CONTENTS1. Definition 9.Treatment2. History 10. Prevention3. Distribution 11. Recomendation4. Epidemiology5. Life cycle6. Symptomology7. Diagnosis8. Prognosis
RABIES!? SAY WUH!? is a viral disease that causes acute encephalitis (inflammation of the brain) in warm-blooded animals Rabies is a zoonotic disease (a disease that is transmitted to humans from animals) that is caused by a virus
Etymology The term is derived from the Latin rabies, "madness". Thi s, in turn, may be related to the Sanskrit rabhas, "to do violence“ The Greeks derived the word "lyssa", from "lud" or "violent"; this root is used in the name of the genus of rabies lyssavirus
The rabies virus is type species of Lyssavirus genus, in the family Rhabdoviridae, order Mononegavirales
The disease infects domestic and wild animals, and is spread to people through close contact with infected saliva via bites or scratches. Dogs are the source of 99% of human rabies deaths Once symptoms of the disease develop, rabies is nearly always fatal.
Where did this all begin? Rabies may be the oldest infectious disease known to man. 2300 BC Dog owners in the Babylonian city of Eshnunna are fined heavily for deaths caused by their dogs biting people.
The first written record of rabies is in the Mesopotamian Codex of Eshnunna (ca. 1930 BC), which dictates that the owner of a dog showing symptoms of rabies should take preventive measure against bites
Inancient medical times, the attachment of the tongue (the frenum linguae, a mucous membrane) was cut and removed from where they thought the rabies came from. This changed once they found the actual cause of rabies.
Rabies was considered a scourge for its prevalence in the 19th century In France and Belgium, where Saint Hubert was venerated, the "St Huberts Key" was heated and applied to cauterize the wound; by an application of magical thinking, dogs were branded with the key in hopes of protecting them from rabies
At Cahors France a 16-Year Old Boy Grabs and Controls a Rabid Dog Which is Terrifying Passers-By
All human cases of rabies were fatal until a vaccine was developed in 1885 by Louis Pasteur and Emile Roux. Their original vaccine was harvested from infected rabbits, from which the virus in the nerve tissue was weakened by allowing it to dry for five to ten days
Distribution occurs in more than 150 countries and territories Worldwide, more than 55 000 people die of rabies every year. Every year, more than 15 million people worldwide receive a post-exposure preventive regimen to avert the disease – this is estimated to prevent 327 000 rabies deaths annually.
Rabies is present on all continents with the exception of Antartica, but more than 95% of human deaths occur in Asia and Africa
Rabies in the Philippines High numbers of rabies cases are from Western Visayas, Central Luzon, Bicol, Central Visayas, Ilocos and Cagayan Valley regions 200- 300 deaths per year (281 in 2007)
Majority of rabies victim are children under 15 years of age More males (55.7%) than females (44.3%) Dogs remain the principal cause of animal bites and rabies cases in 2006- and 2007 90%, Cats (7%)
CHDs with Most Number of Human RabiesRank 2007 2006 (281 cases) (219 cases)1 CHD5(41) CHD2(27)2 CHD3(40) CHD3(23)3 CHD4A(38) CHD5(22)4 CHD2(23) CHD6&12(20)5 CHD7(22) CHD7&8(19)
Provinces with Most Number of Human RabiesRANK 2007 (269 cases) 2006 (219 cases)1 Camarines Sur(21) Cagayan(13)2 Cagayan (16) Isabela(12)3 Nueva Ecija(12) Iloilo(10)4 Bulacan, Bohol(10) Nueva Ecija, Bohol5 Laguna(9) Tarlac (8) Albay(7)
Epidemiology Rabies is widely distributed across the globe, with only a few countries (mainly islands and peninsulas) being free of the disease. Jackals, bat-eared foxes and mongoose are involved in rabies transmission in Africa, particularly in the south-eastern part of the continent.
By contrast, canine rabies predominates in most of the developing countries of central and south America, Africa and Asia, where the greater burden of human rabies falls. More than 90% of cases of human rabies are transmitted by dogs; most deaths occur in Asia and Africa.
Epidemiology in the Philippines Although rabies is not among the leading causes of disease and death in the country it has become a public health problem of significance for two reasons most acutely fatal infections which causes the death of between 200-500 Filipinos annually
4thWorldwide 53.7 percent of animal bites patients are children Based on the report from NCDPC (2004) This is due to early provision of post exposure vaccination to dog bite victims. Dogs remain the principal animal source of rabies
Life Cycle Rabies viruses move from the site of entry, such as through a wound, and are transported along nerve fibres towards the spinal cord and ultimately the brain, where the virus undergoes replication. Abnormal behaviour results from the effects of viral infection in nerve tissues.
From the brain, rabies virus is further spread to other organs via the nervous system. The salivary glands, located in the tissues of the mouth and cheeks, receive high concentrations of virus, making saliva an effective medium for virus transfer when the infected animal bites another animal.
Symptomology The incubation period for rabies is typically 1–3 months, but may vary from <1 week to >1 year. The initial symptoms of rabies are fever and often pain or an unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site.
As the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops. Two forms of the disease can follow. People with furious rabies exhibit signs of hyperactivity, excited behaviour, hydrophobia and sometimes aerophobia. After a few days, death occurs by cardio-
Paralytic rabies accounts for about 30% of the total number of human cases. This form of rabies runs a less dramatic and usually longer course than the furious form. The muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the underreporting of the disease.
Diagnosis Several tests are necessary to diagnose rabies ante-mortem (before death) 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.
Postmortem, the standard diagnostic technique is to detect rabies virus antigen in brain tissue by fluorescent antibody test.
Prognosis Treatment after exposure (receiving the vaccines), known as post- exposure prophylaxis (PEP), is highly successful in preventing the disease if administered promptly, in general within ten days of infection. Begun with little or no delay, PEP is 100% effective against rabies
Inunvaccinated humans, rabies is usually fatal after neurological symptoms have developed, but prompt post- exposure vaccination may prevent the virus from progressing.
Treatment Effective treatment soon (within a few days, but as soon as possible) after exposure to rabies can prevent the onset of symptoms and death. Post-exposure prevention consists of local treatment of the wound, administration of rabies immunoglobulin (if indicated), and immediate vaccination.
post-exposure prophylaxisconsists of 1 dose of rabies immunoglobulin (20IU/kg) and 5 doses of rabies vaccine over 28 days (days 0, 3, 7, 14 and 28)
Table: Recommended post-exposure prophylaxis for rabiesinfectionCategory of exposure to Post-exposure measuressuspect rabid animalCategory I – touching or feedinganimals, licks on intact skin (i.e. Noneno exposure)Category II – nibbling of Immediate vaccination and localuncovered skin, minor scratches treatment of the woundor abrasions without bleedingCategory III – single or multipletransdermal bites or scratches, Immediate vaccination andlicks on broken skin; administration of rabiescontamination of mucous immunoglobulin; local treatmentmembrane with saliva from licks, of the woundexposures to bats.
PREVENTION Eliminating rabies in dogs Rabies is a vaccine-preventable disease. The most cost-effective strategy for preventing rabies in people is by eliminating rabies in dogs through vaccination.
Vaccination of animals (mostly dogs) has reduced the number of human (and animal) rabies cases in several countries, particularly in Latin America. However, recent increases in human rabies deaths in parts of Africa, Asia and Latin America suggest that rabies is re- emerging as a serious public health issues
Preventive immunization inpeople Pre-exposure immunization in people is recommended for travellers to high- risk areas in rabies-affected countries, and for people in certain high-risk occupations such as laboratory workers dealing with live rabies virus and other lyssaviruses, and veterinarians and animal handlers in rabies-affected areas
World Rabies daySeptember 28 raise awareness about the impact of human and animal rabies, how easy it is to prevent it, and how to eliminate the main global sources
Sincethe inaugural campaign in 2007, World Rabies Day events have been held in 135 countries; educating 150 million people and vaccinating 4.6 million dogs.
In the Philippines National Rabies Prevention and Control Program Goal: To eliminate human rabies in the Philippines and Declare a Rabies – free Philippines by year 2020
Recommendations Do a program in order to inform the people where rabies are endemic Inform them on the disease and how to avoid it ○ Includes vaccination of animals
Make it mandatory to have people vaccinate their pets and also dog & cats who are stray If they do not vaccinate, a fee will be imposed Post posters showing the signs and symptoms of a rabid animal and person Once animal is rabid, euthanize it