Rabies

2. RABIES
PRESENTED BY
Soumya ranjan parida

3. DEFINITION
• Rabies is an acute, progressive
encephalomyelitis or highly fatal
viral disease.
• It is an Epizootic disorder.
• The case to fatality rate is the
highest of any infectious disease.

4. HISTORY
• The first written record of Rabies is in the
Mesopotamian civilization (1930 BC), which dictates
that the owner of a dog showing symptoms of Rabies
should take preventive measure against bites.

5. DISTRIBUTION
 Rabies is distributed on all
continents (with the exception of
Antarctica).
 Occurs in more than 150 countries
& territories.
 Globally more than 55,000 people
die of rabies every year.
 Every year, more than 15 million
people worldwide receive a post-
exposure preventive regimen which
is estimated to prevent 3,27,000
cases annually.

6. EPIDEMIOLOGY
AGENT
Rabies is caused by RNA viruses belong to
the family Rhabdoviridae, genus Lyssavirus.
It is a bullet shaped neurotropic RNA
containing virus.

7. HOST & RESERVOIR
 Mammals are the natural hosts of
rabies.
 All warm-blooded vertebrates including
Man are susceptible to Rabies.
 Reservoirs consist of the Carnivorous
such as dog, cat, mongoose, bat etc.

8. Source of Infection
 The source of infection to man is the
saliva of rabid animals.
 In dogs & cats, the virus may be present in
the saliva for 3-4 days before the clinical
onset & during the course of illness till
death.
Cause > 90% of the
Human cases
3 – 5% of Human
cases

9. MODE OF TRANSMISSION

10. INCUBATION PERIOD
• It is highly variable in man, commonly 3-8
weeks following exposure.
– The closer the bite to the brain, the shorter
the incubation.
– Rabies virus travels 1 cm per day.

11. PATHOGENESIS

13. CLINICAL FEATURES
Mainly neurologic;
–Early signs (non-specific)
•Fever, headache, weakness, achy muscles
–Late signs
i.Incoordination, confusion, strange behaviorstrange behavior
ii.ii.Attacking and biting moving at stationaryAttacking and biting moving at stationary
objectsobjects
iii.Salivation (can’t swallow, like choking)
iv.Hydrophobia, Photophobia, Aerophobia
v.Paralysis, Seizures
–Death within 2 weeks of showingDeath within 2 weeks of showing
signssigns

14. RABIES RECOVERY?
WORLDWIDE
• Five historical human
case recoveries, after
vaccination, but before
illness onset.
• Only one documented
unvaccinated human
survivor after clinical
presentation.

15. DIAGNOSIS

16. PREVENTION
• PRE EXPOSURE PROPHYLAXIS
• POST EXPOSURE PROPHYLAXIS

17. Pre exPosure ProPhylaxis
• Provided to subjects at risk before
occupational or vocational exposure
to rabies.
• Subjects include diagnosticians,
laboratory & vaccine workers,
veterinarians, cavers, etc.
• Simplifies post exposure
management.
• Only vaccines used.

18. PeP (Post exPosure ProPhylaxis)
• Provided to subjects after rabies
exposure.
• Consists of wound care, rabies immune
globulin, and vaccine.
• Cleansing
• Chemical Treatment
• Suturing
• Anti-RabiesSerum
• Antibiotics& anti-tetanusmeasure
• Observetheanimal for 10 days.

19. PostexPosure ProPhylaxis
• Wash lesions well with
soap and water (tetanus
booster)
• Infiltrate rabies immune
globulin (20 IU/kg) into and
around the margin of the
bites.
• Administer vaccine on days
0,3,7,14, and 28. (90)

20. raBies VaCCiNe
1. Nervous Tissue Vaccine (NTV)
2. Duck Embryo Vaccine (DEV)
Purified Chick Embryo Cell RabAvert® (PCEC)
3. Cell-culture Vaccine (HDC)
Human Diploid Cell Vaccine Imovax® (HDCV)

21. VACCINE ADMINISTRATION
Class of
treatment
ADULT CHILDREN Duration of
Treatment
Class I 2ml 1ml 7days
Class II 3ml 3ml 10days
Class III 5ml 3ml 10days
(Dosage schedule by Pasture institute, Coonoor)
CLASS –I (Slight risk)
CLASS—II (Moderate risk)
CLASS– III (Severe risk)

22. Vaccine Administration
1. Intramuscular Schedules
 6 doses schedule
Reduced multisite intramuscular
regimen (2-1-1)
2. Intradermal Schedules
2-Site Intradermal schedule(2-2-
2-0-1-1)
8-Site intradermal schedule(8-0-
4-0-1-1)

23. raBies iMMuNoGloBuliN
• Two Human Rabies
Immunoglobulins are
available;
HyperRabTM S/D
Imogam® Rabies-HT
• Both supplied in vials at ~
150 IU/ml
ONLY IN PEP

24. aDVerse reaCtioNs
• PEP should not be interrupted because of
local or mild systemic adverse reactions.
• Use of anti-inflammatory, antihistaminic, and
antipyretic agents suggested.
• Serious systemic, anaphylactic, or
neuroparalytic reactions are rare.

25. CASE MANAGEMENT
The patient should be isolated in a quite
room i.e. protected from external stimuli.
Relieve anxiety & pain by the use of
sedatives.
Morphin in doses of 30-45 mg may be given
repeatedly.
Ensure hydration & diuresis.
Respiratory & cardiac support.

26. NurSiNG rESPONSiBiLiTY
Nursing personnel should be warned
against possible risk of contamination.
They should wear masks, gloves,
goggles & aprons to protect themselves.
Nurses having bruises, cuts or open
wounds should not be entrusted to look
after the patient.
Pre- exposure prophylaxis with 2-3
doses of HDC vaccine is recommended.

27. SuMMAriZATiON

28. OPEN DISCUSSION

30. REFERENCES
• Gulani K. K., Community health nursing,second edition,Delhi:
Kumar publishing house,2012.
• Park K, Preventive and social medicine, 21st edition, Jabalpur:
M/s BanarasiDas Bhanot Publisher,2011, p(226-234)
• Advisory Committee on Immunization Practices (ACIP), 1999
MMWR 48: RR-1
• Center for Disease and Prevention: www.cdc.gov
• NASPHV Compendium of Animal Rabies Prevention & Control,
2007, MMWR 56:RR-3
• World Health Organization Expert Consultation on Rabies,
Geneva, Switzerland, 2005, Tech Rep Ser 931:1-88