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Dog bite (rabies)

dog bite rabies

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Dog bite (rabies)

  2. 2. EPIDEMIOLOGYEPIDEMIOLOGY The study of theThe study of the DISTRIBUTION andand DETERMINANTS of health-relatedof health-related states or events in specified populationstates or events in specified population and application of this study to theand application of this study to the control of health problemscontrol of health problems
  3. 3. 1. DISTRIBUTION OF DISEASE A. When (time) B. Who (person) C. Where (place) Descriptive EpidemiologyEpidemiology
  4. 4. 2. DETERMINANTS OF2. DETERMINANTS OF DISEASEDISEASE A. Why B. How Analytical Epidemiology
  5. 5. DEFINITION Human Rabies is a viral infection of the CNS usually transmitted by contamination of a wound with saliva from a rabid animal and is virtually 100%fatal once symptoms develop.
  6. 6. • Rabies is a zoonotic disease (a disease that is transmitted to humans from animals) that is caused by a virus.
  7. 7. GEOGRAPHIC DISTRIBUTION* Rabies Free Area in which no case has occurred in human or any animal species for 2 years. * Rabies is a major public problem in areas in which Dogs are uncontrolled. * Rabies is present on all continents with the exception of Antarctica, but more than 95% of human deaths occur in Asia and Africa. Once symptoms of the disease develop, rabies is nearly always fatal.
  8. 8. Rabies Human DeathsRabies Human Deaths Annual human deaths worldwide are approximately 55,000; every 15 minutes a patient dies of rabies. In the United States, there has been a mean of 3 deaths per year since 1990.
  9. 9. PAKISTANPAKISTAN • In Pakistan 2000 - 5000 cases / yr. • Rabies is endemic in Pakistan. • Human rabies is not a notifiable disease in Pakistan • The main vector for rabies in Pakistan is the domestic dog
  10. 10. KEY FACTS • Rabies is a vaccine-preventable viral disease which occurs in more than 150 countries and territories. • Infection causes tens of thousands of deaths every year, mostly in Asia and Africa. • 40% of people who are bitten by suspect rabid animals are children under 15 years of age. • Dogs are the source of the vast majority of human rabies deaths.
  11. 11. • Immediate wound cleansing and immunization within a few hours after contact with a suspect rabid animal can prevent the onset of rabies and death. • Every year, more than 15 million people worldwide receive a post-exposure vaccination to prevent the disease – this is estimated to prevent hundreds of thousands of rabies deaths annually. KEY FACTS
  12. 12. INCUBATION PERIODINCUBATION PERIOD Highly variable usually 20 – 180 days, peak at 30 – 60 days
  13. 13. MODE OFMODE OF TRANSMISSIONTRANSMISSION A- ANIMAL BITES : through rabid dog bites and the saliva of the biting animal contain the virus. B- LICKS : licks on abraded skin and mucosa transmit the disease.
  14. 14. Who is most at risk? •Dog rabies potentially threatens over 3 billion people in Asia and Africa. •Poor people are at a higher risk (cost = US$ 49 in Asia) •Although all age groups are susceptible, rabies is most common in children aged under 15 & majority are male.
  15. 15. Rabies attacks theRabies attacks the Central NervousCentral Nervous SystemSystem  Watch as the rabies virus from an exposure on the leg spreads up the spinal cord to the brain and throughout the rest of the body. Rabies virus entering the body.
  16. 16. Headache, fever, sore throat Nervousness, confusion Pain or tingling at the site of the bite Hallucinations – Seeing things that are not really there Hydrophobia – “Fear of water" due to spasms in the throat Paralysis – Unable to move parts of the body Coma and death Signs / SymptomsSigns / Symptoms Clinical DiagnosisClinical Diagnosis
  19. 19. Pre-exposure immunization in people •Travellers spending a lot of time outdoors, especially in rural areas. •People in certain high-risk occupations such as laboratory workers dealing with live rabies virus and other rabies-related viruses. •People involved in any activities that might bring them professionally or otherwise into direct contact with Dogs. •Children. •Living in or visiting high risk areas.
  20. 20. PRE- EXPOSUREPRE- EXPOSURE PROPHYLAXSISPROPHYLAXSIS 1. Vaccination of domestic dogs1. Vaccination of domestic dogs 2. Elimination of stray dogs2. Elimination of stray dogs 3. Eliminating rabies in dogs3. Eliminating rabies in dogs 4. Active Immunization Doses:4. Active Immunization Doses: Day 0,7 and 28 (100% response)Day 0,7 and 28 (100% response)
  21. 21. WHO Recommended Pre-exposure 3-dose series intramuscular Pre-exposure Exposure: No Rabies immunoglobulin needed day 0 7 21 or 28 3 Vaccine should never be administered in the gluteal region.
  22. 22. Was There An Exposure?Was There An Exposure? A bite (penetration of the skin by teeth) from a known or suspect rabid animal Scratches, abrasions, open wounds (bleeding within 24 hrs), or mucous membranes (eyes) contaminated with saliva or other potentially infectious material from a known or suspect rabid animal Other contact - such as petting an animal or contact with urine, feces - does NOT constitute an exposure
  23. 23. 10 Day Confinement10 Day Confinement & Observation Period& Observation Period Clinical course usually less than 7 days - animal dead before end of 10 days
  24. 24. Rabies Vaccination Status ofRabies Vaccination Status of AnimalAnimal Lower risk if animal has been regularly vaccinated But NO vaccine is 100% effective Put as much weight on animal behavior & health status
  26. 26. A) if the animal shows signs of rabies orA) if the animal shows signs of rabies or dies within 10 days of observation.dies within 10 days of observation. B) If the biting animal can not be tracedB) If the biting animal can not be traced oror identified .identified . In general if a biting dog does not die with in 10 days, Rabies is unlikely. RABID DOG
  27. 27. PEP Post-exposure prophylaxis (PEP) •Local treatment of the wound. •Initiated as soon as possible after exposure; a course of potent and effective rabies vaccine that meets WHO recommendations. •Administration of rabies immunoglobulin, if indicated.
  28. 28. A) POST EXPOSURE PROPHYLAXSIS LOCAL TREATMENT OF WOUND A. Mechanical removal By 1. Soap and water : using copious amounts of solution 2. Virucidal solution : 1% povidone-Iodine or 70% alcohol B. Suturing : not done C. Anti biotics & Antitetanus measures.
  29. 29. IMMUNIZATIONIMMUNIZATION 1. ACTIVE IMMUNIZATION VACCINE 2. PASSIVE IMMUNIZATION IMMUNE GLOBULIN 1. Human rabies immune globulin 2. Equine rabies immune globulin
  30. 30. VACCINE TYPESVACCINE TYPES NERVOUS TISSUE VACCINE (NTV) a- Antigenicity was poor b- Multiple Injections were required. c- Post vaccination Encephalitis was frequent problem. This vaccines are still in use in many places in the world.
  31. 31. Human diploid cellsHuman diploid cells vaccinevaccine (HDCV)(HDCV)
  32. 32. 1.1. ACTIVEACTIVE IMMUNIZATIONIMMUNIZATION Human Diploid Cells VACCINEHuman Diploid Cells VACCINE (HDCV)(HDCV) A. No. of doses : 05A. No. of doses : 05 Day 0, 3, 7, 14 and 28Day 0, 3, 7, 14 and 28 B. Quantity :B. Quantity : 1 ml1 ml C. Route : Intra-muscular (Arms)C. Route : Intra-muscular (Arms)
  33. 33. Standard intramuscular regimen. One dose into deltoid on each of days: Essential intramuscular Regimen WHO Recommended PEP Schedule 5 vials 5 visits day 0 3 7 14 28 Rabies immunoglobulin
  34. 34. 2. PASSIVE IMMUNIZATION2. PASSIVE IMMUNIZATION IMMUNE GLOBULINIMMUNE GLOBULIN Human rabies immune globulin A. No. of doses : 01 as soon as possible B. Quantity : 20 IU / Kg C. Route : Half dose Intra-muscular (Arms) Half dose subcutaneously around the bite site
  35. 35. If Person having weight 60 KgIf Person having weight 60 Kg Human rabies immune globulinHuman rabies immune globulin 20 IU / Kg20 IU / Kg 20 x 60 = 1200 IU20 x 60 = 1200 IU 600 IU I/M & 600 IU S/C around the600 IU I/M & 600 IU S/C around the bite site.bite site.
  36. 36. EQUINE RABIES IMMUNE GLOBULINEQUINE RABIES IMMUNE GLOBULIN A. No. of doses : 01 as soon as possibleA. No. of doses : 01 as soon as possible B. Quantity : 40 IU / KgB. Quantity : 40 IU / Kg C. Route : Half dose Intra-muscular (Arms)C. Route : Half dose Intra-muscular (Arms) Half dose subcutaneouslyHalf dose subcutaneously around the bite sitearound the bite site after test doseafter test dose Anaphylaxis is a rare.Anaphylaxis is a rare.
  37. 37. If Person having weight 60 KgIf Person having weight 60 Kg EquineEquine rabies immune globulinrabies immune globulin 40 IU / Kg40 IU / Kg 40 x 60 = 2400 IU40 x 60 = 2400 IU 1200 IU I/M & 1200 IU S/C around the1200 IU I/M & 1200 IU S/C around the bite site.bite site.
  39. 39. Destruction of brain stemDestruction of brain stem neurons inhibitory to theneurons inhibitory to the neurons of the nucleusneurons of the nucleus ambiguous which controlambiguous which control Inspiration.Inspiration.
  40. 40. Why Hydrophobia doesWhy Hydrophobia does not occur in othernot occur in other diseases ?diseases ?
  41. 41. Only Rabies combinesOnly Rabies combines brain stem Encephalitisbrain stem Encephalitis with an intact Cortex andwith an intact Cortex and maintenance ofmaintenance of consciousnessconsciousness