Rabies prevention

2,472 views
2,293 views

Published on

Published in: Business, Technology
1 Comment
1 Like
Statistics
Notes
  • Thanks a lot...nice presentation indeed
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total views
2,472
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
234
Comments
1
Likes
1
Embeds 0
No embeds

No notes for slide
  • 1.Cover slide
  • 2.IntroductionRabies is an acute, progressive encephalomyelitisThe case fatality rate is the highest of any infectious diseaseOne of the oldest described diseasesThe leading viral zoonoses of global public health significance
  • 3.Rabies virusRabies is caused by RNA viruses in the family Rhabdoviridae, genus Lyssavirus type1The type species of the genus is Rabies VirusTypes2,3,4 rare
  • 4.Rabies hosts All warm-blooded vertebrates are susceptible to infectionMammals are the natural hosts of rabiesReservoirs consist of the Carnivora (canids, skunks, raccoons, mongoose, etc.) and Chiroptera (bats)
  • 3.Pathogenesis Virus is transmitted via biteAgents are highly neurotropicEnter peripheral nervesCentripetal travel by retrograde flow in axoplasm of nerves to CNSReplicate in brainCentrifugal flow to innervated organs, including the portal of exit, the salivary glands Viral excretion in saliva
  • 6.Transmission Infected animal saliva inoculated by bite or scratchInfected saliva: contact with mucous membrane, transdermal exposureVirus shed in the saliva during, before or after clinical symptomsHuman-Human: few reported cases following corneal transplantationAerosol transmission: caves containing bats, lab work accident
  • 8.PhasesFirst phase: asymptomaticSecond (prodromal) phase2-10daysViral invasion of CNS (limbic system, spinal cord, brain stem)Headache MalaiseSore throatBehavioral & emotional symptomsLocal pain itching, numbness (50%)
  • 9.Neurologic signsFurious:Hyperactive form Aggressiveness, biting, yelling, hallucinating Triggered by sensory stimuli Hydrophobia: drinking liquids Aerophobia: air blown on face Violent diaphragmatic contractions Hyper-reflexia, cholinergic manifestationslacrimation, salivation, mydriasis, pyrexiaParalytic:20% of patients Flaccid paralysis and paresis Mimics GBS, transverse myelitis Inflammation is more extensive and severe Spinal cord markedly involved
  • 12.Fourth phaseExtensive cortical virus spread Death usually in 7 days Respiratory arrest Myocarditis Supportive care: sedation and analgesia
  • Specimens stored at -20 degree celsius or below.
  • Rapid fluorescent focus inhibition testFluorescent antibody virus neutralisation testelisa
  • 19.DifferentialdiagnosisTetanusGullianebarre syndromeNTV side effectMeningitis/encephalitisEpilepsyDrug toxicity
  • Potency 2.5IU per dose
  • Vidarabine?Alpha interpheron by I v or intrathecal routeAnti thymocyte globulin
  • Registration and licensing of all domestic dogsRestraint of dogs in public placesImmediate destruction of dogs and cats bitten by rabid animalsQuarantine for 6 months of imported dogsHealth education of people
  • Rabies prevention

    1. 1. RABIES PREVENTION AND CONTROL 1 Anukrati Shukla
    2. 2.  Rabies is an acute, progressive encephalomyelitis  The case fatality rate is the highest of any infectious disease  One of the oldest described diseases  The leading viral zoonoses of global public health significance 2
    3. 3. Rabies is caused by RNA viruses in the family Rhabdoviridae, genus Lyssavirus The type species of the genus is Rabies Virus 3
    4. 4.  All warm-blooded vertebrates are susceptible to infection  Mammals are the natural hosts of rabies  Reservoirs consist of the Carnivora (canids, skunks, racoons, mongoose, etc.) and Chiroptera (bats) 4
    5. 5.  Virus is transmitted via bite  Agents are highly neurotropic  Enter peripheral nerves  Centripetal travel by retrograde flow in axoplasm of nerves to CNS  Replicate in brain  Centrifugal flow to innervated organs, including the portal of exit, the salivary glands  Viral excretion in saliva 5
    6. 6.  Infected animal saliva inoculated by bite or scratch  Infected saliva: contact with mucous membrane, transdermal exposure  Virus shed in the saliva during, before or after clinical symptoms  Human-Human: few reported cases following corneal transplantation  Aerosol transmission: caves containing bats, lab work accident 6
    7. 7. 4 1. 2. 3. 4. phases of illness Asymptomatic Prodromal Neurologic signs Coma 7
    8. 8. Virus Incubation period: 3 to 8 weeks (4d-19yr)  First phase: asymptomatic  Second (prodromal) phase 2-10days Viral invasion of CNS (limbic system, spinal cord, brain stem) Headache Malaise Sore throat Behavioral & emotional symptoms Local pain itching, numbness (80%) 8
    9. 9. Third phase: neurologic signs Widespread infection of the brain Furious : Hyperactive form Aggressiveness, biting, yelling, hallucinating Triggered by sensory stimuli Hydrophobia Aerophobia Violent diaphragmatic contractions Hyper-reflexia Lacrimation, salivation, mydriasis, pyrexia Paralytic form: 20% of patients Flaccid paralysis and paresis Mimics GBS, transverse myelitis Inflammation is more extensive and severe Spinal cord markedly involved 9
    10. 10.  Fever  Nuchal rigidity  Paresthesia  Fasiculations  Convulsions  Hypersalivation  Hyperventilation 10
    11. 11.  Fourth phase: Coma Extensive cortical virus spread Death usually in 7 days Respiratory arrest Myocarditis Supportive care: sedation and analgesia 11
    12. 12.  Clinical  Laboratory  Postmortem diagnosis in animals  Intravitam diagnosis in humans  Molecular techniques 12
    13. 13.  MRI: abnormal, ill defined, increased signal intensity on T-2 images Areas involved: brainstem, hippocampi, hypothalami, deep & subcortical white and grey matter 13
    14. 14.  Antigen detection(FA technique):gold standard  Virus isolation  Molecular techniques 14
    15. 15.  Viral culture: skin biopsy of the hair follicles at nape of the neck,saliva, CSF, urine, respiratory secretions (Culture in mice or in mouse neuroblastoma cell line )  Brain tissue: culture, histology for Negri bodies: yield low Immunostain (higher yield) 15
    16. 16.  Antigen detection:FA test on skin biopsies  Antibody titration: in serum or CSF (RFFIT or FAVN) Serology positive in serum in 8 days of symptoms Rabies antibodies infrequently found in CSF. Rabies vaccine does not cause positive CSF antibodies  Molecular studies, monoclonal antibodies in epidemiologic studies  Virus isolation:neuroblastoma cells or intracranial inoculation of mice. 16
    17. 17. A neuron from a formalin-fixed section of a brain from a patient with rabies, showing reddish-brown viral inclusions in the cytoplasm. Processed by immunohistochemistry. 17
    18. 18. Immunofluorescent viral inclusions in a peripheral nerve in a cryostat section from a patient with rabies, obtained via an antemortem nuchal skin biopsy. 18
    19. 19.  Tetanus  Gulliane barre syndrome  NTV side effect  Meningitis/encephalitis  Epilepsy  Drug toxicity 19
    20. 20.  PV Strain(pasteur virus)  PV12 strain  PM strain(pitman moore strain)  CVS strain(challenge virus strain)  LEP Flury chick embryo  HEP  ERA (evelyn rokitinki abelseth)strain of SAD (street alabama dufferin)virus 20
    21. 21.  Human a) b)  a) b) c) d) e) Cell culture vaccine(HDCV,PCECV,PVCV) Purified egg vaccine Animal Modified live virus(oral and injectable) Cell-culture vaccines(inj) Nerve tissue vaccines(inj) Combined(inj) Recombinant(oral) 21
    22. 22.  Human rabies immunoglobulin: 20IU/dose(max=1500IU)  Equine rabies immunoglobulin: 40IU/dose(max=3000IU)  Highly purified F(ab’)2 products from ERIG 40IU/dose(max=3000IU) 22
    23. 23.  Pre-exposure  Post-exposure 23
    24. 24. Pre-exposure prophylaxis: vaccination of people in high risk groups:  Veterinarians  Animal handlers  Certain lab workers Pre-exposure prophylaxis: intramuscular, 1ml (3 doses) or intradermal 0.1ml: at 0, 7, 21/28 days  Antibodies usually persist for 2 yrs  Repeat titres every 6-24 months depending on level of exposure  Acceptable titre levels are 0.5 IU/ml . 24
    25. 25. FACTORS GUIDING TREATMENT  Nature of contact or injury  Area  Availability of animal for lab exam  Species of animal  Clinical status of animal  Vaccination history of animal 25
    26. 26. Category Contact Management 1 Touching,feeding of animals Licks on intact skin none 2 Nibbling of uncovered skin Minor scratches or abrasions without bleeding Vaccine immdiately 3 Single or multiple transdermal bites or scratches, licks on broken skin Contamination of mucous membrane with saliva Exposure to bats Rabies immunoglobulin and vaccine Stop treatment if animal remains healthy throughout 10days or if animal is proven to be negative for rabies by lab techniques 26
    27. 27.  Risk assessment  Local treatment of wounds  Administration of biologicals for passive immunization  Vaccine administration 27
    28. 28.  Cleansing  Chemical treatment  Suturing  Anti-rabies serum  Antibiotics and anti-tetanus measures 28
    29. 29.  Intramuscular a) b. regimens 5 dose(Essen regimen) one dose on days 0,3,7,14,28(deltoid or thigh) Abbreviated multisite i.m. regimen(Zagreb)”2-1-1” one dose into left and right deltoid on day 0 one dose deltoid on days 7 and 21. 29
    30. 30.  Intradermal a) b) regimens Updated Thai Red Cross”2-2-2-0-2”regimen 0.1 ml i.d. at 2 different lymphatic drainage sites(left and right deltoid) on days 0,3,7,28. Eight site i.d. regimen”8-0-4-0-1-1” 0.1 ml on arms,suprascapular,lower abdomen,thighs on day0 0.1ml on arms.thighs on day7 0.1 ml 0n days 28,90. 30
    31. 31.  One dose i.m or i.d on days 0 and 3.  Local wound treatment  No RIG 31
    32. 32.  Antisepsis and local infiltration of RIG in those with low CD4 counts  Cat 2 exposures need RIG too. 32
    33. 33.  Educating children to avoid contact with stray or wild animals  Avoid trying to capture or provoke stray animals  Avoid touching animal carcasses  Secure garbage 33
    34. 34.  Private room (dark and noise free)  Sedation  iv morphine  Muscle relaxants  Life support measures(avoid intubation) 34
    35. 35.  Canine mass parenteral vaccination campaigns  Oral vaccination of dogs  Animal birth control 35
    36. 36.  http://emedicine.medscape.com/article/12271 4-treatment#a1128 (accessed on 6/03/13 at 5.05pm)  Wallace. Public health and preventive medicine, 13th edition  http://www.who.int/nutrition/publications/micro nutrients/IDD/WHO_NUT_96.13/en/index.htm l (accessed on 6/03/13 at 6.08pm)  http://www.who.int/nutrition/publications/micro nutrients/IDD/WHO_NUT_94.4/en/index.html (accessed on 6/03/13 at 6.28pm) 36

    ×