Rabies is a zoonotic disease (a disease that is transmitted from animals(Mammals) to humans). Caused by the rabies virus (The Lyssavirus genus, within the family Rhabdoviridae). Domestic dogs are the most common reservoir of the virus, with more than 95% of human deaths caused by dog-mediated rabies. Let's know the Sign symptoms, Treatment and Prevention of rabies which is 100% fatal and 100% preventable.

1. Rabies

2. Rabies
Dr. Akhiruzzaman
Assistant professor and Head of Community Medicine
Diabetic Association Medical College, Faridpur

3. Rabies,
162

4. Death rate for different diseases

8. Dogs are the source of the vast majority of
human rabies deaths, contributing up to 99% of
all rabies transmissions to humans.
40% of people who are bitten by suspected rabid
animals are children under 15 years of age.
Rabies elimination is feasible through
vaccination of dogs and prevention of dog bites.
Rabies Facts

9. WHO, the World Organisation for Animal
Health (OIE), the Food and Agriculture
Organization(FAO) and the Global Alliance for
Rabies Control (GARC) have established a
global “United Against Rabies” collaboration
to provide a common strategy to achieve
"Zero human rabies deaths by 2030”

10. Human-to-human transmission of RABV is
extremely rare.
The only documented cases of human-to-human
transmission occurred via tissue and organ
transplants from RABV-infected individuals, and a
single case of likely perinatal RABV transmission.
No case of human rabies resulting from
consumption of raw meat or milk from a rabid
animal has been documented.
RABV infection in rodents is very uncommon. No
human rabies cases due to bites by rodents have
been reported.

11. Bangladesh Scenario
In Bangladesh >2000 peoples die every year
from Rabies.
Most (88%) victims are from rural area
Majority of the victims are children (49%).
In 95% cases dog transmits the disease.
In Bangladesh, there are about 1.2 million
dogs of which 83% are stray.
Bangladesh took the challenge for elimination
of rabies in by 2030.

12. What is rabies?
Rabies is a zoonotic disease (a disease that
is transmitted from animals(Mammals) to
humans).
Caused by the rabies virus (The Lyssavirus
genus, within the family Rhabdoviridae).
Domestic dogs are the most common
reservoir of the virus, with more than 95%
of human deaths caused by dog-mediated
rabies.

13. Ecological Triad
Rabies virus
Area
overcrowded
with stray
dogs and
rabid animals
People of all
age specially
children age
<15 years

14. Rabid animals
• Dog
• Bat
• Raccoon
• Skunks
• Rat
• Monkeys
• Foxes
• Wolves
• cats, and
• mongooses etc

15. Dog

16. Bat

17. Fox

18. Skunks

19. Raccoon

20. Mode of Transmission
• The virus is transmitted in the saliva of
rabid animals and generally enters the
body by-
1.Licks: Infiltration of virus-laden saliva
from a rabid animal into a wound (e.g.
scratches),
2.Animal Bites: Direct exposure of
mucosal surfaces to saliva from an
infected animal

21. • The virus cannot infiltrate intact skin.
• Once the virus reaches the brain, it further
replicates, resulting in presentation of clinical
signs from the patient.
• Once the symptoms appear it is 100% fatal
• Rabies virus produces a specific eosinophilic
cytoplasmic inclusion bodies, the Negri body,
in infected nerve cells. Found in about 20%.
Negri bodies are filled with viral nucleocapsids.

23. Incubation Period
 Typically 2-3 months
 However; it can range from 7 days to several
years.
 The incubation period depends on factors
inclusive of:
• Location and severity of bite wound,
• The amount of virus inoculated within the
wound and
• Degree of innervation at the site of the bite
wound.

24. How rabies virus spread?

25. Types of rabies
There are two types of rabies:
• Furious rabies and
• Paralytic rabies

26. 1. The first are flu-like
symptoms
• Fever,
• Headache and
anxiety,
• Sore throat and
cough
Symptoms in Human (In general)
2. Then follows a
neurologic period
• Aggression
• Convulsions
• Hyper-salivation
• hydrophobia
• Hallucinations
• Paralysis
• Hyperventilation
3. The final stage is coma which leads to death

27. Furious rabies: (80% of human cases)
• Signs of hyperactivity
• Hyper-salivation
• Difficulty in swallowing
• Extremely painful muscle spasm in
throat
• Periods of agitation
• Lucidity
• Hydrophobia
• Aerophobia.
• After a few days, the infection
invariably leads to coma and death
by cardio-respiratory arrest.

28. Paralytic (or dumb) rabies: (20% of human
cases):
• Paresthesias/pain/pruritus at site of bite
• Flaccid muscle weakness (Starting at the site
of the bite or scratch. Gradual paralysis to
produce quadriplegia).
• Sensory involvement not occur.
• Death by respiratory failure is generally
preceded by the development of a coma.
The paralytic form of rabies is often
misdiagnosed and unreported.

29. Hydrophobia
• Hydrophobia in Rabies is caused by extreme
pain in the patient when swallowing fluids,
including water and saliva.
• As a matter of fact, Rabies will make the
muscles paralyzed sooner or later. The pain
that the sufferers feel when swallowing
fluids, including saliva, is due to the inability
of the muscles responsible to control
swallowing

30. 1. Animals (domestic)
• Fearfulness
• Aggression
• Excessive drooling
• Difficulty
swallowing
• Staggering
• Seizures
• Depression
• Light sensitivity
2. Animals (wildlife)
• Any of above and
• Unusual behavior
 Nocturnal
animal active
during day
 Lose fear of
humans
Symptoms in Animal

32. Diagnosis
Rabies in human can be difficult to diagnose:
1. History of animal bite.
2. Sign and symptoms
3. Examination.
4. Virus isolation by PCR from CSF, saliva,
tissue.
5. Direct fluorescent antibody test.
6. Animal observation: suspected rabid
animal should be killed for examination of
neural tissue.

33. Wound Management
 Avoid direct touching of
wounds with bare hands.
• Gentle thorough washing
with soap or detergent and
flushing the wound with
running water for 10-15
minutes, for 5 times
 Later anti-septic will be used.
 Suturing of wound should be
avoided as far as possible

34. • If surgically unavoidable, minimum loose
sutures should be applied after adequate
local treatment along with proper
infiltration of rabies immunoglobulins
(RIG).
• Prophylactic antibiotics and tetanus
prophylaxis should be given.

35. Do’s And Don’ts In Management of
Animal Bites : WHO Guidelines
Dos
• Wash the wound with plenty of water and soap.
• If soap is not available, flush the wound with
copious amounts of water.
• Remove soap and apply any
quaternary ammonium compound
- 1 to 4% benzalkonium chloride
- 1% cetrimonium bromide ·
alcohol (70%)
• Tincture of iodine or its aqueous solution
• Administer complete antirabies immunization

36. Don’ts
• Do not cauterize the animal bite wound, as it
leaves a very bad scar, and does not confer any
additional advantage over washing the wound
with water and soap.
• If possible, primary suturing of the animal bite
wounds should be postponed.
• However, if suturing is unavoidable, antirabies
serum should be first infiltrated around the
wound and subsequently minimum possible
stitches should be applied.
• Do not provide incomplete immunization.

37. Rabies Vaccines
• The human diploid cell rabies vaccine (H.D.C.V.)
was started in 1967. Human diploid cell rabies
vaccines are inactivated vaccines made using the
attenuated Pitman-Moore L503 strain of the
virus.
• In addition to these developments, newer and
less expensive purified chicken embryo cell
vaccine(PCECV), and purified Vero cell rabies
vaccine are now available.
• Nerve tissue vaccine, that was used previously
now it is avoided for the complications like,
allergic post encephalitis
• Live attenuated viruses: Used for wild animal.

38. • Street virus:- When freshly isolated in the
laboratory from the infected animals, the
strain is called street virus. Long & variable
incubation period (usually 21 – 60 days) &
produced intra’cytoplasmic inclusion bodies.
• Fixed virus:- Serial brain to brain passage of
street virus in rabbits yields a “fixed” (mutant)
virus. Fixed virus multiplies rapidly & shorter
incubation period (4- 6 days). Used for
vaccination.

39. Prophylaxis with rabies vaccine
• Post exposure prophylaxis
• Pre exposure prophylaxis

40. Post-Exposure Prophylaxis: Category and management

41. • For Non-immunized Individuals: HDCV or
PCECV (Purified Chicken Embryo Cell Vaccines)
1.0 mL, IM (deltoid area), one each on days 0 ,
3, 7, and 14. (RIG required with 1st dose)
*A 5th dose on day 28 may be recommended for
immunocompromised persons
• For Previously Immunized Individuals: HDCV
or PCECV 1.0 mL, IM (deltoid area), one each
on days 0 and 3 (No RIG needed)
Source: CDC PCECV=purified chicken embryo cell vaccines

42. RIG dose
Equine rabies immunoglobulins (ERIG):
40 IU per kg body weight upto a maximum of 3000 IU.
 Human rabies immunoglobulins (HRIG)
20 IU per kg body weight upto a maximum 1500 IU.
If possible, the full dose of RIG should be infiltrated
around any wound(s) and any remaining volume
should be administered IM at an anatomical site
distant from vaccine administration. Also, RIG
should not be administered in the same syringe as
vaccine.

43. Pre-Exposure Prophylaxis

44. Prevention of Rabies
• Mass dog vaccination campaigns
• Pre- Exposure Prophylaxis
• Post- Exposure Prophylaxis
• Continual education of health and
veterinary professionals in rabies
prevention and control
• Public health educational strategies at the
community level within endemic regions

45. Is there any light of HOPE!
• A case in 2011 raised even more questions.
• A high school girl survived rabies without a vaccine.
• The doctor treating her developed a protocol to try
to save her, and it worked!
• This protocol is now called the Milwaukee protocol,
and has reinvigorated curiosity in the treatment and
strategy of this disease.
BUT
• Was the treatment truly effective or was she simply
infected with a weaker strain of the virus? Such
questions don’t have easy answers.

46. 2022

47. THANK YOU