This document provides an overview of rabies, including its epidemiology, clinical manifestations, classification of animal bites, prevention, and control programs. Rabies is a fatal viral infection transmitted through animal bites that is preventable through vaccination. It remains a public health problem worldwide, with tens of thousands of deaths annually, primarily in Asia and Africa. Dogs are the main reservoir and source of human infections. Post-exposure prophylaxis including wound cleansing and vaccination is effective but must be administered promptly after exposure to prevent onset of symptoms.
all about rabies
epidemiology of rabies,
pathogenesis of rabies,
clinical features of rabies,
treatment of rabies,
prevention of rabies,
rabies virus,
post exposure prophylaxis,
rabies in dogs
This ppt is About Rabies epidemiology and treatment .
This is done by using Park book 24th edition of PSM .
This presentation is presented in academics of Master of public health in Christian medical college .
One more Important thing is that that zareb regime (intramuscular ) is not practiced . We try to make this ppt lucid. and the statistics is used in the presentation is upto 27 june 2018
all about rabies
epidemiology of rabies,
pathogenesis of rabies,
clinical features of rabies,
treatment of rabies,
prevention of rabies,
rabies virus,
post exposure prophylaxis,
rabies in dogs
This ppt is About Rabies epidemiology and treatment .
This is done by using Park book 24th edition of PSM .
This presentation is presented in academics of Master of public health in Christian medical college .
One more Important thing is that that zareb regime (intramuscular ) is not practiced . We try to make this ppt lucid. and the statistics is used in the presentation is upto 27 june 2018
Rabies is a viral disease that causes acute encephalitis
(inflammation of the brain) in warm blooded animals. Rabies is a zoonotic disease (a disease that is transmitted to humans from animals) that is caused by a virus
Rabies is a viral disease that causes acute encephalitis
(inflammation of the brain) in warm blooded animals. Rabies is a zoonotic disease (a disease that is transmitted to humans from animals) that is caused by a virus
RABIES-A fatal but preventable viral disease is explained in detail (with exclusive pictures) in this PowerPoint presentation.
It also includes the "updates on prevention and control strategy" and "Zero by 2030-Rabies Elimination Strategy"
This was presented at seminar hall, Department of Community Medicine, IMS, Banaras Hindu University as a part of PG seminar.
(The video by Lancet included in this may not be played in this slideshare platform...one can access youtube for the same)
overview of rabies and rabies post exposure administration.pptxBirhanu Hurisa
Rabies is neglected disease with 100% case fatality. Rabies kills more than 55,000 people each year in which 99% of the deaths are from developing countries. Rabies has been recognized in Ethiopia for centuries, and the disease has become endemic since the early 17th century. By estimation, 2771 to 10,000 people die of rabies each year in Ethiopia.
The only vaccine available for human rabies post-exposure prophylaxis is the obsolete sheep brain-based Fermi vaccine, and has been manufactured since early 1950s in Ethiopia. According to Ethiopian Ministry of Health, the annual performance report, the maximum manufacturing capacity for the Nervous Tissue Vaccine (NTV) of the country is about 32,000 doses, which is far below demand. The NTV is immunogenic, more reactogenic, life threatening and caused neurological adverse reactions in 0.3-0.8 per 1000 vaccinated people.
Rabies is neglected disease with 100% case fatality. Rabies kills more than 55,000 people each year in which 99% of the deaths are from developing countries. Rabies has been recognized in Ethiopia for centuries, and the disease has become endemic since the early 17th century. By estimation, 2771 to 10,000 people die of rabies each year in Ethiopia.
The only vaccine available for human rabies post-exposure prophylaxis is the obsolete sheep brain-based Nervous Tissue vaccine (Fermi vaccine) and has been manufactured since early 1950s in Ethiopia. According to Ethiopian Ministry of Health, the annual performance report, the maximum manufacturing capacity for the Nervous Tissue Vaccine (NTV) of the country is about 32,000 doses, which is far below demand. The NTV is immunogenic, more reactogenic, life threatening and caused neurological adverse reactions in vaccinated people.
Rabies presentation for medical undergraduate students Khan Amir Maroof
for MBBS phase II students
29th July 2021
with videos and pictures
For educational use only and NOT FOR PROFIT
www.consortiumagainstrabies.com
Credit: Dr Anurag Agarwal (Gen Secretary, Consortium Against Rabies)
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. CONTENTS
• INTRODUCTION
• EPIDEMIOLOGY
• CLINICAL MANIFESTATIONS
• CLASSIFICATION OF ANIMAL BITE
• PREVENTION
• POST EXPOSURE PROPHYLAXIS
• PRE EXPOSURE PROPHYLAXIS
• PROGRAMS FOR CONTROL OF RABIES
2
3. INTRODUCTION:
The name Rabies is derived from the Latin word
“madness” also, Sanskrit word ‘Rabhas’ - “to do
violence”.
Rabies is an acute fatal viral encephalitis caused by a
single stranded RNA virus
Zoonotic disease which is virtually 100% fatal but 100%
preventable.
3
4. Rabies occurs in >150 countries and territories.
Worldwide >59,000 people die of rabies every year.
India >10,000
Odisha :6 deaths/100,000 population reported in 2015 ,
3deaths/100,000 population reported in 2016
BURDEN OF RABIES 4
5. 40% of people - children under 15 years of age.
Dogs are the source of 99% of human rabies deaths.
Most recent estimate of the burden of rabies - DALYs
➢direct cost : rabies vaccines immunoglobulins
➢indirect cost: transport and loss of income
Losses in productivity due to premature death (55% of total
cost)
Cost of PEP(20%)
Spending on dog vaccination is <1.5%
(Latin America 17% of costs are allocated to dog vaccination).
For individuals, PEP equivalent to 3.8% of GNI for a person
in Asia(31 days wages for the avg Asian) &
5.80% for a person in Africa(51 days wages for an avg Africa)
5
6. DALYs
3.7 million/year
Most DALYs were due to premature death(99%) & a few to
adverse event after administration of nerve tissue vaccines(0.8%)
6
7. AGENT:
• Single Strand RNA Virus- Lyssa virus
• Order –mononegavirales
• Family- Rhabdoviridae
• Bullet Shaped.
• Size 75 nm x 180 nm.
EPIDEMIOLOGY 7
9. RESERVOIRS OF INFECTION:
A. Urban Rabies: Dogs & Cats
B. Wild Life Rabies ( Sylvatic):
C. Bat Rabies: Vampire Bats
9
10. HOST:
• All age groups, more in children < 15 years
• M > F
Modes of Transmission:
1)Bites from infected animals
2) Licks on Broken Skin or Mucous Membrane
3)Scratches
4)Inhalation of virus containing aerosol.
5) Organ transplantation
10
11. INCUBATION PERIOD (IN MAN):
• 2 weeks – 6 months (in > 85% cases).
• Ranges between 4 days to 19 years.
• Shorter in children (vulnerable group).
11
13. CLINICAL MANIFESTATION:
Furious Type ( 80%)
• Tingling / numbness at
bite site
• Non specific symptoms
• Hydrophobia,
Aerophobia
• Photophobia
• Death (cardio -
respiratory failure)
• Survival : 3 – 5 Days
Paralytic Type ( 20%)
• Tingling / numbness at bite
site
• Non specific symptoms
• Ascending Paralysis
• Coma
• Death (cardio - respiratory
failure)
• Survival : 7 – 21 Days
13
14. LABORATORY DIAGNOSIS:
Laboratory diagnosis is not mandatory for managing
animal bite cases
Samples and tests:
Saliva -Virus isolation / RNA detection
Skin - Antigen detection
CSF - Virus isolation & antigen detection
The samples that afford the highest diagnostic sensitivity are at least
3 saliva samples taken at intervals of 3-6 hr and skin biopsies
(including hair follicles)
Ideally samples should be stored at -20˚c or less.
Brain tissue is the preferred specimen in sampling for post-mortem
diagnosis in humans and animals
14
15. TREATMENT:
• Admit in a separate
quiet & breeze free area.
• Sedation with Morphine / Barbiturates.
• Muscle relaxants, Intensive cardio respiratory support
• Emotional support and physical comfort.
• Barrier nursing and universal precautions.
15
16. • Invasive procedures
should be avoided.
• Early disposal of body by cremation or deep burial.
• All disposables contaminated with secretions or
excretions , patient tissue or body fluids should be
managed as infected.
16
21. INDICATIONS FOR ANTI-RABIES TREATMENT:
a)Observation of biting dog/cat:
If the animal shows signs of rabies or dies within 10
days of observation.
b)Vaccination status of the biting animal:
c)Provoked versus unprovoked bite:
d)Bite by wild animals: category –III
e) Bite by rodents: No requirement of PEP
f) Bat rabies: bat rabies has not been conclusively proved in
India .
21
22. g)post-exposure prophylaxis of immune-compromised
patients:
h)Human to human transmission: few cases resulting from
organ/tissue(cornea) transplant.
CONTRAINDICATIONS
•There is no contraindication to PEP.
•Pregnancy, lactation , infancy , old age and concurrent illness –
no contraindication for PEP
• People taking chloroquine for malaria treatment or prophylaxis
may have a reduced response to ID rabies vaccination. Hence
these people should be given PEP intramuscularly.
22
23. ANTI-RABIES VACCINE ADMINISTRATION:
ARV : Fluid or dried preparation of rabies “fixed” virus grown in neural
tissues of rabbits, sheep, goats, mice, rats or in embryonated duck eggs or
in cell cultures and inactivated by a suitable method.
1.Nervous tissue vaccines (NTV) :Govt. of India stopped producing nervous
tissue vaccine since 2004.
2.Purified Duck embryo vaccine (PDEV)
3. Cell-culture vaccines(CCVs)
• ARVs are produced as one single intramuscular dose with potency of
>2.5IU per IM dose for post exposure and pre- exposure prophylaxis.
• It is absolutely essential that every batch of CCVs have minimum potency
of 2.5IU per IM dose, irrespective of whether the vaccine is administered
by IM or ID route.
23
24. Indications: all animal bite victims of category II and III
Storage and transportation: temp 2-8˚c and protected from sunlight
Reconstitution and storage: the lyophilized rabies vaccine should be
reconstituted with the diluent provided with the vaccine immediately prior to
use.
Some vaccines have 0.5ml diluents and others have 1ml diluents as per the
approval of the brand, which can not be altered.
ID administration- vaccine vial should be stored at 2-8˚c after
reconstitution. The total content of the vial should be used as soon as possible
but at the maximum within 8 hours.
IM administration- vaccine should be used immediately after
reconstitution.
24
25. INTRADERMAL (ID) REGIMEN:
•Pioneered by the Queen Saovabha Memorial Institute of the Thai Red Cross
Society during the 1980s
•Vaccines approved by DCGI
➢ PVRV – Verorab, Aventis Pasteur (Sanofi Pasteur) India Pvt. Ltd.
➢ PCECV – Rabipur, Chiron Behring Vaccines Pvt. Ltd.
➢ PVRV – Pasteur Institute of India, Coonoor
➢ PVRV – Abhayrab, Human Biologicals Institute
Regimen Updated Thai Red Cross Schedule (2-2-2-0-2) on
days 0, 3, 7 and 28.
•This involves injection of 0.1ml of reconstituted vaccine per ID site and on
two sites per visit (one on each deltoid area, an inch above the insertion of
deltoid muscle) on days 0, 3, 7 and 28.
•The day 0 is the date of first dose administration of anti-rabies vaccine and
may not be the date of rabies exposure/animal bite.
25
26. Advise to the vaccinated person:
•Do not rub the injection site
•Do not apply anything to the injection site Complete the course of
vaccination
Materials required
•A vial of anti-rabies vaccine along with its diluent that is approved by the
DCGI for ID administration.
•2 ml disposable syringe with 24 G needle for reconstitution of vaccine.
•Disposable 1 ml (insulin) syringe (with gradations up to 100 units) with a
fixed (self-mounted) (28 G or more) needle
•Disinfectant swabs (e.g. 70% ethanol, isopropyl alcohol) for cleaning the top
of the vial and the patients' skin.
26
27. INTRAMUSCULAR SCHEDULES
A) Essen Regimen :
• Dose : 1 ml, 6 doses
• Site : Deltoid or anterolateral
aspect of thigh (children)
27
28. B) Zagreb regimen (2 – 1 – 1) :
❖Humoral antibodies play an important role in protection against rabies.
❖Anti –rabies neutralizing antibody titre of 0.5 IU/ml or more in serum is
considered as protective.
❖This level is achieved in most healthy individuals by day 14 of PEP
regimen, with or without simultaneous administration of rabies
immunoglobulin.
28
29. PASSIVE IMMUNIZATION:
All category III exposures, irrespective of status of biting
animal.
Administer even when treatment is delayed but (not after 7
days of start of vaccination-3 doses administered)
In re-exposure cases (completed post exposure prophylaxis
previously) RIGs are not indicated.
29
30. ADMINISTRATION OF RABIES
IMMUNOGLOBULIN (RIG)
• Infiltrate into the depth of the wound and around the wound
• Quantities/volume of RIG:
20IU/ kg for Human RIG or 40 IU/ kg of Equine RIG
• If the calculated dose is insufficient to infiltrate all wounds,
sterile saline may be used to dilute it 2 to 3 fold to permit
thorough infiltration
• For adults 400 Rs. and children 200 Rs .
• Sensitivity test before administration of
ERIG
30
31. Test dose (ERIG)
Inject 0.1 ml of 1:10 dilution of the ERIG in normal saline,
ID over flexor aspect of forearm.
Observe for : Wheal, Erythema, Induration, Itching,
Tachycardia, Fall in Blood Pressure, Feeble Pulse.
RIG Infiltration:
Positive test reaction: Induration >10mm
If skin test is positive – HRIG is preferred
If ERIG has to be administered then pre- treat with Adrenaline
/ Epinephrine and with Antihistamine before administering full
dose.
31
32. ✓If re-exposed persons who have previously received and
documented full pre- or post-exposure prophylaxis (either by IM or ID
route) with a cell-culture vaccine or PDEV should now be given only
two booster doses intramuscularly (0.5ml/1ml) or CCVs intra-dermally
(0.1 ml at 1 site) on days 0 and 3.
▪Proper wound toilet should be done.
▪Treatment with RIG is not required.
✓Persons who have previously received full post-exposure treatment
with NTV or vaccine of unproven potency or cannot document
previous pre- or post-exposure treatment should be treated as fresh case
and given treatment as per merits of the case.
VACCINATION AFTER RE-EXPOSURE:32
33. PRE - EXPOSURE PROPHYLAXIS
• Groups of persons at high risk of exposure to live rabies virus
• Three doses of vaccine on days 0, 7 and 28
Dose : IM : HDCV, PCEC & PDEV - 1 ml
PVRV - 0.5ml
ID : 0.1 ml
Monitoring
• Persons working with live rabies virus in diagnostic
laboratories, research laboratories, vaccine production
laboratories
✓one serum sample every six months
✓ booster when the titre falls below 0.5 IU/ml
• Others professions (veterinarians, animal handlers, wildlife
officers...) at permanent risk of exposure to rabies
✓testing every year
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34. ADVICE TO PATIENTS:
• No dietary restrictions.
• No restriction of physical exercise.
• Report adverse effects (if any) to the physician without fail.
• Best to avoid consumption of alcohol during the course of
treatment.
• Complete the course of vaccination.
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38. RABIES IN ANIMALS
Excitative Type or “Furious” rabies:
Agitated, restless, excitable, Indiscriminant biting, Profuse
salivation, Vocal cords affected, Convulsions, paralysis, and death
Paralytic Type or “Dumb” rabies:
Muscles of head and neck affected, Difficulty in swallowing,
Paralysis spreads to extremities, coma, death.
Unexplained sudden deaths in dogs should be viewed as
suspected rabies, hence handlers should be treated by PEP
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39. SIGNS OF RABIES IN DOGS / CATS DURING 10
DAYS’ OBSERVATION PERIOD
Change in behaviour – undue aggression/ depression.
Running aimlessly and attacking others without any provocation.
Becomes too drowsy and withdraws itself to a corner.
Excessive Salivation.
Change in voice.
Refusal to feed or eating unusual objects like stones, papers, wood, metal
pieces.
Death of animal due to unknown cause.
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40. RESERVOIR CONTROL
Domestic animals
• Vaccination programs for all dogs and cats.
• Removal of strays and unwanted animals.
• Animal Birth Control (ABC) for stray dogs
• To create rabies free areas and maintain them by adequate
Monitoring and surveillance
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41. IMMUNIZATION OF DOGS
• Primary immunization at age of 3-4 months
A) BPL inactivated nervous tissue vaccine:
• 20% suspension of infected sheep brain
• Dose: Dogs- 5ml; Cats – 3ml
• Booster : after 6 months
& every year
41
42. B) Modified Live Virus Vaccine:
• 33% chick embryo suspension infected with modified virus.
• Dose: 3ml
• Booster: every 3 years
42
43. CONTROL OF URBAN RABIES:
• Registration and licensing of domestic dogs
• Restraint of dogs in public places
• Immediate destruction of dogs and cats bitten
by rabid animals
• Quarantine for about 6 months of imported dogs
• Health education of people regarding the care of dogs and
prevention of rabies
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44. PERSONAL SAFETY AGAINST RABIES
Do not touch animal bite wounds with bare hands.
Do not touch fomites (Chain, food plate etc.) of an animal
suspect or proven rabid.
Keep away from stray / sick animals.
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45. Do not stare at or provoke any animal.
Take pre-exposure vaccination if you are in constant touch
with animals.
Avoid contact with saliva, urine, tears, semen, vaginal
secretions and other body secretions of a rabies patient.
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46. RECOMMENDATIONS FOR HEALTH CARE
PERSONNEL AND FAMILY MEMBERS OF
PATIENTS WITH RABIES:
•Post exposure prophylaxis(PEP)
•Personal protective equipment's( wearing gloves, glasses &
mask)
•Hospitals that are likely to receive rabies patients can consider
PrEP for health care staff who may be involved in their mgt.
•PEP for partners of patients; however no reports have clearly
established human to human transmission
•Risk of an infant contracting rabies from breast milk is not
reported yet. However it is advisable for avoidance of
breastfeeding.
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47. EDUCATION OF PET OWNERS:
Get your pet regularly and periodically examined by a
qualified veterinarian.
Get your pet vaccinated
at three months of age
and again 1 month later
Boosters every year
subsequently.
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48. NATIONAL RABIES CONTROL PROGRAMME
• Pilot tested under 11th five year plan in 2008, found
successful
• Ministry of HFW has approved the programme in 12th five
year plan
• NCDC New Delhi is the nodal centre
• One Health approach includes animal and human component
• Animal welfare board, min of environment and forest will be
nodal centre for co-ordinating human component
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49. ORGANIZATIONS /AGENCIES
INVOLVED IN RABIES CONTROL IN
INDIA
• Governmental Agencies
• Ministry of Health -Central and State
• Ministry of Agriculture--Central and State
• State Animal Husbandry Department
• Animal Welfare Board
• Local Civic bodies
• National Institute of Mental Health & Neurosciences, Bangalore
• Government Veterinary Colleges
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50. NON GOVERNMENTAL ORGANIZATIONS
INVOLVED IN RABIES CONTROL IN INDIA
• Kempegowda Institute of Medical Sciences, Bangalore
• Rabies in Asia Foundation (RIA)
• Association for the Prevention and Control of Rabies in India
(APCRI)
• Commonwealth Veterinary Association (CVA)
• Global Alliance for Rabies Control (GRAC)
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