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HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 1
VIRULOGYVIRULOGY
HIV, POLIOMYELITIS VIRUS,HIV, POLIOMYELITIS VIRUS,
RABIES VI...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 2
HUMAN IMMUNODEFICIENCYHUMAN IMMUNODEFICIENCY
VIRUSVIRUS
(HIV)(HIV)
Dr. Ashish JawarkarDr. Ashish Jawarkar
M.D. (Pathology)...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 4
HistoryHistory
 USA - 1981USA - 1981
 Sudden emergence of large number of c...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 5
 This was found to be due to a virus –This was found to be due to a virus –
...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 6
Problem statementProblem statement
 UNAIDS/WHO (2008)UNAIDS/WHO (2008)
 33....
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 7
EpidemiologyEpidemiology
 Spread by ONLY three modesSpread by ONLY three mod...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 8
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 9
RELATIVE RISKRELATIVE RISK
 Blood and its productsBlood and its products 90%...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 10
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 11
Health care workers (OccupationalHealth care workers (Occupational
exposure)...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 12
Structure of HIVStructure of HIV
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 13
 GenesGenes functionfunction
 gaggag p24p24
 envenv gp160gp160
 polpol p...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 14
PathogenesisPathogenesis
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 15
Clinical featuresClinical features
 Symptoms are due to failure of immuneSy...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 16
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 17
Acute HIV infection (0-3 weeks)Acute HIV infection (0-3 weeks)
 FeverFever
...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 18
 HIV p24 antigen – POSITIVEHIV p24 antigen – POSITIVE
 HIV antibodies - Ne...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 19
Asymptomatic/Clinically latentAsymptomatic/Clinically latent
stagestage
 Ar...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 20
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 21
AIDSAIDS
 Irreversible break down of immune systemIrreversible break down o...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 22
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 23
 Presents with one or more of the followingPresents with one or more of the...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 24
AIDS related complex (ARC)AIDS related complex (ARC)
 Weight loss of >10% o...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 25
Lab diagnosisLab diagnosis
 Antigen detectionAntigen detection
 As early a...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 26
 Antibody detectionAntibody detection
 At around 6 weeksAt around 6 weeks
...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 27
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 28
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 29
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 30
Why no vaccineWhy no vaccine
 Diverse antigenic types and subtypesDiverse a...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 31
Structure of HIVStructure of HIV
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 32
PreventionPrevention
 Health educationHealth education
 Identification of ...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 33
TreatmentTreatment
 Treatment should be started on anyTreatment should be s...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 34
POLIO VIRUSPOLIO VIRUS
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 35
POLIO VIRUSPOLIO VIRUS
 Polio – grayPolio – gray
 Myelitis – inflammation ...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 36
 Gray matter – motor neuronsGray matter – motor neurons
 White matter – se...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 37
EpidemiologyEpidemiology
 Exclusively human diseaseExclusively human diseas...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 38
PathogenesisPathogenesis
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 39
Clinical featuresClinical features
 Earliest – fever, headache, sore throat...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 40
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 41
Lab diagnosisLab diagnosis
 Sample – blood, CSFSample – blood, CSF
 Isolat...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 42
Serological testsSerological tests
 Demonstration of four fold rise in anti...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 43
ProphylaxisProphylaxis
 VaccineVaccine
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 44
OPVOPV IPVIPV
 Attenuated virusAttenuated virus
 OralOral
 CheaperCheaper...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 45
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 46
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 47
 India overcame huge challenges, with a strongIndia overcame huge challenge...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 48
 To immunize children on the move, transit vaccinatorsTo immunize children ...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 49
RABIES VIRUSRABIES VIRUS
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 50
RabiesRabies
 Derived from sanskrit –Derived from sanskrit – rabhasrabhas -...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 51
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 52
Pasteur and MeisterPasteur and Meister
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 53
EpidemiologyEpidemiology
 Virus is present in all terrestrial animalsVirus ...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 54
PathogenesisPathogenesis
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 55
Clinical featuresClinical features
 Acute encephalitisAcute encephalitis
 ...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 56
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 57
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 58
Lab diagnosisLab diagnosis
 Ante mortemAnte mortem
 Biopsy from cornea/ski...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 59
Ante mortemAnte mortem
 Demonstration of rabies virus byDemonstration of ra...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 60
Post mortemPost mortem
 Brain biopsy – negri bodies inBrain biopsy – negri ...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 61
ProphylaxisProphylaxis
 Pre exposure prophylaxisPre exposure prophylaxis
 ...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 62
Anti rabies vaccineAnti rabies vaccine
 Neural vaccine – out dated – no lon...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 63
Vaccination scheduleVaccination schedule
 Five to six dosesFive to six dose...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 64
TreatmentTreatment
 Rabies is fatalRabies is fatal
 No treatment available...
HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 65
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VIRULOGY - HIV (AIDS) , POLIOMYELITIS VIRUS, RABIES VIRUS

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Transcript of "VIRULOGY - HIV (AIDS) , POLIOMYELITIS VIRUS, RABIES VIRUS"

  1. 1. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 1 VIRULOGYVIRULOGY HIV, POLIOMYELITIS VIRUS,HIV, POLIOMYELITIS VIRUS, RABIES VIRUSRABIES VIRUS
  2. 2. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 2
  3. 3. HUMAN IMMUNODEFICIENCYHUMAN IMMUNODEFICIENCY VIRUSVIRUS (HIV)(HIV) Dr. Ashish JawarkarDr. Ashish Jawarkar M.D. (Pathology)M.D. (Pathology)
  4. 4. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 4 HistoryHistory  USA - 1981USA - 1981  Sudden emergence of large number of cases ofSudden emergence of large number of cases of Kaposci’s sarcoma and P. carinii pneumoniaKaposci’s sarcoma and P. carinii pneumonia among homosexualsamong homosexuals  Research showed they had low immunity thatResearch showed they had low immunity that made them vulnerable to infection andmade them vulnerable to infection and malignanciesmalignancies  This condition was given the name –This condition was given the name – ACQUIRED IMMUNO DEFICIENCYACQUIRED IMMUNO DEFICIENCY SYNDROME - AIDSSYNDROME - AIDS
  5. 5. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 5  This was found to be due to a virus –This was found to be due to a virus – Human immunodeficiency virus - HIVHuman immunodeficiency virus - HIV
  6. 6. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 6 Problem statementProblem statement  UNAIDS/WHO (2008)UNAIDS/WHO (2008)  33.4 million people infected with HIV33.4 million people infected with HIV  2.7 million new cases2.7 million new cases  2 million deaths2 million deaths  INDIAINDIA  2-3.1 million cases2-3.1 million cases  Males>femalesMales>females  Prevalence is high in sexually active age group – 15-Prevalence is high in sexually active age group – 15- 49 years49 years
  7. 7. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 7 EpidemiologyEpidemiology  Spread by ONLY three modesSpread by ONLY three modes  Sexual contact with infected personSexual contact with infected person  Blood and blood productsBlood and blood products  Infected mother to babyInfected mother to baby
  8. 8. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 8
  9. 9. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 9 RELATIVE RISKRELATIVE RISK  Blood and its productsBlood and its products 90%90%  Mother to babyMother to baby 30%30%  IntercourseIntercourse 0.1-1%0.1-1%  Sharp injuriesSharp injuries 0.5-1%0.5-1%
  10. 10. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 10
  11. 11. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 11 Health care workers (OccupationalHealth care workers (Occupational exposure)exposure)  Needle stick injuriesNeedle stick injuries  Disposable needlesDisposable needles  Donot recapDonot recap  Universal precautionsUniversal precautions
  12. 12. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 12 Structure of HIVStructure of HIV
  13. 13. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 13  GenesGenes functionfunction  gaggag p24p24  envenv gp160gp160  polpol p31, p51, p66p31, p51, p66
  14. 14. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 14 PathogenesisPathogenesis
  15. 15. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 15 Clinical featuresClinical features  Symptoms are due to failure of immuneSymptoms are due to failure of immune responseresponse  AIDS patient dies not due to AIDS but dueAIDS patient dies not due to AIDS but due to oppurtunistic infections andto oppurtunistic infections and malignanciesmalignancies
  16. 16. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 16
  17. 17. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 17 Acute HIV infection (0-3 weeks)Acute HIV infection (0-3 weeks)  FeverFever  MalaiseMalaise  HeadacheHeadache  LymphadenopthyLymphadenopthy
  18. 18. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 18  HIV p24 antigen – POSITIVEHIV p24 antigen – POSITIVE  HIV antibodies - NegativeHIV antibodies - Negative
  19. 19. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 19 Asymptomatic/Clinically latentAsymptomatic/Clinically latent stagestage  Around 10 yearsAround 10 years  HIV antibodies keep virus under checkHIV antibodies keep virus under check  CD4 cell count is >200CD4 cell count is >200  p24 antigen – Negativep24 antigen – Negative  HIV antibodies - PositiveHIV antibodies - Positive
  20. 20. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 20
  21. 21. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 21 AIDSAIDS  Irreversible break down of immune systemIrreversible break down of immune system  CD4 cell count <200CD4 cell count <200  p24 - positivep24 - positive  Antibodies - positiveAntibodies - positive
  22. 22. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 22
  23. 23. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 23  Presents with one or more of the followingPresents with one or more of the following infections / malignanciesinfections / malignancies  Respiratory systemRespiratory system  TuberculosisTuberculosis  P. carinii pneumoniaP. carinii pneumonia  GITGIT  CysypotsporoidosisCysypotsporoidosis  ThrushThrush  Herpetic stomatitisHerpetic stomatitis  CNSCNS  ToxoplasmosisToxoplasmosis  CryptococcosisCryptococcosis  MalignanciesMalignancies  Kaposci’s sarcomaKaposci’s sarcoma  DementiaDementia
  24. 24. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 24 AIDS related complex (ARC)AIDS related complex (ARC)  Weight loss of >10% of body weightWeight loss of >10% of body weight  Generalised lymphadenopathy andGeneralised lymphadenopathy and splenomegalysplenomegaly
  25. 25. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 25 Lab diagnosisLab diagnosis  Antigen detectionAntigen detection  As early as 2-3 weeks following infectionAs early as 2-3 weeks following infection  For testing needle stick injury patientsFor testing needle stick injury patients  For testing blood donorsFor testing blood donors  Can be done by ELISA, PCRCan be done by ELISA, PCR
  26. 26. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 26  Antibody detectionAntibody detection  At around 6 weeksAt around 6 weeks  Highly infectious in window periodHighly infectious in window period  Cannot be used for blood donor screeningCannot be used for blood donor screening  Screening test – ELISA (antibody detection)Screening test – ELISA (antibody detection)  Confirmatory test – western blot (antigenConfirmatory test – western blot (antigen isolation)isolation)
  27. 27. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 27
  28. 28. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 28
  29. 29. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 29
  30. 30. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 30 Why no vaccineWhy no vaccine  Diverse antigenic types and subtypesDiverse antigenic types and subtypes  Long latencyLong latency  Persistence in infected cells as provirusesPersistence in infected cells as proviruses
  31. 31. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 31 Structure of HIVStructure of HIV
  32. 32. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 32 PreventionPrevention  Health educationHealth education  Identification of sourcesIdentification of sources  Elimination of high risk activitiesElimination of high risk activities
  33. 33. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 33 TreatmentTreatment  Treatment should be started on anyTreatment should be started on any symptoms with CD4 count <350symptoms with CD4 count <350 cells/mm3cells/mm3  Anti retroviral drugsAnti retroviral drugs  ZidovudineZidovudine  LamivudineLamivudine  NevirapineNevirapine  EfavirenzEfavirenz
  34. 34. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 34 POLIO VIRUSPOLIO VIRUS
  35. 35. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 35 POLIO VIRUSPOLIO VIRUS  Polio – grayPolio – gray  Myelitis – inflammation of spinal cordMyelitis – inflammation of spinal cord
  36. 36. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 36  Gray matter – motor neuronsGray matter – motor neurons  White matter – sensory neuronsWhite matter – sensory neurons  Polio affects gray motor neurons – causesPolio affects gray motor neurons – causes paralysisparalysis
  37. 37. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 37 EpidemiologyEpidemiology  Exclusively human diseaseExclusively human disease  Symptomless carrier shed virus in fecesSymptomless carrier shed virus in feces  Spreads via contaminated food and waterSpreads via contaminated food and water  Infection is asymptomaticInfection is asymptomatic  Patient presents with paralysisPatient presents with paralysis
  38. 38. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 38 PathogenesisPathogenesis
  39. 39. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 39 Clinical featuresClinical features  Earliest – fever, headache, sore throat –Earliest – fever, headache, sore throat – abortive poliomyelitisabortive poliomyelitis  Later – biphasic fever, stiff neck – nonLater – biphasic fever, stiff neck – non paralytic poliomyelitisparalytic poliomyelitis  Still later – paralysis – paralyticStill later – paralysis – paralytic poliomyelitispoliomyelitis
  40. 40. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 40
  41. 41. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 41 Lab diagnosisLab diagnosis  Sample – blood, CSFSample – blood, CSF  Isolation of polio virus in cell cultureIsolation of polio virus in cell culture
  42. 42. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 42 Serological testsSerological tests  Demonstration of four fold rise in antibodyDemonstration of four fold rise in antibody titre is diagnostictitre is diagnostic
  43. 43. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 43 ProphylaxisProphylaxis  VaccineVaccine
  44. 44. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 44 OPVOPV IPVIPV  Attenuated virusAttenuated virus  OralOral  CheaperCheaper  Herd immunityHerd immunity  Long lasting immunityLong lasting immunity  Stops epidemicStops epidemic  Easy to implementEasy to implement  Killed virusKilled virus  InjectableInjectable  ExpensiveExpensive  No herd immunityNo herd immunity  Short lastingShort lasting  Doesn’t stopDoesn’t stop  Not easy toNot easy to implementimplement
  45. 45. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 45
  46. 46. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 46
  47. 47. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 47  India overcame huge challenges, with a strongIndia overcame huge challenges, with a strong commitment that matched $ 2 billion allocation over thecommitment that matched $ 2 billion allocation over the years to stop polio. Implementing innovative strategies,years to stop polio. Implementing innovative strategies, the programme reaches an incredible 99 per centthe programme reaches an incredible 99 per cent coverage in polio campaigns, ensuring every child, evencoverage in polio campaigns, ensuring every child, even in the remotest corner of the country is protected againstin the remotest corner of the country is protected against polio. polio.   India introduced the oral polio vaccine in 1985 in theIndia introduced the oral polio vaccine in 1985 in the Universal Immunisation Programme in the backdrop ofUniversal Immunisation Programme in the backdrop of over 200,000 cases of polio annually (as per estimatesover 200,000 cases of polio annually (as per estimates of the Indian Academy of Pediatrics). In 1995, the firstof the Indian Academy of Pediatrics). In 1995, the first national polio immunization campaign was held; sincenational polio immunization campaign was held; since then two national and multiple sub-national campaignsthen two national and multiple sub-national campaigns are rolled out every year for children up to 5 years ofare rolled out every year for children up to 5 years of age.age.  In each national polio campaign, 2.3 million lakhIn each national polio campaign, 2.3 million lakh vaccinators, led by 155,000 upervisors, visit 209 millionvaccinators, led by 155,000 upervisors, visit 209 million households to immunize 170 million children up to thehouseholds to immunize 170 million children up to the age of 5 years. age of 5 years. 
  48. 48. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 48  To immunize children on the move, transit vaccinatorsTo immunize children on the move, transit vaccinators are positioned at bus stands, train stations, on trains,are positioned at bus stands, train stations, on trains, market places and important road intersections. Nearlymarket places and important road intersections. Nearly 10 million children are immunized by the transit teams in10 million children are immunized by the transit teams in each polio campaign, of them 100,000 on trains.each polio campaign, of them 100,000 on trains.  Focusing on the migrant population, the people on theFocusing on the migrant population, the people on the move in search of livelihood who miss poliomove in search of livelihood who miss polio immunization in view of their transient nature, theimmunization in view of their transient nature, the programme covers 70,000 brick kilns and 38,000programme covers 70,000 brick kilns and 38,000 construction sites. Nearly 4.5 million children areconstruction sites. Nearly 4.5 million children are immunized in the high-risk migrant settlements in eachimmunized in the high-risk migrant settlements in each polio campaign.polio campaign.  Since the start of the polio campaigns in 1995, as manySince the start of the polio campaigns in 1995, as many as 131 polio campaigns have been held in India till date,as 131 polio campaigns have been held in India till date, in which 12.1 billion doses of polio vaccines have beenin which 12.1 billion doses of polio vaccines have been administered.administered.
  49. 49. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 49 RABIES VIRUSRABIES VIRUS
  50. 50. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 50 RabiesRabies  Derived from sanskrit –Derived from sanskrit – rabhasrabhas - mad- mad
  51. 51. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 51
  52. 52. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 52 Pasteur and MeisterPasteur and Meister
  53. 53. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 53 EpidemiologyEpidemiology  Virus is present in all terrestrial animalsVirus is present in all terrestrial animals  India – 30,000 death due to rabies / yearIndia – 30,000 death due to rabies / year  Can be prevented by simple vaccination ofCan be prevented by simple vaccination of humanshumans  Dog/cat/bat population in India is non vaccinatedDog/cat/bat population in India is non vaccinated  Rabies has been eliminated from Britain andRabies has been eliminated from Britain and Japan by strict vaccination and quarantineJapan by strict vaccination and quarantine
  54. 54. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 54 PathogenesisPathogenesis
  55. 55. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 55 Clinical featuresClinical features  Acute encephalitisAcute encephalitis  HydrophobiaHydrophobia  Generalised convulsionsGeneralised convulsions  Death due to respiratory arrestDeath due to respiratory arrest
  56. 56. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 56
  57. 57. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 57
  58. 58. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 58 Lab diagnosisLab diagnosis  Ante mortemAnte mortem  Biopsy from cornea/skin (face)Biopsy from cornea/skin (face)  salivasaliva  Post mortemPost mortem  Brain biopsyBrain biopsy
  59. 59. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 59 Ante mortemAnte mortem  Demonstration of rabies virus byDemonstration of rabies virus by immunofluorescenceimmunofluorescence
  60. 60. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 60 Post mortemPost mortem  Brain biopsy – negri bodies inBrain biopsy – negri bodies in hippocampus and cerebellumhippocampus and cerebellum
  61. 61. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 61 ProphylaxisProphylaxis  Pre exposure prophylaxisPre exposure prophylaxis  Three doses on days 0,7,21 or 0,28,56Three doses on days 0,7,21 or 0,28,56  Booster after 1 year and then every 5 yearsBooster after 1 year and then every 5 years  Post exposure prophylaxis (humans)Post exposure prophylaxis (humans)  Wound cleaned with soap and waterWound cleaned with soap and water  Apply betadine, savlon, 70% alcoholApply betadine, savlon, 70% alcohol  Donot sutureDonot suture  Administer TTAdminister TT  Give anti rabies immunoglobulin – both locally intoGive anti rabies immunoglobulin – both locally into wound and systemicallywound and systemically  Anti rabies vaccineAnti rabies vaccine
  62. 62. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 62 Anti rabies vaccineAnti rabies vaccine  Neural vaccine – out dated – no longerNeural vaccine – out dated – no longer used – epileptogenicused – epileptogenic  Non neural (cell culture vacccines) –Non neural (cell culture vacccines) – routinely usedroutinely used
  63. 63. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 63 Vaccination scheduleVaccination schedule  Five to six dosesFive to six doses  Days 0,3,7,14,30 and optionally 90Days 0,3,7,14,30 and optionally 90  Gives protection for 5 yearsGives protection for 5 years  Given in deltoid regionGiven in deltoid region
  64. 64. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 64 TreatmentTreatment  Rabies is fatalRabies is fatal  No treatment availableNo treatment available
  65. 65. HIV-AIDS, POLIO, RABIESDr. Ashish Jawarkar 65
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