The document summarizes a seminar on rabies that covers the disease's introduction, historical perspective, epidemiology, pathogenesis, clinical features, diagnosis, prevention, and treatment. Key points include that rabies is a fatal viral disease transmitted through animal bites, especially from dogs; it has been known since ancient times but was discovered in the 15th century; and while incurable once symptoms appear, post-exposure prophylaxis including vaccination and immunoglobulin administration can prevent the disease if administered promptly after exposure.
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
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
Scrub typhus, also known as bush typhus, is a disease caused by a bacteria called ORIENTIA TSUTSUGAMUSHI.
Scrub typhus is spread to people through bites of infected chiggers (larval mites).
Most cases of scrub typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia. Anyone living in or travelling to areas where scrub typhus is found could get infected
Scrub typhus is not transmitted directly from person to person; it is only transmitted by the bites of vectors
Chiggers are abundant in locales with high relative humidity (60%–85%), low temperature (20°C–30°C), low incidence of sunlight, and a dense substrate-vegetative canopy.
Occupational risk is higher in farmers (aged 50–69 years), females.
Pertussis : Highly contagious respiratory infection caused by Bordetella pertussis
Outbreaks first described in 16th century
Bordetella pertussis isolated in 1906
Estimated >300,000 deaths annually worldwide
Before the availability of pertussis vaccine in the 1940s, public health experts reported more than 200,000 cases of pertussis annually.
Since widespread use of the vaccine began, incidence has decreased more than 75% compared with the pre-vaccine era.
In 2012, the last peak year, CDC reported 48,277 cases of pertussis.
Extremely contagious-attack rate 100%
Immunity is never complete
Protection begins to wane in 3-5 yrs after vaccination
A mosquito-borne viral disease occurring in tropical and subtropical areas.
Spreads by animals or insects
Requires a medical diagnosis
Lab tests or imaging often required
Short-term: resolves within days to weeks
Those who become infected with the virus a second time are at a significantly greater risk of developing severe disease.
Symptoms include high fever, headache, rash and muscle and joint pain. In severe cases there is serious bleeding and shock, which can be life threatening.
Treatment includes fluids and pain relievers. Severe cases require hospital care.
japenese encephalitis is an important vector borne disease which carries a high mortality as well as high disability. it is a preventable disease and an effective vaccine is available for it.the vaccine is an important part of universal immunization program in india. Environmental modification and control of vector will go long way in the control of this disease.
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
Scrub typhus, also known as bush typhus, is a disease caused by a bacteria called ORIENTIA TSUTSUGAMUSHI.
Scrub typhus is spread to people through bites of infected chiggers (larval mites).
Most cases of scrub typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia. Anyone living in or travelling to areas where scrub typhus is found could get infected
Scrub typhus is not transmitted directly from person to person; it is only transmitted by the bites of vectors
Chiggers are abundant in locales with high relative humidity (60%–85%), low temperature (20°C–30°C), low incidence of sunlight, and a dense substrate-vegetative canopy.
Occupational risk is higher in farmers (aged 50–69 years), females.
Pertussis : Highly contagious respiratory infection caused by Bordetella pertussis
Outbreaks first described in 16th century
Bordetella pertussis isolated in 1906
Estimated >300,000 deaths annually worldwide
Before the availability of pertussis vaccine in the 1940s, public health experts reported more than 200,000 cases of pertussis annually.
Since widespread use of the vaccine began, incidence has decreased more than 75% compared with the pre-vaccine era.
In 2012, the last peak year, CDC reported 48,277 cases of pertussis.
Extremely contagious-attack rate 100%
Immunity is never complete
Protection begins to wane in 3-5 yrs after vaccination
A mosquito-borne viral disease occurring in tropical and subtropical areas.
Spreads by animals or insects
Requires a medical diagnosis
Lab tests or imaging often required
Short-term: resolves within days to weeks
Those who become infected with the virus a second time are at a significantly greater risk of developing severe disease.
Symptoms include high fever, headache, rash and muscle and joint pain. In severe cases there is serious bleeding and shock, which can be life threatening.
Treatment includes fluids and pain relievers. Severe cases require hospital care.
japenese encephalitis is an important vector borne disease which carries a high mortality as well as high disability. it is a preventable disease and an effective vaccine is available for it.the vaccine is an important part of universal immunization program in india. Environmental modification and control of vector will go long way in the control of this disease.
NDWC Chennai 2013 - The One Health approach towards Rabies elimination in Asi...Dogs Trust
Dr Abdul Rahman's presentation on ''The One Health approach towards Rabies elimination in Asia'' at the National Dog Welfare Conference, Chennai India 27th and 28th February 2013.
One World - One Health presentation Katinka de Balogh FAOHarm Kiezebrink
During the FVE conference in Brussels on April 7, 2014, Katinka de Balogh, leader the global Veterinary Public Health activities of the FAO, presented the One-Health approach to highlight the importance of prevention, ensuring health and welfare of people and animals in a globalized environment:
• The benefit coming from the implementation of good health management in practice, both in terms of health and welfare, as well as, of financial sustainability
• The importance of coordinating actions in both sectors via a One-Health approach, with a particular focus on zoonotic diseases
• The role of the medical and veterinary profession in assuring these matters and educating the society
Katinka de Balogh is of Dutch and Hungarian origins and grew up in Latin-America. She studied veterinary medicine in Berlin and Munich and graduated and obtained her doctorate in tropical parasitology from the Tropical Institute of the University of Munich in 1984. In the late 80’s she had spent two years as a young professional at the Veterinary Public Health Unit of the World Health Organization (WHO) in Geneva. In 2002 she started working at the Food and Agriculture Organization of the United Nations (FAO) in Rome.
Rabies ,a deadly viral disease transmitted by the most beautiful beings. by ...uzmashireenmbe01
This ppt features all the basic aspects of Rabies with respect to virology. From students to teachers this ppt is handy for everyone. This includes rabies case study introduction, structure, virus life cycle, pathogenesis, transmission, symptoms, treatment and awaresess.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
2. CONTENTS
• INTRODUCTION
• HISTORICAL PERSPECTIVE
• EPIDEMIOLOGY
– PROBLEM STATEMENT
– AGENT AND RESERVOIR OF INFECTION
– MODES OF TRANSMISSION
• PATHOGENESIS
• CLINICAL FEATURES
• RABIES SURVEILLENCE
• DIAGNOSIS
• PREVENTION
• TREATMENT
• CONCLUSION
3. INTRODUCTION
• Rabies is one of the oldest recognized diseases affecting
humans and one of the most important zoonotic diseases
• Discovered and named by Girolamo Fracastoro in 15th
century
• Acute, highly infectious and fatal disease of the CNS
• Caused by Lyssavirus type 1
• Zoonotic disease of warm blooded animals
• Transmitted by bites of rabid animal
• Long and variable IP with short period of illness
• Virtually 100% fatal but 100% preventable
5. HISTORICAL PERSPECTIVE
• The word “Rabies” has been derived from the Sanskrit
word “Rabhas” which means “To do violence”
• Another belief is that, the word has originated from the
Latin word “Rebere” which means “To rave”, meaning
talking irrelevantly (delirium)
• Also known as “Jalasanthra”, which means agony
caused by water
• Shushrutha emphasized that the antecedent cause of
this condition in human being was the bite of a mad
dog and it was fatal
6. • Because of its potentially violent nature, rabies has
been known since 2200 B.C.
• The first written record of rabies is in the
Mesopotamian Codex of Eshnunna (1930 BC), which
dictates that the owner of a dog showing symptoms of
rabies should take preventive measure against bites
• If another person was bitten by a rabid dog and later
died, the owner was heavily fined
7. 7
Painting of a rabid dog
biting a man
Arabic
A.D. 1224
Baghdad school, by
Abdallah ibn al-Fadl
Picture courtesy of
Smithonian Institution,
Washington D.C.
8. • Rabies was considered a scourge for its prevalence in the
19th century
• In France and Belgium, where Saint Hubert was
venerated, the "St Hubert's Key" was heated and applied
to cauterize the wound; by an application of magical
thinking, dogs were branded with the key in hopes of
protecting them from rabies
• 6th July 1885- Sir Louis Pasteur for the first time
successfully treated a 9 yr. old boy (Joseph Meister) with
his vaccine
9. • 1903- Negri, an Italian scientist, demonstrated inclusion
bodies in the neurons of rabid animal, which are named
after him as “Negri Bodies”
• 1911- David Semple developed Semple vaccine or BPL
vaccine
• 1964- Witkor and Kaprowski, developed tissue culture
vaccine by culturing the virus in human diploid cell
• 6th July is celebrated as world zoonoses day or world
Rabies free day
13. • Enzoonotic as well as epizoonotic disease
• Occurs in more than 100 countries and territories
• Potential threat to more than 3 billion people
• Incidence -- 35,000-50,000 deaths/Year (WHO)
30,000 deaths/yr in India
24,000 deaths/yr in Africa
• 15 million people receive rabies prophylaxis annually
with majority males
PROBLEM STATEMENT
14. INDIA
• 20,000 Deaths, 17.4 million animal bite case annually.
• India accounts for 36% of the Global and 65% of the
Asian human rabies deaths.
• In India rabies is reported from all states except In India
rabies is reported from all states except Lakshadweep
and the Andaman & Nicobar Islands.
• No age or sex predilections (higher incidence of animal
bites and rabies deaths among children and adult males)
• 96 % of human rabies cases are due to bites
16. Rabies free areas
Continents: Australia and Antarctica
Asia: Japan, Malaysia, Oman and Qatar
Europe: Great Britain, Scandinavian countries, Spain and
Portugal
America: Guyana, Uruguay and Jamaica
Oceania: Fiji and Papua New Guinea
India: Andaman & Nicobar and Lakshadweep
Islands
17. AGENT- RABIES VIRUS
• Rhabdovirus
• Lyssa virus -type 1
• Bullet shaped virus
• Size is 180 x 75 nm
• Has Lipoprotein envelope
• Knob like spikes /Glycoprotein G (Antigenic substance)
• M protein layer
• Genome-unsegmented,Linear, negative sense
18. AGENT-RABIES VIRUS
Taxonomy:
• Family: Rhabdoviridae
• Genus: Lyssavirus type 1
• Species: Rabies virus
• Bullet-shaped
• Has lipoprotein envelope
• Knob like spikes /Glycoprotein G (Antigenic
substance)
• ~180 nm long and ~75 nm wide
• Single-stranded
• Negative sense RNA
19.
20. TYPES OF RABIES VIRUS
STREET VIRUS
Definition: The virus
recovered from naturally
occurring cases of rabies is
called “street virus”
Sources: It is naturally
occurring virus. It is found
in saliva of infected
animal
FIXED VIRUS
Definition: the virus which
has a short, fixed and
reproducible incubation
period is called “fixed
Virus”
Sources: It is prepared by
repeated culture in brain
of rabbit such that its I.P.
is reduced & fixed
21. Features
• It produces Negri bodies
• Incubation period is long
i.e. 3 weeks to 3 months
• It is pathogenic for all
mammals
• Cannot be used for
preparation of vaccine
Features
• It does not form Negri bodies
• Incubation period is constant
between 5-6 days
• It can be pathogenic for
humans under certain
conditions
• Is used for preparation of
antirabies vaccine
22. RESERVOIR OF INFECTION
URBAN RABIES:
• From Dogs and cats.
• 99% cases in India
• A single infected dog
is capable of
transmitting over an
area of 40km
23. WILDLIFE RABIES
• SYLVATIC RABIES
• Unidentified reservoir of
infection
• Foxes, jackals, hynas, skunks
etc
• Enzootic in South America by
Mongoose
• Transmit infection among
themselves and to dogs and
man
24. BAT RABIES
• Latin American Countries, USA
• Vampire bats-feed on blood of
man and animals
• Found from Mexico to
Northern Argentina
• Cause havoc to cattle
• Not reported in India
• Constant source of infection to
man and animals
• Transmission by bites and
aerosols
25.
26. INFECTIVE MATERIAL
• Rabid animals- saliva, serum, urine and milk
• Human cases- saliva, sweat, semen and tears
PERIOD OF INFECTIVITY
• The rabid dog is infectious during last 3-5 days of
incubation period and during the entire period of
illness, 8-10 days
27. SOURCE OF INFECTION
• Saliva of Rabid animal
• Dogs and cats-virus in saliva 3-
4 days before clinical
symptoms
• Variable in quantity
28. MODES OF TRANSMISSION
Bites from infected animals
Licks on Broken Skin or Mucous
Membrane
Scratches
Inhalation
Organ transplantation
29. Host Factors
• All warm blooded animals including man
• Rabies in man is a dead-end infection
• People at risk-lab workers, veterinarians, dog handlers,
hunters, etc
30. INCUBATION PERIOD:
• Normally 3 weeks – 3 months
• May be short that is 15 days or may be prolonged for
years.
• Depends on
– site of bite
– Severity of bite
– Richness of nerve supply
– Amount of saliva deposited
– Species of biting animal
– Protection provided by clothing
33. • Despite 100% fatal nature of the disease there are
only minimal pathological changes
• Grossly - Brain is oedematous, congested
• Histopathology -Perivascular cuffing, Gliosis
• Minimal Neuronal Damage – necrosis
• Presence of Negri bodies is Pathognomonic
PATHOLOGY
34.
35. Human rabies: Clinical stages
Death usually occurs within a few days after the
appearance of clinical symptoms
First
neurologic
signs
Clinical
stage
Incubation
period
Prodrome
phase
Acute
neurologic
phase
Coma
Usual
duration
First
clinical
signs
Exposure Onset of
coma
Death
2-10 days 2-7 days 0-14 days
Onset of rabies symptoms may start rather
late, ie, onset of symptoms documented
months, even years, after exposure
20-90 days
36. Clinical Rabies in Humans
CLASSICAL HYDROPHOBIA: (80-90% of cases)
Prodromal stage:
• First clinical symptoms: non-specific, i.e., malaise,
fever,headache, tingling and numbness at the site of
bite
Stage of excitement:
• CNS is affected in the following order- sensory, motor
and sympathetic system
Stage of paralysis
37. DUMB/PARALYTIC RABIES: (10-20% of cases)
• Seen among partially immunized persons
• Common clinical features include
Gradual ascending paralysis
Constipation and urinary retention
Stupor, coma and death within 1-2 weeks
• Hydrophobia is usually absent
38. Clinical rabies in Dogs
• Two forms of rabies are distinguished:
• Furious or Frank Rabies (75-80%) (encephalitic; three-
forth of all cases):
– Rabies transmitted from dogs is usually furious
• Paralytic (20-25%) (dumb; one-fourth of all cases)
40. Rabies prevention
Human rabies Dog rabies
Post-exposure
prophylaxis
Mass vaccination of
dogs
Pre-exposure
prophylaxis Dog-population
management
Increased access to
vaccines
41. Rabies surveillance
Essential to detect high-risk areas and outbreaks
quickly and to monitor the use of vaccine
In Human populations
Surveillance of human exposure to rabies
Surveillance of cases of human rabies
Rapid exchange of information with services in
charge of animal rabies surveillance and control is
required
Epidemiological investigation of outbreaks
42. In animal populations
Surveillance in endemic areas for similar illness in
both wild & domestic species likely to be reserviors
Laboratory based- on human exposure
Suspected domestic animals- kept under observation
for 10 days
Rapid exchange of information
Where samples can not be collected, cases to be
recorded as suspected animal rabies & data sharing
43. Prevention
• Immunize all dogs and cats owned by an individual or by
the community
• Reduce the size of the ownerless dog population by
reproduction control, reduction of the carrying capacity
of the environment and law inforcement when needed
Epidemics
• Intensive vaccination of dogs in combination with dog-
• population control and movement restriction to be
implemented immediately
45. Ante-mortem Diagnosis
Samples-saliva, serum, spinal fluid, and skin biopsies
of hair follicles at the nape of the neck
Saliva-virus isolation or reverse transcription
followed by polymerase chain reaction (RT-PCR)
Serum and spinal fluid-antibodies to rabies virus
Skin biopsy specimens are examined for rabies
antigen in the cutaneous nerves at the base of hair
follicles.
46. Diagnostic tests
Histopathology & Electron Microscopy
Detection of antigen by taking skin biopsy using
Direct fluorescent antibody test (DFA)
Virus isolation from saliva & other secretions
CSF analysis and CT scan
ELISA
RT-PCR- saliva & skin biopsy
Negri bodies
47. Post-exposure prophylaxis
Management of animal bite wound(s)
Passive immunization with Rabies
Immunoglobulin (RIG)
Active immunization with Anti-Rabies Vaccines
(ARV)
48. Management of animal bite wound(s)
Wound(s) toilet
Mechanical removal of virus
from the wound(s)
Inactivation of the virus
50. • Application of antiseptics
• Local infiltration of rabies immunoglobulin
• Suturing
• Cauterization
• Tetanus prophylaxis
51. Prevention of human rabies
The 5 Important Things
Magico-Religious Practices
(e.g. witchcraft, turmeric
powder etc.) DO NOT
HELP
Wash the wound
thoroughly with plenty of
water and soap
Apply an antiseptic
(povidone iodine) or even
alcohol
Do not cover or
Suture
the wound
Vaccinate
Immediately
e.g. Raibipur 1 mL
52. Category of bites (WHO)
• Touching or feeding of animals
• Licks on intact skin
• Contact of intact skin with secretions/
excretions of rabid animal/human case
Category I
• Nibbling of uncovered skin
• Minor scratches or abrasions without
bleeding
Category
II
• Licks on mucous membrane
• Single or multipe transdermal bites or
scratches, licks on broken skin
Category
III
53. Recommended Treatment
• NoneCategory I
• Local Rx of wounds
• Anti rabies vaccine
Category II
• Local Rx of wounds
• Anti rabies vaccine
• Rabies immunoglobulin
Category III
54. Rabies Immunoglobulin (RIG)
• Ready-made anti-rabies antibodies, to tide over the initial
phase of the infection
• Binds with the rabies virus resulting in neutralization and thus
loss of infectivity
• Infiltrated locally at the site of wound/bite
Two types are available:
Equine Rabies Immunoglobulin (ERIG)
Human Rabies Immunoglobulin (HRIG)
• Indicated to i. all category III exposures
ii. both category II and III exposures in immuno-
compromised patients
55. Equine Rabies Immunoglobulin
• Heterologous, produced by hyperimmunisation of
equines
• Highly purified Fab 2’ fragments
• Small risk of anaphylactic reaction
• Dose of ERIG is 40 IU per kg body weight of patient
• Preparations contain 300 IU of immunoglobulin per
ml
56. Currently available equine rabies
immunoglobulin in India
Brand Product Pharmaceutical
Anti-Rabies
Serum
(ARS)
Purified equine RIGs, 5 ml vial
(300 IU/ml, 1500 IU potency)
Central Research
Institute, Kasauli,
Himachal Pradesh
Equirab Purified Equine RIGs, 5ml vial (300
IU/ml, 1500 IU potency)
Bharat Serums and
Vaccines Limited,
Mumbai
Vinrig Purified Equine RIGs, 5ml vial (300
IU/ml, 1500 IU potency)
VINS Biopharma,
Hyderabad
Abhayrig Purified Equine RIGs, 5 ml vial
(300 IU/ml, 1500 IU potency)
Human Biologicals
Institute, Hyderabad
57. Human Rabies Immunoglobulin
• Homologous origin; relatively free from the side
effects
• Expensive and is imported from other countries
• Longer half-life-given at half the dose of equine anti-
rabies serum
• Dose of the HRIG is 20 IU per kg body weight
• HRIG preparation is available in concentration of 150
IU per ml
58. Currently available human rabies
immunoglobulin in India
Brand Product Pharmaceutical
Berirab-P Human Rabies Immunoglobulin,
150IU/ml; 2 ml (300 IU) ampoule
& 5 ml (750 IU) ampoule
ZLB Behring AG,Marburg,
Germany/Bharat Serums
and Vaccines Ltd.,
Mumbai.
Imogamrab Human Rabies Immunoglobulin,
150IU/ml; 2 ml (300 IU) ampoule
& 5 ml (750 IU) ampoule
Sanofi Pasteur, France
Kamrab Human Rabies Immunoglobulin,
150 IU/ml; 2 ml (300 IU) vial and 5
ml (750 IU) vial
Kamada Ltd.,Beit-Kama,
Israel /Synergy
Diagnostics Pvt.
Ltd.,Thane,Maharashtra
59. Administration of RIG
Do’s
• Should be brought to room temperature before
administration
• As much of the dose is anatomically feasible should
be infiltrated into and around the wound
• Remaining dose to be administered by deep IM at a
site distant from the vaccine injection site
• If multiple wounds present, calculated volume to be
diluted in sterile normal saline to a volume sufficient
to infiltrate all the wounds
60. • Can be administered up to the seventh day after the first
dose of ARV
• Tip of finger/s and toe/s, ear lobe/s or bites on nose or
around the eye should be carefully infiltrated without
excessive pressure
• Patient kept under observation for at least half–an–hour
after administration of ERIG
Don’t’s
• Multiple needle injections into the wound/s should be
avoided
61. • Total recommended dose of RIG must not be
exceeded→ suppress antibody production
• Should never be administered in the same syringe or
at the same anatomical site as vaccine
62. Anti-Rabies vaccines
• Nerve tissue vaccines used previously
• Reactogenic and less immunogenic
• Production was stopped in December, 2004
• Cell culture vaccines (CCVs) and Purified Duck Embryo
vaccines (PDEV) are now used for active immunization
• Given as one single intramuscular dose with potency of >
2.5IU per IM dose
• CCVs approved for intradermal could be given ID
• Adverse events following immunization (AEFI) very
minimal with CCVs & PDEVs
63. Vaccines
1. Cell Culture Vaccines
• Human Diploid Cell Vaccine (HDCV), Liquid (Adsorbed),
1ml: Produced locally in private sector
• Purified Chick Embryo Cell Vaccine (PCECV), 1ml:
Produced locally in private sector
• Purified Vero Cell Rabies Vaccine (PVRV), 0.5ml and 1ml:
Imported and also produced locally in public & private
sectors
2. Purified Duck Embryo Vaccine (PDEV), 1ml: Produced
locally in private sector
64. Currently available anti-rabies vaccines in India
Brand Product Pharmaceutical
Abhayrab* Purified Vero cell Rabies Vaccines
(PVRV)
Human Biologicals Institute,
Hyderabad
Indirab* Chromatographically purified
(PVRV)
Bharat Biotech International
Ltd, Hyderabad
PVRV Purified Vero cell Rabies Vaccine
(PVRV)
Pasteur Institute of India,
Coonoor, Tamilnadu
Rabipur* Purified Chick Embryo Cell Vaccine
(PCECV)
Novartis Vaccines, Mumbai
Rabivax Human Diploid Cell Culture Vaccine
(HDCV) (Liquid)
Serum Institute of India,
Pune
Vaxirab Purified Duck Embryo Vaccine
(PDEV)
Zydus Health Care ltd.,
Ahmedabad
Vaxirab-N* Purified Chick Embryo Cell Vaccine
(PCECV)
Zydus Health Care Ltd,
Ahmedabad
Verorab* Purified Vero cell Rabies Vaccines Sanofi Pasteur/ Zuventus
65. Storage, Transport & Reconstitution
• Most CCVs and PDEV are stored and marketed in freeze
dried (lyophilized) form
• But vaccines should be kept and transported at a
temperature range of 2-8ºC and protected from sunlight
• Reconstituted with the diluent prior to use
• IM dose to be given immediately after reconstitution
• Should not be used after 8 hours of reconstitution
• For ID administration, vaccine vial should be stored at 2-8ºC
after reconstitution and total content should be used at the
most within 8 hours
66. Immunity & antibody titre
• Lasting immunological memory with CCVs & PDEVs
• Good anamnestic responses for booster vaccination
in those who received primary series 5-21 years back
• No difference in response with route of vaccination
• Anti-rabies neutralizing antibody titre of 0.5 IU/ml or
more in serum is considered as protective
• Achieved in most healthy individuals by day 14 of a
post-exposure regimen
67. Common PEP regimens
Regimen
Doses in
the regimen Site of injection
Amp
used
Dose
(ml)
Essen (IM) 1-1-1-1-1 Deltoid
Ant Lat Thigh
5 0.5
or 1
Abbreviated
Multisite IM
(Zagreb)
2-0-1-0-1 Rt arm0, Left arm0
Deltoid
4 0.5
or 1
8-site ID 8-0-4-0-1-1 Deltoid, thigh, Supx,
lower ant abd
<2 0.1
Thai Red
Cross (ID)
2-2-2-0-1-1 Both Deltoid <2 0.1
Updated
Thai Red
Cross (ID)
2-2-2-0-2 Both Deltoid <2 0.1
68. Post-exposure prophylaxis IM administration:
Essen regimen
One IM dose of vaccine on Days 0, 3, 7, 14, and 28
RIG is always recommended for transdermal wounds
5 doses – 5 visits
1. WHO 2004; 2. WHO 2007
1 mL (IM) into
deltoid (adults) or
into anterolateral
area of thigh
(children)
69. Post-exposure prophylaxis IM administration:
Updated Thai Red Cross (2-2-2-0-2)
8 doses – 4 visits
RIG is always recommended for transdermal wounds
Days 0, 3, 7, and 28 – two 0.1 mL doses
0.1 mL per site
Administered in right and
left deltoid
1. WHO 2004; 2. WHO 2007
70. •The needle should be almost parallel with the skin
surface and the bevel of the needle facing upwards
•Inserted approximately 2 mm into the superficial
layers of the dermis
•Intradermal injections reduce the volume of vaccine
required and vaccine cost by 60% to 80%
ID injection technique
71. DCGI recommended post-exposure
IM and ID regimens: Summary
Regimen Day 0 Day 3 Day 7 Day 14 Day 21 Day 28 Day 90 mL Visits
Thai Red
Cross
(updated)
2 x
0.1 mL
2 x
0.1 mL
2 x
0.1 mL
– –
2 x
0.1 mL
– <1 4
Regimen Day 0 Day 3 Day 7 Day 14 Day 21 Day 28 Day 90 Vials Visits
Essen 1.0 mL 1.0 mL 1.0 mL 1.0 mL – 1.0 mL – 5 5
National Guidelines for Rabies Prophylaxis and Intra-dermal Administration of Cell Culture Rabies Vaccines, 2007
72. Management of re-exposure in previously
vaccinated individuals
• Priming of immune system and the development of
immunological memory→ long lasting immunity
• Anamnestic response to one or more booster doses in
persons previously receiving complete PrEP or PEP
• Two booster doses IM (0.5ml/1ml) or CCVs ID (0.1 ml at 1 site)
on days 0 and 3
• Proper wound toilet should be done
• Treatment with RIG not required
• Persons previously receiving NTV or vaccines of unknown
efficacy should be treated as fresh case & given full regimen
73. Pre-Exposure Prophylaxis (PrEP)
Full IM dose or 0.1 ml ID dose to be given on days 0, 7
and either day 21 or 28
Laboratory staff handling the virus and infected material
Clinicians, Persons attending to human rabies cases
Veterinarians, Animal handlers and catchers
Wildlife wardens
Quarantine officers and travelers from rabies free areas to
rabies endemic areas
Antibody titres checked every 6 months during the initial
two years period after the primary vaccination
If it is less than 0.5 IU/ml a booster dose of vaccine should
be given.
Subsequently, sero-monitoring is recommended every two
years.
74. Treatment
Most rabies deaths are caused by
temporary brain dysfunction with little to
no damage occurring to the brain itself
Willoughby et al at Children’s Hospital
of Wisconsin put Jeanna Giese into an
induced coma with ketamine &
midazolam (“Milwaukee protocol”)
Amantadine & Ribavarin was given
First & only person to
survive rabies without
vaccine
There is no specific treatment for rabies; it is invariably fatal
Giese brought out of coma after 6 days once immunity regained