rabies and has been rigorously
evaluated by international, national, and state
health laboratories.
The DFA test is currently the only
recommended diagnostic method for routine
rabies determination in animals.
Treatment
- There is no specific treatment for rabies.
- Case management procedures includes
1. Isolation of patient in quiet room.
2. Patient should be protected from
external stimuli like
- Bright light
" Cold draughts
- Noise, (these factors may precipitate
spasms or convulsions)
- There is no specific treatment for rabies.
- Case management procedures includes
1. Isolation of patient in quiet room.
2. Patient should be protected from
external stimuli like
- Bright light
" Cold draughts
- Noise, (these factors may precipitate
spasms or convulsions)
3. Use of sedatives to relieve anxiety
and pain.
4. Drugs with curare like action for
spastic muscular contractions.
5. Ensure hydration and diuresis.
6. Intensive care - Cardiac support and
respiratory support.
and pain.
4. Drugs with curare like action for
spastic muscular contractions.
5. Ensure hydration and diuresis.
6. Intensive care - Cardiac support and
respiratory support.
Precautions
・ Patients with Rabies are potentially Infectious,
because the virus may be present in the saliva,
tears, vomits, urine and other body fluids.
ㆍ Therefore health care workers, attending the
rabies patients must wear face masks, gloves,
goggles, apron, for their protection.
* Persons having bruises, cut or open wounds
should not look after the patients.
・ Patients with Rabies are potentially Infectious,
because the virus may be present in the saliva,
tears, vomits, urine and other body fluids.
ㆍ Therefore health care workers, attending the
rabies patients must wear face masks, gloves,
goggles, apron, for their protection.
* Persons having bruises, cut or open wounds
should not look after the patients.
Rabies ( Part - 3)
Prevention of Human Rabies
Prevention of Human Rabies
Key
CNS
m PNS
Brain
Spinal cord
Peripheral
Bite from Rabid Dog
CNS
m PNS
Brain
Spinal cord
Peripheral
Bite from Rabid Dog
Hypersalivation, piloerection,
Furious rabies pedi alos ote ps don
f à _aerophobia, dysphagia, inspiratory spasms, :
Exposure | First symptom | Clinical expression hyperventilation and haematemesis | | Coma
20-90 days Prodrome (1-2 days) Acute neurological phase (1-4 days)
Fever, pruitus and paraesthesia | | Quadrplegia psa, dysphagia, hypersalvaton,
inspiratory spasms, respiratory failure and hydrophobia
‘or aerophobia fin ~50% of cases)
Furious rabies pedi alos ote ps don
f à _aerophobia, dysphagia, inspiratory spasms, :
Exposure | First symptom | Clinical expression hyperventilation and haematemesis | | Coma
20-90 days Prodrome (1-2 days) Acute neurological phase (1-4 days)
Fever, pruitus and paraesthesia | | Quadrplegia psa, dysphagia, hypersalvaton,
inspiratory spasms, respiratory failure and hydrophobia
‘or aerophobia fin ~50% of cases)
Prevention of Human Rabies
CCIN,
la ASE
la ASE
Prevention of Human Rabies
1. Post exposure prophylaxis
2. Pre exposure prophylaxis
3. Post exposure treatment of persons
who have been vaccinated previously.
1. Post exposure prophylaxis
2. Pre exposure prophylaxis
3. Post exposure treatment of persons
who have been vaccinated previously.
AD) contamination
Before symptoms begin early post-
exposure prophylaxis intervention
may prevent the disease
INCUBATION PERIOD A
mie days © arter sywpros 0501.
nothing can be done to stop
progression of the disease
Before symptoms begin early post-
exposure prophylaxis intervention
may prevent the disease
INCUBATION PERIOD A
mie days © arter sywpros 0501.
nothing can be done to stop
progression of the disease
1) post exposure prophylaxis.
* General consideration
* Local treatment of wound
* Immunization
* General consideration
* Local treatment of wound
* Immunization
General Consideration
+ Aim - Aim of post exposure prophylaxis
is to neutralise the inoculated virus
before itinvade nervous system.
* The best prophylactic treatment includes,
combined administration of single dose
of rabies immunoglobulin with a course
of vaccine.
+ Aim - Aim of post exposure prophylaxis
is to neutralise the inoculated virus
before itinvade nervous system.
* The best prophylactic treatment includes,
combined administration of single dose
of rabies immunoglobulin with a course
of vaccine.
Prompt and adequate local treatment is essential for
bites and scratches.
Purpose of local treatment - To remove the virus as
much as possible, from the site of inoculation, before it
reaches peripheral nerve endings.
Local treatment should be applied immediately after
exposure. If possible it should be started within minutes.
Local treatment is most valuable and should not be
neglected.
Local treatment can reduce development of rabies by
80%
bites and scratches.
Purpose of local treatment - To remove the virus as
much as possible, from the site of inoculation, before it
reaches peripheral nerve endings.
Local treatment should be applied immediately after
exposure. If possible it should be started within minutes.
Local treatment is most valuable and should not be
neglected.
Local treatment can reduce development of rabies by
80%
Cleansing - How to clean
wound?
* Sites of bite / bites or scratches and the
surrounding areas should be cleaned
with plenty of soap and water.
* Preferably running tap water should be
used.
" Cleaning should be done for at least 15
minutes.
wound?
* Sites of bite / bites or scratches and the
surrounding areas should be cleaned
with plenty of soap and water.
* Preferably running tap water should be
used.
" Cleaning should be done for at least 15
minutes.
- If soap is not available, simple flushing
of the wounds with plenty of water
should be done.
- In case of punctured wounds, these
wounds should be irrigated using
catheters.
- Cleansing minimizes risk of contracting
rabies.
of the wounds with plenty of water
should be done.
- In case of punctured wounds, these
wounds should be irrigated using
catheters.
- Cleansing minimizes risk of contracting
rabies.
Bite ES > | Y
Rabies Wiz
post-exposure
prophyl axis
Rabies Wiz
post-exposure
prophyl axis
Chemical Treatment
* Should be done after Cleansing.
- Helps to remove Residual virus after
Cleansing.
* Virucidal agents are used to inactivate
rabies virus.
. Alcohol ( 400 - 700 ml/ litre) or
. Tincture lodine or
. 0.01% aqueous solution of lodine or
. Povidone lodine.
RON =
* Should be done after Cleansing.
- Helps to remove Residual virus after
Cleansing.
* Virucidal agents are used to inactivate
rabies virus.
. Alcohol ( 400 - 700 ml/ litre) or
. Tincture lodine or
. 0.01% aqueous solution of lodine or
. Povidone lodine.
RON =
Suturing
Bite wounds should NOT be IMMEDIATELY
SUTURED.
Suturing may cause additional trauma and
favour spread of virus to the deeper tissues.
If suturing is necessary, it should be done 24 to
48 hours later. Minimum stitches should be
applied with local use of rabies
immunoglobulin.
Bite wounds should NOT be IMMEDIATELY
SUTURED.
Suturing may cause additional trauma and
favour spread of virus to the deeper tissues.
If suturing is necessary, it should be done 24 to
48 hours later. Minimum stitches should be
applied with local use of rabies
immunoglobulin.
* Following Cleansing, and Chemical
treatment,
1. Antibiotics and
2. Anti tetanus measures, can be used
treatment,
1. Antibiotics and
2. Anti tetanus measures, can be used
Immunization
* Vaccines useful for pre exposure
prophylaxis and post exposure
prophylaxis includes,
1. Purified Cell Culture Vaccine ( CCV /
PCCV)
2. Embryonated Egg based Vaccine ( EEV)
* Vaccines useful for pre exposure
prophylaxis and post exposure
prophylaxis includes,
1. Purified Cell Culture Vaccine ( CCV /
PCCV)
2. Embryonated Egg based Vaccine ( EEV)
* The internationally available CCVs and
EEVs consists of rabies virus, which is
propagated in cell substrates like,
. Human diploid cells,
2. Fetal rhesus diploid cells,
3. Vero cells, ( Kidney cells from African
green monkey)
4. Primary Syrian hamster kidney cells,
5. Primary chick embryo cells or
6. Embryonated duck eggs.
中
EEVs consists of rabies virus, which is
propagated in cell substrates like,
. Human diploid cells,
2. Fetal rhesus diploid cells,
3. Vero cells, ( Kidney cells from African
green monkey)
4. Primary Syrian hamster kidney cells,
5. Primary chick embryo cells or
6. Embryonated duck eggs.
中
“As compared to HDCV ( Human Diploid
Cell Vaccine),
1. Chick embryo cells vaccine and
2. Vero cells vaccines are
* Safe,
- Efficacious and
* Less expensive.
Cell Vaccine),
1. Chick embryo cells vaccine and
2. Vero cells vaccines are
* Safe,
- Efficacious and
* Less expensive.
* Rabies vaccines prequalified by WHO,
“Do not contain preservatives like
thiomersal.
* Their shelf life is_> 3 years.
* Should be stored at 2 to 8 degrees
Celsius.
* Should be protected from sunlight.
* After reconstitution these vaccines
should be stored properly and used
within 6 - 8 hours.
* Single IM dose_> 2.5 IU (0.5 mL or 1 ml
after reconstitution, depending upon the
vaccine.
“Do not contain preservatives like
thiomersal.
* Their shelf life is_> 3 years.
* Should be stored at 2 to 8 degrees
Celsius.
* Should be protected from sunlight.
* After reconstitution these vaccines
should be stored properly and used
within 6 - 8 hours.
* Single IM dose_> 2.5 IU (0.5 mL or 1 ml
after reconstitution, depending upon the
vaccine.
WHO Guidelines for Post
Exposure Treatment
Exposure Treatment
Categories of contact with suspect rabid
animal and Post-exposure prophylaxis
measures
Category ! - touching or feeding animals,
animal licks on intact skin (no exposure)
Washing of exposed skin surfaces,
no PEP
Category Il - nibbling of uncovered skin, minor
scratches or abrasions without bleeding
(exposure)
animal and Post-exposure prophylaxis
measures
Category ! - touching or feeding animals,
animal licks on intact skin (no exposure)
Washing of exposed skin surfaces,
no PEP
Category Il - nibbling of uncovered skin, minor
scratches or abrasions without bleeding
(exposure)
Category 111 - single or multiple transdermal
bites or scratches,
contamination of mucous membrane or broken
skin with saliva from animal licks,
exposures due to direct contact with bats
(severe exposure)
Wound washing, immediate vaccination
and administration of rabies immunoglobulin.
bites or scratches,
contamination of mucous membrane or broken
skin with saliva from animal licks,
exposures due to direct contact with bats
(severe exposure)
Wound washing, immediate vaccination
and administration of rabies immunoglobulin.
Categori
| Post - exposure prophyla
rabid animal
Category!
* Touching of feeding animals
* Licks on intact skin
Category Il
* Nibbling of uncovered skin
* Minor scratches or abrasions
without bleeding
Category III
・ Single or multiple transdermal
bites or scratches
* Licks on broken skin
・ Contamination of mucous
membrane with saliva from licks
・ Contacts with bats
measures
None
1. Immediate vaccination and
2. Local treatment of wound
1. Immediate vaccination
2. Administration of rabies
immunoglobulin
3. Local treatment of the wound
| Post - exposure prophyla
rabid animal
Category!
* Touching of feeding animals
* Licks on intact skin
Category Il
* Nibbling of uncovered skin
* Minor scratches or abrasions
without bleeding
Category III
・ Single or multiple transdermal
bites or scratches
* Licks on broken skin
・ Contamination of mucous
membrane with saliva from licks
・ Contacts with bats
measures
None
1. Immediate vaccination and
2. Local treatment of wound
1. Immediate vaccination
2. Administration of rabies
immunoglobulin
3. Local treatment of the wound
All category Il and 111 exposures assessed
as carrying a risk of developing rabies require
PER
This risk is increased if:
* the biting mammal is a known rabies
reservoir or vector species
* the exposure occurs in a geographical
area where rabies is still present
* the animal looks sick or displays
abnormal behaviour
as carrying a risk of developing rabies require
PER
This risk is increased if:
* the biting mammal is a known rabies
reservoir or vector species
* the exposure occurs in a geographical
area where rabies is still present
* the animal looks sick or displays
abnormal behaviour
* a wound or mucous membrane was
contaminated by the animal's saliva
* the bite was unprovoked
* the animal has not been vaccinated.
* if biting animal can not be traced or
identified.
contaminated by the animal's saliva
* the bite was unprovoked
* the animal has not been vaccinated.
* if biting animal can not be traced or
identified.
The vaccination status of the suspect
animal should not be the deciding factor
when considering to initiate PEP or
not when the vaccination status
of the animal is questionable.
This can be the case if dog vaccination
programmes are not being sufficiently
regulated or followed out of lack of resources
or low priority.
animal should not be the deciding factor
when considering to initiate PEP or
not when the vaccination status
of the animal is questionable.
This can be the case if dog vaccination
programmes are not being sufficiently
regulated or followed out of lack of resources
or low priority.
- Post exposure prophylaxis may be
discontinued if,
- If the suspected animal is proved to be
free of rabies, by appropriate laboratory
examination ( Direct Fluorescent
Antibody test)
"OR
“In case of domestic dogs, cats, if animal
remains healthy throughout a 10 day
observation period starting from the day
of bite.
discontinued if,
- If the suspected animal is proved to be
free of rabies, by appropriate laboratory
examination ( Direct Fluorescent
Antibody test)
"OR
“In case of domestic dogs, cats, if animal
remains healthy throughout a 10 day
observation period starting from the day
of bite.
* Post exposure prophylaxis is
recommended for category Il and III
exposures.
* Depending on the vaccine 0.5 or 1 ml
dose should be given. (1 ml for HDCV or
PCEC)
* Sites - Deltoid muscle.
In case of children < 2 years of age age,
anterolateral aspect of thigh.
* Regimens includes,
1. Essen regimen - 5 dose regimen
2. Zagreb regimen - 4 dose regimen
recommended for category Il and III
exposures.
* Depending on the vaccine 0.5 or 1 ml
dose should be given. (1 ml for HDCV or
PCEC)
* Sites - Deltoid muscle.
In case of children < 2 years of age age,
anterolateral aspect of thigh.
* Regimens includes,
1. Essen regimen - 5 dose regimen
2. Zagreb regimen - 4 dose regimen
Rabies Vaccine Injection Sites
Do NOT inject in
7 the gluteal region
7 the gluteal region
Intramuscular regimens for rabies
Post-Exposure Prophylaxis
The 5 dose intramuscular
Essen regimen: (1-1-1-1-1) ㅣ ~” £
+ One dose of the vaccine x ES
should be administered on
days O, 3, 7, 14 and 28
« Given in the deltoid regio:
or, for young children, into
the anterolateral area of the
thigh muscle.
5 vials
5 visits
Post-Exposure Prophylaxis
The 5 dose intramuscular
Essen regimen: (1-1-1-1-1) ㅣ ~” £
+ One dose of the vaccine x ES
should be administered on
days O, 3, 7, 14 and 28
« Given in the deltoid regio:
or, for young children, into
the anterolateral area of the
thigh muscle.
5 vials
5 visits
Intramuscular administration of
vaccine for post-exposure prophylaxis
+ Essen regimen : The 5-dose regimen prescribes 1 dose
on each of days 0, 3, 7, 14, and 28
Dose: one IM dose (1.0 or 0.5 mi) into deltoid (or thigh)
Day: 0 3 7 14 28
DM
Rabies immunoglobulin
vaccine for post-exposure prophylaxis
+ Essen regimen : The 5-dose regimen prescribes 1 dose
on each of days 0, 3, 7, 14, and 28
Dose: one IM dose (1.0 or 0.5 mi) into deltoid (or thigh)
Day: 0 3 7 14 28
DM
Rabies immunoglobulin
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