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RABIES
INTRODUCTION
• Highly fatal disease of CNS
• Caused by Lyssavirus type 1
• Zoonotic disease of warm blooded animals
• Transmitted to humans by bites of rabid animal
• Long and variable IP with short period of illness
• no treatment, only prevention
RABIES VIRUS
• Rhabdovirus
• Lyssavirus-type 1
• Bullet shaped virus
• Size is 180 x 75 nm
• Has Lipoprotein envelop
• Knob like spikes /Glycoprotein G
RABIES VIRUSES ARE SENSITIVE
TO COMMON CHEMICALS
• The virus is sensitive to Ethanol Iodine Soap /
Detergents Ether, Chloroform, Acetone Destroyed at 500
c in 1 hour at 600 c in 5 minutes.
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.
• Incubation period is long i.e. 20 to
60 days
• It is pathogenic for all mammals.
• Cannot be used for preparation of
vaccine.
• 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.
• Incubation period is constant
between 4-6 days
• It can pathogenic for humans
under certain conditions
• Is used for preparation of
antirabies vaccine
EPIDEMIOLOGY
• 87 countries contain Rabies, but more cases are
reported in Asia. In Indo-Pakistan rabies is a major public
health problem mainly due to presence of a large no: of
stray dogs. More than 30,000 people died of Rabies
every year in Asia. Every year 10 million people require
treatment and protection from Rabies which is great
Financial loss.
EPIDEMIOLOGY
• North America 4 - 8
• Europe 10 - 20
• Latin America 200 - 400
• Africa 500 - 1,000
• Asia 30,000 - 40,000
• Rabies free areas, Australia, New zealand, Taiwan,
Cyprus, Iceland, Ireland, Japan, U.K., Finland, Norway,
Sweden
MODE OF TRANSMISSION
• Animal bites
• Licks
• Aerosol
• Person to person
INCUBATION PERIOD
• Normally 3 - 8 wks
• May be short that is 4 days or may be prolonged for years.
• Depends on-
• site of bite
• Severity of bite
• Number of wounds
• Amount of virus injected Species of biting animal
• Protection provided by clothing Treatment taken
PATHOGENESIS
Sign & Symptoms
• Headache
• fever,
• sore throat
• Nervousness
• confusion
• Pain or tingling at the site of
the bite
• Hallucinations
• Hydrophobia
• Paralysis
• Coma and death
• Bizarre behavior, Agitation,
Seizures, Difficulty in drinking,
Patients will be able to eat
solids, Afraid of water -
Hydrophobia.
• Spasms of Pharynx produces
choking, Death in 1 -6 days.
• Respiratory arrest / Death /
Some may survive.
CLINICAL PICTURE
• Early stage (1-3 days)
• fever(37.5-38)
• vomit
• wound: pain, red, itching.
• Exciting stage(1-3 days)
• fever(39-40)
• hydrophobia: pharyngeal muscle cramp, dyspnea
• dehydration.
• Paralytic stage(15-20 days)
• nerve fiber paralysis
• respiratory and circulatory failure
• death
CATEGORY OF BITES (WHO)
• Category I:
• Licks on unbroken skin
• Touching/ feeding animals
• Category II:
• Nibble, cuts, scratches without oozing of blood.
• Category III:
• Licks on mucous membrane or broken skin
• Bites with breach of skin, bleeding
DIAGNOSIS
• History
• Signs and symptoms
• Clinical examination
• Detection of antigen by taking skin biopsy using
immunofluorescence.
• virus isolation from saliva & other secretions.
• CSF analysis and CT scan
• ELISA
• PCR
TREATMENT
• No established treatment for rabies.
• Isolation of the patient
• Post-exposure prophylaxis
• Antianxiety drugs and sedatives
• Muscle relaxants with curare like action
• Ensure hydration and diuresis
• Cardiac and respiratory support
TREATMENT
• 1.POST-EXPOSURE PROPHYLAXIS
• To reduce viral load by elimination from the wound
• To neutrilise the virus at site of entry
• To prevent nerve infection
• To induce systemic immunity
• Includes
• wound treatment
• observation of the animal
• immunization
• advice to patient
TREATMENT
• The first human was successfully vaccinated for rabies in
1885 after being bitten by a rabid dog. vaccination is
normally only given to people who are exposed to a
rabid animal or those who are at an increased risk of
being exposed, such as veterinarians and animal care
workers.
TYPE OF VACCINE
• NERVOUS TISSUE VACCINE (NTV):
• Derived from adult animal nervous tissue eg. Sheep
• Derived from suckling mouse brain
• Type: Killed viral vaccine Dose: Schedule: 14 doses.
• Duck Embryo Vaccine (DEV):
• Type: Killed viral vaccine Schedule: 14 doses OD not
available in Pakistan.
• CELL CULTURE VACCINES:
• Type: Killed viral vaccine
• Schedule: on 0, 3, 7, 14, 28 day, booster on day 90
PREVENTION
• Regist:,licensing & taxation of dog.
• Yearly mass vaccination of dog
• Destruction of stray dogs
• Facilities for diagnosis of rabies in dogs
• Destruction of wildlife where the animals are known to be
the reservoir of infection.
• Publicity

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Rabies

  • 2. INTRODUCTION • Highly fatal disease of CNS • Caused by Lyssavirus type 1 • Zoonotic disease of warm blooded animals • Transmitted to humans by bites of rabid animal • Long and variable IP with short period of illness • no treatment, only prevention
  • 3. RABIES VIRUS • Rhabdovirus • Lyssavirus-type 1 • Bullet shaped virus • Size is 180 x 75 nm • Has Lipoprotein envelop • Knob like spikes /Glycoprotein G
  • 4. RABIES VIRUSES ARE SENSITIVE TO COMMON CHEMICALS • The virus is sensitive to Ethanol Iodine Soap / Detergents Ether, Chloroform, Acetone Destroyed at 500 c in 1 hour at 600 c in 5 minutes.
  • 5. 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. • Incubation period is long i.e. 20 to 60 days • It is pathogenic for all mammals. • Cannot be used for preparation of vaccine. • 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. • Incubation period is constant between 4-6 days • It can pathogenic for humans under certain conditions • Is used for preparation of antirabies vaccine
  • 6. EPIDEMIOLOGY • 87 countries contain Rabies, but more cases are reported in Asia. In Indo-Pakistan rabies is a major public health problem mainly due to presence of a large no: of stray dogs. More than 30,000 people died of Rabies every year in Asia. Every year 10 million people require treatment and protection from Rabies which is great Financial loss.
  • 7. EPIDEMIOLOGY • North America 4 - 8 • Europe 10 - 20 • Latin America 200 - 400 • Africa 500 - 1,000 • Asia 30,000 - 40,000 • Rabies free areas, Australia, New zealand, Taiwan, Cyprus, Iceland, Ireland, Japan, U.K., Finland, Norway, Sweden
  • 8. MODE OF TRANSMISSION • Animal bites • Licks • Aerosol • Person to person
  • 9. INCUBATION PERIOD • Normally 3 - 8 wks • May be short that is 4 days or may be prolonged for years. • Depends on- • site of bite • Severity of bite • Number of wounds • Amount of virus injected Species of biting animal • Protection provided by clothing Treatment taken
  • 11. Sign & Symptoms • Headache • fever, • sore throat • Nervousness • confusion • Pain or tingling at the site of the bite • Hallucinations • Hydrophobia • Paralysis • Coma and death • Bizarre behavior, Agitation, Seizures, Difficulty in drinking, Patients will be able to eat solids, Afraid of water - Hydrophobia. • Spasms of Pharynx produces choking, Death in 1 -6 days. • Respiratory arrest / Death / Some may survive.
  • 12. CLINICAL PICTURE • Early stage (1-3 days) • fever(37.5-38) • vomit • wound: pain, red, itching. • Exciting stage(1-3 days) • fever(39-40) • hydrophobia: pharyngeal muscle cramp, dyspnea • dehydration. • Paralytic stage(15-20 days) • nerve fiber paralysis • respiratory and circulatory failure • death
  • 13. CATEGORY OF BITES (WHO) • Category I: • Licks on unbroken skin • Touching/ feeding animals • Category II: • Nibble, cuts, scratches without oozing of blood. • Category III: • Licks on mucous membrane or broken skin • Bites with breach of skin, bleeding
  • 14. DIAGNOSIS • History • Signs and symptoms • Clinical examination • Detection of antigen by taking skin biopsy using immunofluorescence. • virus isolation from saliva & other secretions. • CSF analysis and CT scan • ELISA • PCR
  • 15. TREATMENT • No established treatment for rabies. • Isolation of the patient • Post-exposure prophylaxis • Antianxiety drugs and sedatives • Muscle relaxants with curare like action • Ensure hydration and diuresis • Cardiac and respiratory support
  • 16. TREATMENT • 1.POST-EXPOSURE PROPHYLAXIS • To reduce viral load by elimination from the wound • To neutrilise the virus at site of entry • To prevent nerve infection • To induce systemic immunity • Includes • wound treatment • observation of the animal • immunization • advice to patient
  • 17. TREATMENT • The first human was successfully vaccinated for rabies in 1885 after being bitten by a rabid dog. vaccination is normally only given to people who are exposed to a rabid animal or those who are at an increased risk of being exposed, such as veterinarians and animal care workers.
  • 18. TYPE OF VACCINE • NERVOUS TISSUE VACCINE (NTV): • Derived from adult animal nervous tissue eg. Sheep • Derived from suckling mouse brain • Type: Killed viral vaccine Dose: Schedule: 14 doses. • Duck Embryo Vaccine (DEV): • Type: Killed viral vaccine Schedule: 14 doses OD not available in Pakistan. • CELL CULTURE VACCINES: • Type: Killed viral vaccine • Schedule: on 0, 3, 7, 14, 28 day, booster on day 90
  • 19. PREVENTION • Regist:,licensing & taxation of dog. • Yearly mass vaccination of dog • Destruction of stray dogs • Facilities for diagnosis of rabies in dogs • Destruction of wildlife where the animals are known to be the reservoir of infection. • Publicity