Rabies presentation

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  • Rabies is an acute progressive encephalomyelitis transmitted through bite of a rabid or suspected rabid animal
    Infectious disease with highest mortality rate ( almost 100%) yet it is a preventable disease
    The leading viral zoonosis of global public
    health significance
  • Dog is the most common animal, more than 90% cases pertain to dogs , both stray and unvaccinated pet dogs can be responsible. 5-10% cases belong to other domestic and farm animal such as cats, cows horeses mules . donkey, Majority animals present with furious rabies in which rabid animal becomes aggressive attacks without provoking,tries to eat abnormal things like wood, stones. Grass. Saliva dribbles from the mouth , attacks many people a ta time and can bite other animals
  • Rabies presentation

    1. 1. * Rabies is a zoonotic disease (a disease that is transmitted from animals to humans) that is caused by a virus. * Nearly half of those bitten by suspect rabid animals are children under 15 years of age. * Rabies is spread to people through close contact with infected saliva via bites or scratches. * Most of the deaths occur in the absence of post- exposure prophylaxis
    2. 2. Element of paralysis is dominating, animal is quiet ,timid and shy
    3. 3. *Rabies is caused by RNA virus of genus Lyssavirus *Family-Rhabdoviridae *Bullet shape *Neurotropic virus *New species discovered in bats
    4. 4. Virus is transmitted through saliva of infected animal *Bites *scratch *Licks on injured skin *Licks on mucous membranes *Aerosols (bats in caves) Uncommon routes *Transplants of infected organs *Bite of a rabid human being
    5. 5. Incubation period Varies from few days to years Average 30-90 days Depends upon site, degree and virus load, number of wounds Provides opportunity to start treatment
    6. 6. Sr. No District/Area No. of Rabies Patients Treatment Time between bite and rabies 1. Lahore 01 Not received One month 2. Lahore 01 Not received 20 days 3. Lahore 01 Not received one and a half month 4. Lahore 01 Not received 3 months 5. Shakargarh (Narowal) 01 Not received one and a half month 6. Chakwal 01 Not received one and a half month 7. Rahim Yar Khan 01 Not received 3 months 8. Khushab 01 Not received one and a half month 9. Shraqpur Sharif 01 Not received 2 months 10. Okara 01 Not received 5 months 11. Muridke 01 Partly received One month 12. Daska 01 Not received 2 and half month 13 Sialkot 01 Not received 3 months 14. Qadirabad 01 Not received One year 15. Sargodha 01 Not received 3 months 16. DG gkan 01 Not received 2.5 years
    7. 7. S.No District Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 Attock 213 163 207 159 172 170 136 226 182 173 122 143 2 Bahawalnagar 202 249 302 277 223 231 351 368 314 180 155 148 3 Bahawalpur 202 253 367 258 253 288 392 401 279 290 219 213 4 Bhakkar 220 212 259 235 296 198 162 196 88 194 178 222 5 Chakwal 153 217 229 204 212 226 248 251 191 163 158 150 6 Chiniot 113 96 106 106 96 106 107 76 64 86 112 103 7 D.G.Khan 790 100 185 56 312 252 402 60 307 31 158 142 8 Faisalabad 367 469 698 707 719 519 610 573 559 527 405 448 9 Gujranwala 230 189 491 429 424 766 274 360 305 204 144 694 10 Gujrat 350 199 219 247 249 1034 666 172 652 831 883 278 11 Hafizabad 132 371 299 292 281 302 433 328 223 252 193 220 12 Jhang 247 214 258 173 149 202 240 202 192 191 162 179 13 Jhelum 145 205 245 179 96 202 163 156 198 171 121 184 14 Kasur 452 449 484 608 729 503 584 579 350 511 536 539 15 Khanewal 163 227 230 234 263 340 199 259 194 250 200 173 16 Khushab 128 95 90 95 102 141 141 111 140 129 80 124 17 Lahore 215 188 343 448 671 695 366 403 214 583 61 216 18 Layyah 161 149 198 214 235 177 242 99 193 108 2 15 19 Lodhran 309 206 256 650 228 208 268 506 340 263 186 232 20 M.B.din 62 58 61 51 41 60 87 86 75 104 62 74 21 Mianwali 379 689 362 424 273 345 526 456 487 146 233 151 22 Multan 205 221 210 265 283 250 273 233 178 191 169 152 23 Muzaffargarh 228 200 482 647 527 557 515 184 376 382 460 269 24 Nankana Sahib 68 67 88 108 93 112 104 128 99 86 76 140 25 Narowal 85 104 138 100 92 69 82 89 86 78 66 73 26 Okara 148 178 157 190 169 218 172 174 187 103 160 149 27 Pakpattan 166 143 273 222 182 198 200 211 270 186 134 144 28 R.Y.Khan 394 425 564 452 552 441 463 584 345 313 259 226 29 Rajanpur 135 157 179 192 215 219 248 202 220 148 129 140 30 Rawalpindi 158 155 180 119 223 211 190 228 196 194 144 138 31 Sahiwal 238 146 233 157 208 302 116 253 235 201 140 146 32 Sargodha 131 122 123 98 81 108 136 152 138 113 114 200 33 Sheikhupura 249 317 314 335 329 221 258 223 221 213 187 200 34 Sialkot 216 248 273 239 283 273 238 286 208 133 200 186 35 T.T.Singh 107 91 325 226 227 220 294 232 152 179 112 217 36 Vehari 294 273 395 356 252 272 319 280 320 260 243 257
    8. 8. S.No District Jan-11 Feb-11 Mar-11 Apr-11 1 Attock 141 191 272 199 2 Bahawalnagar 179 207 212 220 3 Bahawalpur 211 262 497 749 4 Bhakkar 61 121 133 101 5 Chakwal 185 223 235 261 6 Chiniot 109 137 149 92 7 D.G.Khan 188 212 227 163 8 Faisalabad 552 673 621 310 9 Gujranwala 503 355 376 135 10 Gujrat 327 121 160 1061 11 Hafizabad 148 120 166 132 12 Jhang 133 186 185 177 13 Jhelum 203 114 210 196 14 Kasur 599 504 500 392 15 Khanewal 251 213 193 237 16 Khushab 134 114 104 156 17 Lahore 555 514 714 423 18 Layyah 150 100 108 60 19 Lodhran 250 278 258 299 20 M.B.din 58 69 88 84 21 Mianwali 216 205 201 132 22 Multan 139 145 200 232 23 Muzaffargarh 369 320 208 230 24 Nankana Sahib 70 86 143 80 25 Narowal 76 87 61 50 26 Okara 158 177 166 189 27 Pakpattan 185 120 223 191 28 R.Y.Khan 351 284 361 300 29 Rajanpur 205 179 185 146 30 Rawalpindi 145 183 233 197 31 Sahiwal 195 187 219 205 32 Sargodha 205 218 116 198 33 Sheikhupura 228 174 190 271 34 Sialkot 245 218 217 331 35 T.T.Singh 128 195 116 180 36 Vehari 216 301 288 304 TOT AL 8068 7793 8535 8683
    9. 9. Prodromal Phase (2-10 days) Fever, flu like symptoms, headache, anorexia, lethargy, itching or abnormal sensation at the site of wound Acute Neurological Phase (2-7 days) Anxiety, confusion, aggression or lack of aggression, hyper salivation, muscular spasm, difficulty in swallowing leading to hydrophobia, photophobia, aerophobia
    10. 10. Coma and Death Symptoms progress towards paralysis and coma in both furious and dumb rabies Death usually occurs from respiratory paralysis within days after onset of symptoms
    11. 11. *Wounds should be washed/flushed and disinfected immediately. Vaccine and immunoglobulin therapy (when required for the latter) instituted as soon as possible, * If rabies immunoglobulin is not available on first visit its use can be delayed by a maximum of 7 days from date of first vaccine injection, *Initiation of PEP should not await the results of laboratory diagnosis or be delayed by dog observation when rabies is suspected, *Pregnancy and infancy are never contraindications to PEP, *Persons who present for evaluation and rabies post-exposure prophylaxis even months after having been bitten should be dealt with in the same manner as if the contact occurred recently.
    12. 12. *Category I :  touching, feeding of animals or licks on intact skin no exposure  therefore no prophylaxis if history reliable *Category II:-  minor scratches or abrasions without bleeding or and nibbling of uncovered skin  use vaccine alone *Category III:  single or multiple transdermal bites or scratches, licks on broken skin, contamination of mucous membrane with saliva (i.e. licks) and suspect contacts with bats:  use immunoglobulin plus vaccine
    13. 13. * Should be immediate * Is essential even if the person presents long after exposure Consists of: *Immediate washing and flushing for 15 minutes with soap and water, or water alone, *disinfection with ethanol (700ml/l) or iodine (tincture or aqueous solution).
    14. 14. * The 5 dose intramuscular regime: one dose of the vaccine should be administered on days 0, 3, 7, 14 and 28 in deltoid region or, in small children, into the antero-lateral area of the thigh muscle; * The 2-1-1 regimen may also be used. Two doses are given on day 0 in the deltoid muscle, right and left arm. In addition one dose in the deltoid muscle on day 7 and one on day 21. * Vaccines should not be injected into the gluteal region;
    15. 15. *This vaccine is of sufficient potency to allow its safe use in one of the WHO recommended intradermal post-exposure regimens
    16. 16. *Immediate Case Notification. *Availability of Anti-Rabies Vaccine. *Special Dog killing campaigns launched by the districts. * Behavioural Change Campaigns. *World Rabies Day- 28th September.

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