Rabies is a fatal viral disease transmitted primarily through bites from rabid animals like dogs, cats, and wildlife. The virus affects the central nervous system. It is prevented through vaccination and treated through a combination of vaccines and antibodies after exposure. Pre-exposure vaccination involves three doses while post-exposure treatment requires immediate vaccination and antibodies at the site of bite along with further booster shots. Rabies remains a public health problem in many developing countries where dog vaccination programs are lacking.

2. RABIES
 Primarily a Zoonotic disease of warm
blooded animal
 such as :-
 Dogs,
wild cats,
 Jackals,
wolves etc.
 It is caused by the Neurotropic RNA virus belongs to
Rhabdoviridae type I (LYSSAVIRUS type I) is Bullet
shaped virus

3.  It is an acute
 Highly fatal viral dis: of CNS
Transmitted to man by:
 Bites
OR
 Licks of rabid animals

5. Rabies virus structure
Envelope
Matrix protein
Glycoprotein
Nucleocapsid protein
Source: http://www.cdc.gov

6. History of Rabies Virus
Man described the disease in 2300 B.C.
The origin “rabhas”, meaning “to do violence”
comes from ancient Indian Sanskrit dating 3000
B.C.

7. History of the Rabies Virus
Since Roman times, man established the link between
the infectivity of a rabid dogs saliva and the spread of
the disease.
Because there is no cure for rabies, those that had been
bitten by a rabid dog would commonly commit suicide to
avoid the painful death that would inevitably follow.

8. History of the Rabies Virus
 Louis Pasteur was the first person to
diagnose that rabies targeted the CNS.
 Also determined that nervous tissue of an
infected human or animal also contained
the virus.
 In 1890 created the rabies vaccine and
saved 9 year old child after he had been bit
by a rabid dog.

9. 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.

10. RESERVOIR OF INFECTION
1) URBAN RABIES:
From Dogs and
cats.

11. 2) WILD LIFE RABIES:
From jackals and foxes.

12. 3) BAT RABIES:
Vampire bats which live on the blood of animals and men.
These are one of the main causes of the death of bovine, around 0.5
to 1 million per year.

13. Source of Infection
 Saliva of Rabid animal

14. Host Factors
 All warm blooded animals including man.
 Rabies in man is a dead-end infection.

15. Mode of Transmission
1. ANIMAL BITES
2. LICKS
3. AEROSOL
4. PERSON TO PERSON

16. INCUBATION PERIOD:
 normally it is 3 - 8 wks
may be short that is 4 days
 or may be prolonged for years.

17. CLINICAL PICTURE
1. Prodromal symptoms
Headache, malaise, sore throat, low
fever, pain at the site of bite
2. Excitation Symptoms
sensory sys: involvement
Aero phobia, excitation of N.S.
Motor sys: inv:
increase reflexes, muscle spasm,
Symp:inv: dilatation of Pupils. increase
perspiration, salivation, and Lacrimation,

18. Mental changes: fear of death, anger,
irritability and depression
Hydrophobia ( Fear of water)
sight or sound of water may produce
spasm of degulation
the duration of illness is 2-3 days may be
prolonged to 5-6 days
Stage of paralysis & coma
DEATH / Recovery

20. Clinical forms of rabies
 encephalitic = furious
 ~ 80%
 paralytic = dumb
 ~ 20%

21. Encephalitic rabies
 prodromal symptoms
 paresthesias/pain/pruritus at site of bite
 episodes of generalized arousal or
hyperexcitability separated by lucid
periods
 autonomic dysfunction
 hydrophobia

22. Paralytic rabies
 paresthesias/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

23. DIAGNOSIS
1. History
2. Sign and symptom
3. Examination
4. Detection of Antigen by taking Skin
Biopsy using Immunofluorescence
by virus isolation from Saliva &
other secretions.

24. Control Measures
 Notification
 Isolation
 Disinfection
 Immunization

25. Prevention of human rabies
post Exposure prophylaxis
1. General consideration:- Aim is to neutralize virus before entering CNS
2. LOCAL WOUND TREATMENT
a, Cleansing of wound(soap & water)
b, Chemical treatment:
 Either Alcohol 400-700 ml /liter
 Tincture Iodine

26. c, Suturing not recommended
d, Anti Rabies Serum
e, Antibiotic and ATS
f, Observe the animal for 10 days

27.  3, Immunization
 1,NERVOUS TISSUE VACCINE (NTV
2, Human diploid cell vaccine
(HDCV)

28. Rabies postexposure guide:
exposure to dogs, cats, and ferrets
Evaluation of Animal Recommendation
Healthy and available for
10 days observation
No treatment unless
animal develops clinical
signs of rabies
Rabid or suspected rabid Immediate treatment*
Unknown (e.g., escaped) Consult local
public health
department
*Discontinue treatment if tests on animal prove negative.

29. Vaccines for immunization
Definition:
it is fluid or dried preparation of
Rabies “Fixed” virus grown in the
Neural tissue of
Rabbits,
Sheep,
Goats,
Mice or Rats
OR in embryonated duck eggs
OR in cell culture

30. Nervous Tissue
vaccine
Duck embryo
vaccine
Cell culture
vaccine
preparation From fixed virus grown in
brain of sheep or other
animals
potency Low or variable Eliminate Neuroparalytic
factors
More potent
more safer
Doses Large nos: are required Fewer doses of small
volume
Side effects Severe & fatal reactions Allergic risks Fewer
Uses Exposed subjects Used in UK,USA in past 1, (HDC) safe, potent
Pre & post
expos:Immunization
Suckling mouse brain V
Devoid of Neuroparalytic
effect
Used in Latin America
Improvement over adult
animal nervous tissue V
Now purified DEV
developed
Improvement over adult
animal nervous tissue V
Not available in India &
Pakistan
2Tissue culture 2nd G
(Non-human)
Potent, low cost
WHO recommendatio

31. Type of Vaccine
NERVOUS TISSUE VACCINE (NTV)
a. Derived from adult animal nervous
tissue eg. Sheep
b. Derived from suckling mouse brain
Type: Killed viral vaccine
Dose: 2.5 ml S/C (Ant.
Abdominal wall)
Schedule: 14 doses

32. Type of Vaccine (conti)
Duck Embryo Vaccine (DEV)
Type: Killed viral vaccine
Dose: 1 ml S/C ( Ant. Abdominal wall)
Schedule: 14 doses OD
not available in Pakistan

33. Type of Vaccine (conti)
CELL CULTURE VACCINES
a. Human diploid cell vaccine (HDCV)
b. Second generation tissue culture
vaccine (non- Human)
Type: Killed viral vaccine
Dose: 1 ml IM
Schedule: on 0, 3, 7, 14, 28 day,
booster on day 90

34. Adverse Reactions to Rabies Vaccines
Most common side-effects of rabies vaccines:
 Systemic reactions such as headache,
myalgia, malaise (5-40%)
 Mild to moderate local reactions at injection
site (30-74%)

35. PASSIVE IMMUNIZATION
 Horse Anti Rabies serum: 40 iu / kg at
0 day
 Human rabies immunoglobin (HRIG):
20 iu / kg around the wound and rest
in IM on 0 day
 Booster doses are essential whenever
anti rabies serum is given with the
vaccine

36. IMMUNITY
 Duration of Immunity is upto 06
month
 If again bite by rapid animal than
dose according to blood titre
if more than 0.5 i.u. / ml than only two
dose 0, 3 day
if less than 0.5 i.u. / ml than 0, 3, 7
day

37. General measures
 Regist:,licensing & taxation of dog.
 Muzzling of dogs
 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

38. Preexposure rabies prophylaxis
 3 doses of rabies vaccine (days 0, 7, and 21
or 28)
 May check rabies antibody titre periodically –
want >0.5 IU/mL
 after a rabies exposure:
 2 doses of IM rabies vaccine (days 0 and 3)
 no HRIG

39. Pre-exposure rabies prophylaxis
Tissue culture vaccine: 1 dose IM or 0.1 ml ID
Day 0 7 21 28

40. Rabies prevention - Summary
 Rabies is a preventable disease.
 Failure to recognize a risk of infection results
in human deaths.
 Increased awareness of sources and routes
of virus transmission could save lives.
 Pre-exposure vaccination should be used
widely.
 Post-exposure treatment is urgent.
 For previously vaccinated people post
-exposure treatment is simpler, cheaper and
more effective.