Rabies is a viral zoonotic disease transmitted through the saliva of infected animals, most commonly through bites. It causes approximately 55,000 human deaths annually, mostly in Asia and Africa. Dogs are the primary reservoir and transmission occurs when their saliva comes into contact with open wounds in humans. Post-exposure prophylaxis within 6 days of exposure can prevent disease if the complete vaccine series is administered in combination with rabies immunoglobulin for severe exposures. Pre-exposure vaccination also provides protection for those at high risk of exposure. Controlling rabies in animals through vaccination programs and limiting contact with strays can help reduce human cases.

1. RABIES
Dr Pallavi Potdar
Associate Prof.,
Community Medicine
D.Y. Patil Medical College Kolhapur

2. Classification-
1) Anthropozoonosis –
2) Zooanthroponosis-
3) Amphixenosis-
ZOONOTIC DISEASES

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. Categories ..
 Meta-zoonosis- invertebrate vectors
vertebrate vector
e.g plague, schistosomiasis
 Sapro- zoonosis- vertebrate host + non-animal site
e.g larva migrants

5. RABIES

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.  In India alone, 20,000 deaths are estimated to
occur annually, i.e. 2 per 1,00,000 population
 Rabies free areas ?

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. RabiesVirus

10. Electron MicroscopeView
Negatively Stained RabiesVirus

11. Reservoirof infection
 Urban- dogs & cats
 Wild-life ( sylvatic)- jackal,fox
 Bat rabies- vampire bats

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. Carrier
 Dogs

14. Host
 all age groups are susceptible
 most common in children aged below 15 years
 High risk group-

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. Transmission
Animal bites-
Licks- on abraded skin/ mucosa
Aerosols – bats/labs
Person –person- corneal/organ transplant

17. Transmission
 Almost all
transmission is by bite
 50 times greater risk
than a scratch
 Pathogenesis

18. Animal Behavior
 Classic Picture of rabid,
dog foaming at the
mouth…
 aggressive behavior, ataxia,
irritability, anorexia,
lethargy or excessive
salivation.

19. clinical features in man
 Prodromal stage -3-5 days
 Sensory-
 Motor- muscle spasms
 Sympathetic-salivation,perspiration
 Mental system-
 hydrophobia

21. Rabies in man
 Diagnosis-
 Ag detection –immunofluorescence of skin
biopsy
 Virus isolation
 Treatment

22. 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

23.  HDC- human diploid fibroblast cells
 Safe, highly potent
 Animal vaccines- chick embryo fibroblast, dog
kidney cells

24. Prevention of human rabies
 Post-exposure prophylaxis
 Pre-
 Post-exposure Rx of patients previously
vaccinated.

26. Post-exposureprophylaxis
 Local treatment of wound-
cleansing
savlon, cetavlon ?
suturing ?
anti-rabies serum
antibiotics & TT
observe animal for 10 days

27. 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

28. 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

29. 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.

30. 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

31. Pre- exposure prophylaxis
 1 ml im/ 0.1 ml id
 O , 7 , 28
 Booster injections every 2 yrs

32. Postexposure Rx of previouslyvaccinated
 0, 3 ,7

33. Rabies in Dogs
 Incubation period- 3-8 wks
 2 forms-
 Furious rabies
 Dumb rabies
 Lab –
 Vaccination of dogs-

34. 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?

35. 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

36. How toavoid dog bites.
 If a growling dog comes near you…..
 ….stand still with your arms down, pretend you
are a tree.

37. How toavoid dog bites.
 If a dog attacks you….
 ….. curl into a ball and protect your face, pretend
you are a rock.