Rabies is a fatal viral disease transmitted through the saliva of infected mammals. It causes acute inflammation of the brain and is nearly 100% fatal in humans if left untreated. Dogs are the primary source of human rabies infections. Post-exposure prophylaxis, consisting of wound cleansing, rabies immune globulin injection, and a vaccine series, is highly effective in preventing the disease if administered promptly after exposure. No approved treatments exist once symptoms develop, making vaccination an important part of rabies prevention.

1. RABIES
PRESENTED BY
MISS SUJATA MOHAPATRA.

2. DEFINITION
• Rabies is an acute, progressive
encephalomyelitis or highly fatal
viral disease.
• It is an Epizootic disorder.
• The case to fatality rate is the
highest of any infectious disease.

3. HISTORY
• The first written record of Rabies is in the
Mesopotamian civilization (1930 BC), which dictates
that the owner of a dog showing symptoms of Rabies
should take preventive measure against bites.

4. DISTRIBUTION
 Rabies is distributed on all
continents (with the exception of
Antarctica).
 Occurs in more than 150 countries
& territories.
 Globally more than 55,000 people
die of rabies every year.
 Every year, more than 15 million
people worldwide receive a post-exposure
preventive regimen which
is estimated to prevent 3,27,000
cases annually.

5. EPIDEMIOLOGY
AGENT
Rabies is caused by RNA viruses belong to
the family Rhabdoviridae, genus Lyssavirus.
It is a bullet shaped neurotropic RNA
containing virus.

6. HOST & RESERVOIR
Mammals are the natural hosts of
rabies.
All warm-blooded vertebrates including
Man are susceptible to Rabies.
Reservoirs consist of the Carnivorous
such as dog, cat, mongoose, bat etc.

7. Source of Infection
 The source of infection to man is the
saliva of rabid animals.
 In dogs & cats, the virus may be present in
the saliva for 3-4 days before the clinical
onset & during the course of illness till
death.
Cause > 90% of the
Human cases
3 – 5% of Human
cases

8. MODE OF TRANSMISSION

9. INCUBATION PERIOD
• It is highly variable in man, commonly 3-8
weeks following exposure.
– The closer the bite to the brain, the shorter
the incubation.
– Rabies virus travels 1 cm per day.

10. PATHOGENESIS

12. CLINICAL FEATURES
Mainly neurologic;
–Early signs (non-specific)
•Fever, headache, weakness, achy muscles
–Late signs
i.Incoordination, confusion, ssttrraannggee bbeehhaavviioorr
iiii..AAttttaacckkiinngg aanndd bbiittiinngg mmoovviinngg aatt ssttaattiioonnaarryy
oobbjjeeccttss
iii.Salivation (can’t swallow, like choking)
iv.Hydrophobia, Photophobia, Aerophobia
v.Paralysis, Seizures
–DDeeaatthh wwiitthhiinn 22 wweeeekkss ooff sshhoowwiinngg
ssiiggnnss

13. RABIES RECOVERY?
WORLDWIDE
• Five historical human
case recoveries, after
vaccination, but before
illness onset.
• Only one documented
unvaccinated human
survivor after clinical
presentation.

14. DIAGNOSIS

15. PREVENTION
• PRE EXPOSURE PROPHYLAXIS
• POST EXPOSURE PROPHYLAXIS

16. PRE ExPOsuRE PROPhylaxIs
• Provided to subjects at risk before
occupational or vocational exposure
to rabies.
• Subjects include diagnosticians,
laboratory & vaccine workers,
veterinarians, cavers, etc.
• Simplifies post exposure
management.
• Only vaccines used.

17. PEP (POsT ExPOsuRE PROPhylaxIs)
• Provided to subjects after rabies
exposure.
• Consists of wound care, rabies immune
globulin, and vaccine.
• Cleansing
• Chemical Treatment
• Suturing
• Anti-Rabies Serum
• Antibiotics & anti-tetanus measure
• Observe the animal for 10 days.

18. POsTExPOsuRE PROPhylaxIs
• Wash lesions well with
soap and water (tetanus
booster)
• Infiltrate rabies immune
globulin (20 IU/kg) into and
around the margin of the
bites.
• Administer vaccine on days
0,3,7,14, and 28

19. RaBIEs VaCCINE
1. Nervous Tissue Vaccine (NTV)
2. Duck Embryo Vaccine (DEV)
Purified Chick Embryo Cell RabAvert® (PCEC)
3. Cell-culture Vaccine (HDC)
Human Diploid Cell Vaccine Imovax® (HDCV)

20. VACCINE ADMINISTRATION
Class of
treatment
ADULT CHILDREN Duration of
Treatment
Class I 2ml 1ml 7days
Class II 3ml 3ml 10days
Class III 5ml 3ml 10days
(Dosage schedule by Pasture institute, Coonoor)
CLASS –I (Slight risk)
CLASS—II (Moderate risk)
CLASS– III (Severe risk)

21. Vaccine Administration
1. Intramuscular Schedules
 6 doses schedule
Reduced multisite intramuscular
regimen (2-1-1)
2. Intradermal Schedules
2-Site Intradermal schedule(2-2-
2-0-1-1)
8-Site intradermal schedule(8-0-
4-0-1-1)

22. RABIES IMMUNoGLoBULIN
ONLY IN PEP
• Two Human Rabies
Immunoglobulins are
available;
HyperRabTM S/D
Imogam® Rabies-HT
• Both supplied in vials at ~
150 IU/ml

23. ADVERSE REACTIoNS
• PEP should not be interrupted because of
local or mild systemic adverse reactions.
• Use of anti-inflammatory, antihistaminic, and
antipyretic agents suggested.
• Serious systemic, anaphylactic, or
neuroparalytic reactions are rare.

24. CASE MANAGEMENT
The patient should be isolated in a quite
room i.e. protected from external stimuli.
Relieve anxiety & pain by the use of
sedatives.
Morphin in doses of 30-45 mg may be given
repeatedly.
Ensure hydration & diuresis.
Respiratory & cardiac support.

25. NURSING RESPoNSIBILITY
Nursing personnel should be warned
against possible risk of contamination.
They should wear masks, gloves,
goggles & aprons to protect themselves.
Nurses having bruises, cuts or open
wounds should not be entrusted to look
after the patient.
Pre- exposure prophylaxis with 2-3
doses of HDC vaccine is recommended.

26. SUMMARIZATIoN

27. OPEN DISCUSSION