Rabies is a fatal zoonotic viral disease primarily affecting the nervous system and transmitted through bites or exposure to infected saliva. The document discusses the epidemiology, clinical manifestation, and prevention strategies for rabies, highlighting its prevalence in Asia and Africa. It emphasizes the importance of vaccination and immediate wound management for unvaccinated individuals post-exposure.

1. RABIES
Dr.Muhammad Umair
Pharm.D, M.Phil. Clinical Pharmacy
Lecturer
Lahore Pharmacy College Of
Lahore Medical & Dental College (Pakistan)

2. Rabies
• Zoonotic viral infectious diseases; almost invariably fatal
• Virus attacks on the nerves system and later excreted in saliva
• A person can become victim in following ways;
• Bites of diseasedanimals
• Non-bites exposure
• Human to Human Transmission

3. Virology
• Rabies virus belongs to Lyssavirus genus of Rhabdoviridae
family
• Virus is enveloped and has a single stranded RNA genome
• All rahbdoviruses have two major structural components;
• Helical ribonucleoprotein core (RNP)
• Surrounding envelops

5. Epidemiology
• Asia
• Most of the developing countries in Asia are the victims
• Over 30,000 people die every year due to rabies in Asia
• 15% are likely to be the children under 15 years
• India, Srilanka, Bangladesh, Pakistan, Nepal are high risk areas
• Africa
• More than 24,000 deaths per year in Africa
• Majority of them are from poor rural communities or children
• Angola, Namibia, Mozambique, Zimbabwe are high risk areas

6. • Europe and united states
• On verge of disappearance from many
countries
• Policy of animalvaccination

7. Rabies free zones

8. Pathogenesis
• Transmission
• Bite of a rabid animal (Dogs, Bats, Racoons, Foxes,Skunks)
• Contamination of scratch wounds by virus infected saliva
• Incubation
• Replication in the striated or connective tissue at the site of
inoculation
• Enters the peripheral nerves through the neuromuscular junction

10. Clinical manifestation
• Initial symptoms (Prodrome)
• nonspecific
• Neuropathic pain at site of bite pruritus tingling
• Fever, anxiety, and malaise
• The initial symptoms of rabies are often vague and it can be easy to mistake them for other,
less serious, types of infection. Theyinclude:
• Fever
• Headache
• Feeling generally unwell
• Feeling scared or anxious

11. • After 2–10 days neurological signs appear
• Encephalitic and Paralytic forms
• Encephalitic manifestations
• May appear in episodes
• cerebral dysfunction and autonomic dysfunction
• Agitation, confusion, hydrophobia,aerophobia,
• hyperventilation, hyper-salivation, priapism, and convulsions
• Paralytic manifestations
• Peripheral nerves accompanied byfever
• Within 2–12 days, coma and cardiorespiratory failure starts

12. • Advanced symptoms
• After 10-14 days of prodromal phase, more severe symptoms start todevelop.
• Aggressive behaviour, hallucinations, agitation and producing lots of saliva
• Paralysis, and eventually death

14. Clinical forms of rabies
• Encephalitic = furious
• ~ 80%
• Paralytic = dumb
• ~ 20%

15. Encephalitic rabies
• Prodromal symptoms
• Paresthesia, Pain, Pruritus at site of bite
• Episodes of generalized arousal or hyper-excitability separated by lucid
periods
• Autonomic dysfunction
• Hydrophobia

16. Paralytic rabies
• Paresthesia, Pain, Pruritus at site of bite
• Early flaccid muscle weakness
• Often begins in bitten extremity
• Progresses to produce Quadriparesis
• Bilateral facial weakness
• Sensory examination is usually normal
• Sphincter involvement
• Fatal outcome
• Often misdiagnosed as Guillain - Barré syndrome

17. Diagnosis
• Tests are also performed on the samples of saliva, serum, and skin biopsies
of hair follicles at the nape of the neck

18. Human rabies prevention
• Pre-exposure prophylaxis
• Post-exposure management

19. Post-exposure immunization individuals
not previously vaccinated
• Wound site(s)
• Immediate thorough cleansing of all wounds with soap and water.
• Tetanus prophylaxis; antibiotics
• Human Rabies Immune Globulin (RIG)
• 20 IU/kg body weight
• As much of the RIG as possible should be infiltrated in wound(s)
• The remainder should be given IM at a site distant from vaccine
• Rabies Vaccine
• IM (1 mL) in the deltoid area on days 0, 3, 7, 14, and 28

20. Pre-exposure prophylaxis
• Populations at increased risk of exposure torabies
• Rabies research laboratory workers
• Veterinarians, staff, veterinary students
• Animal control and wildlife workers
• Bat handlers
• Spelunkers
• Travellers to certain rabies-endemic areas

21. • Rabies Vaccine
• 3 doses of rabies vaccine (days 0, 7, and 21 or28)
• May check rabies antibody titer periodically (>0.5 IU/mL)
• After a rabies exposure
• 2 doses of IM rabies vaccine (days 0 and3)
• No HRIG