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Rabies

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Rabies

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Rabies

  1. 1. RABIES Dr Pallavi Potdar Associate Prof., Community Medicine D.Y. Patil Medical College Kolhapur
  2. 2. Classification- 1) Anthropozoonosis – 2) Zooanthroponosis- 3) Amphixenosis- ZOONOTIC DISEASES
  3. 3. 4 categoriesof zoonosis-  Direct zoonosis- direct contact contact with fomite mechanical vector e.g rabies, brucellosis  Cyclo-zoonosis- more than 1 vertebrate host no invertebrate host e.g taeniasis,echinococcosis
  4. 4. Categories ..  Meta-zoonosis- invertebrate vectors vertebrate vector e.g plague, schistosomiasis  Sapro- zoonosis- vertebrate host + non-animal site e.g larva migrants
  5. 5. RABIES
  6. 6. Epidemiology  Magnitude of the problem :  Approximately 55,000 people die from rabies each year  majority of these deaths occurring in Asia and Africa.  In Africa, there are estimated at 24,000 (or 4 per 1,00,000 population) deaths annually.
  7. 7.  In India alone, 20,000 deaths are estimated to occur annually, i.e. 2 per 1,00,000 population  Rabies free areas ?
  8. 8. Agent  : Lyssavirus type 1  Rhabdoviridae family.  This RNA virus is bullet shaped  100 - 300 nm in length and 75 nm in diameter.  lipid envelope , spike like projections.
  9. 9. RabiesVirus
  10. 10. Electron MicroscopeView Negatively Stained RabiesVirus
  11. 11. Reservoirof infection  Urban- dogs & cats  Wild-life ( sylvatic)- jackal,fox  Bat rabies- vampire bats
  12. 12. Sourceof infection  Saliva of rabid animals  4-6 days before onset of symptoms till death of animal  virus-Not in all rabid animals saliva
  13. 13. Carrier  Dogs
  14. 14. Host  all age groups are susceptible  most common in children aged below 15 years  High risk group-
  15. 15. Incubation period  Man-  four days to as long as 19 years.  The usual duration is between 20 to 90 days.  95% cases have incubation period less than one year.  Factors affecting -
  16. 16. Transmission Animal bites- Licks- on abraded skin/ mucosa Aerosols – bats/labs Person –person- corneal/organ transplant
  17. 17. Transmission  Almost all transmission is by bite  50 times greater risk than a scratch  Pathogenesis
  18. 18. Animal Behavior  Classic Picture of rabid, dog foaming at the mouth…  aggressive behavior, ataxia, irritability, anorexia, lethargy or excessive salivation.
  19. 19. clinical features in man  Prodromal stage -3-5 days  Sensory-  Motor- muscle spasms  Sympathetic-salivation,perspiration  Mental system-  hydrophobia
  20. 20. Rabies in man  Diagnosis-  Ag detection –immunofluorescence of skin biopsy  Virus isolation  Treatment
  21. 21. Preventionand Control  Rabies Vaccines 1)Nerve Tissue Vaccine (NTV) 2) Duck embryo vaccine (DEV) 3)Cell culture vaccine a) human diploid cell vaccine(HDC) b)tissue culture –animal cell vaccine
  22. 22.  HDC- human diploid fibroblast cells  Safe, highly potent  Animal vaccines- chick embryo fibroblast, dog kidney cells
  23. 23. Prevention of human rabies  Post-exposure prophylaxis  Pre-  Post-exposure Rx of patients previously vaccinated.
  24. 24. Post-exposureprophylaxis  Local treatment of wound- cleansing savlon, cetavlon ? suturing ? anti-rabies serum antibiotics & TT observe animal for 10 days
  25. 25. Indications foranti-rabies treatment  Animal shows signs /dies within 10 days  Biting animal cant be traced  Unprovoked bites  Lab tests- FRA, Negri bodies  All bites by wild animals
  26. 26. Postexposure prophylaxis schedule Route/day of administration D0 D3 D7 D14 D21 D28 D90 Essen ( im) 1 1 1 1 - 1 +/_* Zagreb ( im) 2 - 1 - 1 - - Oxford ( intra- dermal) 8 - 4 - - 1 1 2 site 2 2 2 - - 1 1
  27. 27. Rabies Immunoglobulin (RIG)  equine (ERIG) -40 IU/ kg  human (HRIG) -20 IU/ kg  all category III exposures and  in category II exposures involving immunodeficient individuals.
  28. 28. RIG..  infiltrated into and around the wounds.  The remainder should be administered by deep intramuscular injection at an injection site distant from the vaccine injection site.  In case of multiple wounds, the RIG should be diluted with normal saline to make sufficient volume to ensure infiltration at all wound sites
  29. 29. Pre- exposure prophylaxis  1 ml im/ 0.1 ml id  O , 7 , 28  Booster injections every 2 yrs
  30. 30. Postexposure Rx of previouslyvaccinated  0, 3 ,7
  31. 31. Rabies in Dogs  Incubation period- 3-8 wks  2 forms-  Furious rabies  Dumb rabies  Lab –  Vaccination of dogs-
  32. 32. Control of urban rabies  Registration & licensing of all domestic dogs  Immediate destruction of dogs bitten by rabid animal  Imported dogs- quarantine -6 mths  Health education  Oral vaccine?
  33. 33. How toavoid dog bites.  Never disturb a dog who is…..  Eating  Sleeping  Caring for puppies  Do not …..  Look a dog straight in the eye  Throw anything at a dog  Run near dogs
  34. 34. How toavoid dog bites.  If a growling dog comes near you…..  ….stand still with your arms down, pretend you are a tree.
  35. 35. How toavoid dog bites.  If a dog attacks you….  ….. curl into a ball and protect your face, pretend you are a rock.

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