RABIES PROPHYLAXIS national rabies conttol programme.pptx.ppt

Drp

1. 1Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
District Health TapiDistrict Health Tapi

2. 2Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
INTRODUCTION
•Defination : Rabies is an acute viral disease that causes fatal
encephalomyelities in virtually all warm blooded animals including man.
•Virus transmission : to other animals and humans through their
saliva(following bites,scratches,licks on broken skin and mucous
membrane).
•Commonly animal bite : Dogs(95%),Cats(2%),Jackals,mongoose and
others(1%)

3. 3Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
INTRODUCTION
•Rabies virus- RNA Virus(Rhabdovirus)
•Incubation Period :2-3 months,but may vary from 6
days to 6 yrs
•Symptoms:
Initial-Fever with pain,tingling,pricking,or burning sensation(Paraesthesia)
at the wound site
Later-As the virus spread to CNS,progressive and fatal inflammation of
brain and spinal cord develops –hydrophobia(fear of
water),aerophobia(fear of air),death due to cardiorespiratory arrest
Paralytic cases-20%..then coma and death

4. 4Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
National Rabies control
programme
•Implemented in country since 12
th
five year plan with an objectives to
prevent DEATH due to rabies in humans.
•Nodal Centre for disease control(Delhi)-nodal centre for implementation.
•Key strategies are:
1)Strengthening surveillance of animal bites and human rabies
2)Capacity building of health care professionals for appropriate management
of Animal Bites victims
3)Increase awareness about rabies in the community
4)Inter-sectoral colloboration-veternary/animal husbandary

5. 5Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
POST EXPOSURE PROPHYLAXIS
•CONDITIONS:
•Bites by – Warm blooded animals
•Exposure to wild animals- CAT III exposure
•Rodent bites- domestic/forest area
•Exposure to bats- doen’t need PEP
•Human to human transmission-minamal/not doccumented but should
PEP in organ transplant(cornea)-should not collected from Rabies-leke
encephalitis cases
•Although it is “not an emergency but it is an urgency”

6. 6Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
cont…
•Observation of biting Animal:
•PEP-started immediately with observation of 10 days(cat/dog only –
natural history in other animals not fully understood)
•After 10 days- animal healthy-modified treatment as pre-exposure
prophylaxis- skip dose on day14 -give on day 28 –by IM route,and
complete the course by ID
•Vaccination status of animal and in provoked bite-give vaccine in each
case

7. 7Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
cont…
•Contraindications : No any contraindication to PEP - safe in
pregnancy/lactation/infancy/old age/concurrent
illness
•Caution- to pts on chloroquine,reduce response to ID route.so give
vaccine by IM route.

8. 8Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
Catagorization of bite wound-
exposure

9. 9Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
Approach to pep
1) Management of animal bite wound(S)
2) Passive immunization with Rabies
Immunoglobulin(RIG)
3) Active immunization with ARV

10. 10Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
Management of wound(s)

11. 11Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
cont…

12. 12Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
cont…
•Suturing of wounds: not to be done but if Can Not be avoided ,clean the
wound and thoroughly infiltrated with ERIG or HRIG.
Caution should be taken for compression syndrome(tips
of fingures/toes,ear lobes,cartilage areas).
 TT and antibiotic prophylaxis
 Counselling of animal/dog bite victim

13. 13Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
Rabies immunoglobulin-RIG
•Has property of binding with the RABV,neutralization and loss of
infectivity of the virus
•Indications:
 1) All CAT-III animal bite exposures cases
 2) Exposure to all wild animals should be treated
as cat-III exposure.

14. 14Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
Cnti…..
•Types of RIGs are :
1) Equine Rabies Immunoglobulin
(ERIG)
2) Human Rabies Immunoglobulin (HRIG)
DOSES OF RIGS:
1) ERIG : 40 IU per kg body weight
2) HRIG : 20 IU per kg body weight

15. 15Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
ADMINISTRATION OF RIGS :
•Before administration-should brought to 25 to 30 degree
•Except those who have previously received complete PrEP or PEP
•Not indicated beyond the 7
th
day oafter 1
st
dose of ARV, regardless of
whether the doses were received on days 3 and 7
•As much as anatomically possible
•Mucosal exposure with no wound-rinsing with RIG
•Observation for 15-20 mins are required after administration.

16. 16Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in

17. 17Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
Rabies vaccine
•CCVs : Cell Culture Vaccine
•Dose : produced as one single IM dose with a potency of >2.5 IU per IM
dose for PrEP or PEP
•Indications : all CAT-II and CAT-III
•Storage – 2 to 8 degree celcius
after reconstitution – use within 6 hrs.

18. 18Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
Updated Thai Red Cross Regimen

19. 19Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
5 Dose (Essen) Intramuscular Regime

20. 20Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in
Vaccine schedule

21. 21Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in

22. 22Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in

23. 23Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in

24. 24Health & Family Welfare Dept, Govt of
Gujarat
www.gujhealth.gov.in