This document provides an overview of rabies disease management. It discusses that rabies is caused by a virus in the Rhabdovirus family and is typically transmitted to humans via bites or scratches from infected animals. Common symptoms include anxiety, confusion, hydrophobia, and paralysis. Diagnosis involves detecting viral antigens or nucleic acids in samples. Post-exposure prophylaxis, consisting of wound cleaning and a vaccine series with or without immunoglobulin administration, must begin immediately after exposure to prevent disease onset. Preventive measures include vaccinating pets, avoiding wild animals, and seeking medical care after a potential exposure.

1. CLINICAL PHARMACY
DISEASES MANAGEMENT-
RABIES
BY DR SABA RAZZAK

2. 6/10/2020 2

3. OUTLINES
O INTRODUCTION
O ETIOLOGY
O TRANSMISSION
O CAUSES
O SYMPTOMS
O DIAGNOSIS
O RISK FACTORS
O PRE-EXPOSURE IMMUNIZATION
O PREVENTION
O POST EXPOSURE PROPHYLAXIS
O OTHER MEASURES
O REFERENCE
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4. INTRODUCTION
O Rabies is a vital infectious disease caused by Rhabdovirus.
O Transmitted to humans by the infected animals through bites, scratches or licks on
broken skin or membrane, usually via saliva.
O Different animal can cause rabies but the 99% of cases are due to dog bite.
O Resulting the inflammation of CNS and Salivary glands.
O Prevalence of rabies is mostly in rural areas involves poor and vulnerable
populations.
O These populations cannot easily obtainable effective immunizations that available
for rabies.
O Mostly children under age 15 are prone to infection with rabies and deaths are
also reported.
O Globally about 15 million population receive post exposure prophylaxis for rabies
that avoid death of infected individual. 6/10/2020 4

5. O Rabies is caused by lyssaviruses in the Rhabdovirus
family.
O Lyssaviruses are usually confined to 1 major reservoir
species in a given geographic area.
O Rabies is worldwide distributed with the exception of a few
countries like Australia New Zealand UK, are free historically
free of this disease and 59 others countries like Malaysia,
Singapore.
O The Island of Taiwan, /Hawaii, Fiji have achieved Rabies free
status. .
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E P I D E M I O L O G
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6. O About 98.9% of cases transfer to human through rabid dogs by biting or
scratch.
O Africa and Asia suffer about 98% deaths due to rabies worldwide.
O Bats are main factor of human rabies death in America, Australia and
Western Europe.
O Death of human also occurs by the foxes, jackals, mongooses, raccoons,
and wild carnivore.
In contact with contaminated material like saliva enter into rupture
mucosa or skin wounds.
Inhalation of virus contaminated aerosols and infected organ
transplantation is less. Other animals are also responsible for rabies
viruses.
T R A N S M I S S I O N
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7. MODE OF TRANSMISSION
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8. TRANSMITTED ANIMALS
PETS AND FARM
ANIMALS
WILD ANIMAL
Cats,
cows,
dogs,
ferrets,
goats,
Horses.
Coyotes,
Monkey,
Raccones,
Bats,
Beavers.
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9. 6/10/2020 9

10. CAUSES
O Most common cause of rabies is virus. Death
may occur if brain is infected.
O Virus reside inside Subcutaneous tissue and
muscles when an animal bites a person.
Through peripheral nerve virus get entered
into brain and then again through these
nerves spread throughout the body.
O Different mammals may also cause rabies.
O Rabies not only occur in humans it may also a
disease of Cows, Cats, ferrets and horses.
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11. SYMPTOMS
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13. TYPES OF RABIES
Paralytic Rabies:
In 20% of cases laggardly muscles become
paralyzed that mostly occur when an animal
bite.
Furious Rabies:
80% cases of rabies are ‘furious rabies’’. In this
type patient having classic symptom of rabies
including:
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14. CONTINUE
Anxiety and
confusion
Encephalitis
leads to
hallucinations,
confusion and
coma
Hypersensitivity Hydrophobia
Difficult
swallowing
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15. 6/10/2020 15

16. Headway of rabies involve
5 steps; incubation,
prodrome, acute
neurologic period, coma &
Death
1,Incubation: time
period of 3-12 weeks
prior symptom
appearance. It may be
of minimum 5 days and
maximum 2 years.
2,Prodrome: Primal symptom
similar to ‘flu-like’’ subsume
fever, headache, anxiety, sore
throat and cough, nausea and
vomiting.
3,Acute neurologic
period: At these stage
symptoms appear are
related to brain that are
confusion, aggression,
convulsions, partial
paralysis.
4,Coma and
5,Death: Once patient
goes in coma, he/she
may not survive more
than few hours until
ventilator is not
attached.
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17. 6/10/2020 17

18. DIAGNOSIS
Recent methods used for diagnosis does not give results until the clinical disease
is not occur.
It is difficult to diagnose clinically unless symptoms of hydrophobia or aerophobia
appears.
Saliva, blood sample, spinal fluid and skin samples are commonly used for
human diagnosis.
Diagnostic test detect protein as surface of rabies virus, demonstrate
antibody(immune) response to virus and detect genetic material of virus. But this
rabies confirmation test are intra-vitam and post-mortam.
These are accomplished by diagnostic techniques detecting whole viruses,
nucleic acid in infected tissues (brain, skin, saliva or urine), viral antigen etc.
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19. RISK FACTORS
O Low income developing countries contribute to infect the traveller
by rabies like Africa and south- eastern.
O Involvement of activities with wild animal also transmit rabies.
O Searching that areas where bats live.
O Not taken any protective method to keep away wild animal from
camp.
O When not use the safety protocol in laboratory from rabies virus
during working.
O In the brain travelling of rabies virus due to head or neck injury or
wounds.
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20. PRE-EXPOSURE IMMUNIZATION:
Diploid cell vaccine is
injected IM 1ml three
injections on day 0,7, 21
Or 28 due to pre-
exposure proplylaxis in
those persons having
greater chambers of
exposure.
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21. PREVENTIVE MEASURES
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22. PREVENTIVE MEASURES
O As we know rabies is a fatal viral disease
that must be controlled and prevented,
results in reduce mortality rate due to
rabies disease. Variety of parameters
must be taken, to reduce the risk of
coming in touch with rabid/infected
animals,
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23. PREVENTIVE MEASURES
O PETS VACCINATION
O KEEP YOUR PETS CONFINED
O GIVE MORE CARE TO SMALL PETS FROM PREDATORS
O REPORT OFFICIAL LOCAL AUTHORITIES IF YOUR PET
IS LOST
O STAY AWAY FROM WILD ANIMALS
O AVOID BATS ENTRY TO YOUR HOME
O DO VACCINATION IF YOU ARE TRAVELLING
O AWARENESS
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24. POST EXPOSURE PROPHYLAXIS
(PEP)/TREATMENT:
O Instant treatment after exposure to a bite is post exposure prophylaxis.
O The bite victim may become rabies and can results into entry of virus to the
brain which can be fatal. PEP avoids/prevents entrance of the virus into the
CNS so it should be recommended immediately after coming contact with a
rabies infected animal.
O Before symptoms start to appear after exposure, series of measures should
be taken as PEP. Strategies of PEP involves;
O Thorough wound washing and local treatment immediately after exposure.
O Rabies vaccination should be potent, effective and WHO provided.
O Rabies immunoglobulin (RIG)’s administration, if needed.
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25. RECOMMENDED PEP
Provision of PEP is
recommended on the basis
of how severe the contact is
with rabies infected animals.
Table 1 -CONTACT
CATEGORIES AND
RECOMMENDED
POSTEXPOSURE
PROPHYLAXIS(PEP)-
WHO
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26. CATEGORY EXTENT OF
CONTACT
EXPOSURE PEP
MEASURES
Category 1 Contact with
animals or
licks on
unbroken
skin
No exposure No measure
taken
Category 2 A small bite ,
scratch or a
minor bruise
without any
bleeding or
licks on
peeled skin.
Minor
exposure
Local wound
treatment
And
immediate
vaccine
administratio
n
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27. CATEGORY EXTENT OF
CONTACT
EXPOSURE PEP
MEASURES
Category 3 Single or multiple
bites
transdermally,bru
ises or licks on
exposed skin.
Mucous
membrane
contamination
with
saliva due to
licks.
Bats exposure
Severe
Exposure
Immediate
administration
of
rabies
immunoglobuli
ns and
instant
vaccination.
Local wound
care
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28. EXTENSIVE WOUND
WASHING
Emergency care should be given to
an injured person before regular
medical care can be provided.
Instant and
Extensive washing of the wound for
about 15 minutes with water and
soap, detergent, povidone iodine or
with
other substances that can act as
virucidal.
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29. ADMINISTRATION OF RABIES
IMMUNOGLOBULINS (RIG)
A fast acting dose of RIG should be given to injured and infected person as
rapidly as you can, to prevent the infection.
It is supposed to neutralize the virus and is administered as a first dose of the
rabies vaccine.
It is given at once as a single dose.
Recommended dose for children and adult is “human rabies immunoglobulin
20 IU/kg or highly purified require immunoglobulin derivative F(ab)2, 40 IU/kg”.
In case you missed the RIG
on first day or not available then rabies vaccination will be administered alone
as a first dose.
RIG can be effective only for 7 days of bite after that it will not effective
because vaccine induced immunity will start to develop after this time.
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30. RABIES VACCINATIONS
For category 1 and 2, A complete coarse of rabies
vaccination is recommended. From the day of bite,
vaccination should be initiated and continued to
completion ever after risks of rabies eliminated.
Various types are available for rabies vaccines; some
vaccines are obtained from cell culture (CCV) such as
Human diploid cells (HDCV)
Vero cells (PVRV)
Chick embryo cells (PCECV)
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31. O The CCV(s) must substitute nerve tissue
vaccines (NTC).
O WHO have provided shortest vaccination
regimen;
O Table 2-POSTEXPOSURE
VACCINATION REGIMEN
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32. NO Pre-exposure vaccination or
unknown vaccination status or
incomplete pre-exposure vaccination
or complete pre-exposure vaccination with a
NTV
Complete pre-
exposure
vaccination with
a CCV
Intramuscular (IM) 2-0-1-1
Administer in the deltoid muscle
(anterolateral thigh in children <2
years), never in the gluteal muscle
One IM dose =0.5 or 1 ml
(depending on the manufacturer)
Intradermal
(ID)*
2-2-2-0-2
Use only PVRV
or PCECV
vaccine
One ID dose
=0.1ml
IM or ID*
1-1
One IM dose =
0.5 or 1ml
(depending on
the
manufacturer)
One ID
dose=0.1ml
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33. D0 2 doses
(one dose in each
arm or thigh
2 doses
(1 dose in
each arm)
1 dose
D3 2 doses
( 1 dose in
each arm)
D7 1 dose
(in the arm or thigh)
2 doses
(1 dose in
each arm)
D
21
1 dose
(in the arm or thigh )
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34. D28 2 doses
(1 dose in
each arm)
+ RIG on Day 0, if indicated NO RIG
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35. OTHER MEASURES:
For infected
wounds
antibiotics
such as co-
amoxiclav is
indicated for
about 5-7
days.
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36. THANKYOU
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