The document discusses rabies, including: 1) Rabies is caused by a virus that primarily infects dogs, cats, and wildlife like bats and foxes. It is transmitted through bites or scratches from infected animals. 2) There is no cure for rabies once symptoms appear, but it can be prevented through vaccination. Louis Pasteur developed the first rabies vaccine in the late 1800s. 3) In 2004, Jeanna Giese survived rabies after being bitten by a bat using an experimental treatment involving inducing a coma and using antiviral drugs, becoming one of only two known survivors of rabies without pre-exposure vaccination.

2. Rabies: Share the Message-“SAVE A LIFE”
Dr. Ripan Biswas
(Public Health Veterinarian)
Assistant Professor
Department of Veterinary Public Health
West Bengal University of Animal & Fishery Sciences

4. RABIES
(Hydrophobia, Lyssa, Rage, Tollwut)
 Rhabdovirus – enveloped
 ssRNA enveloped virus- bullet-shaped with 6-7 nm spike projections.
 -ve stranded RNA codes for 5 proteins; G, M, N, L, S
 Virus may persist upto 18 days at inoculation site
 Virus travels - 3mm/hr
Genotype
s
Serotype Host Geographical
occurrence
1 classical rabies virus Canids, racoons,
skunks etc.
Worldwide
2 Lagos bat virus Fructivorous bats Africa
3 Mokola virus Fructivorous bats Africa
4 Duvenhage virus Fructivorous bats South Africa
5 & 6 European bat Lyssavirus 1 and 2 Insectivorous bats Europe
7 Australian bat Lyssavirus (ABLV Flying foxes
(Megachiroptera
Australia

5. 87 countries contain Rabies, but more cases
are reported in Asia.
FREE RABIES ZONE:
• Australia,
• China,
•Iceland,
• Ireland,
• Japan,
• New Zealand etc

6. The Virus
• Shaped somewhat like a
bullet.

7. History of the Virus
The origin
“rabhas”,
meaning “to
do
violence”
comes from
ancient
Indian
Sanskrit
dating 3000
B.C.

8. •Outbreak of rabies in Europe in
20th century spawned the Vampire
myth- linked to bats.
•Rabies epidemic in 13th century
France may have spurred Were
wolf myth as well- linked to wolves.
•Rabies is commonly spread by
bats and wolves and other wildlife
like foxes
History of the Virus

9. Since Roman times, man established the link between the
infectivity of a rabid dog’s 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.
History of the Virus

10. 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 Joseph Meister
after he had been bite by a
rabid dog.
History of the Virus

11. 28 September also marks the anniversary of
Louis Pasteur's death

14. Clinical forms of rabies
• encephalitic = furious
– ~ 80%
• paralytic = dumb
– ~ 20%

15. The rabies infection and the symptoms that
accompany it is classified by five
stages:
1. Incubation (1-3 months)
2. Prodromal, where first symptoms occur
3. Acute neurological phase
4. Coma
5. Death or recovery

18. 18
 Human mortality from endemic area estimated -30,000- 55, 000 deaths/ year
 Half of the global human population lives in canine rabies endemic areas
(WHO, 2005)
 96% of cases due to bite of dogs (18 billion)
 3 - 3.5 million take post-exposure vaccines
 Economic cost due to rabies in Asia US $ 563 million
 Livestock losses: rabies incidence rate / lac cattle = 5
 Annual no. of cattle deaths = 21,150
(WHO Bull., 2005)
Human mortality Urban Rural
Total population (millions) 284.7 732.2
Population at risk (millions) 284.7 710.4
No. of bites from suspected rabid dogs (1000) 409.4 893.4
No. of rabies deaths 1058 18201
No. of deaths/ 1 lac people 0.37 2.49
Economic impact

19.  Dogs are the principle reservoirs of rabies.
 Cats, wolf, jackal, mongoose and monkeys are other
important reservoirs of rabies in India.
 Bats, rodents and squirrels has not been reported from India
 Transmitted mainly through the bite from infected animals.
 Wound contamination through infected materials like saliva
or infected nervous tissue
 Aerosol infection in bat infested caves.
 Virus circulates in a wide variety of wild animals which are the
potent source of being reservoirs.
 Human to human – possible mainly through corneal transplant
 In dead animals – virus become inactivated during autolysis
 In winter or refrigeration- virus remain for several month in
cadaver
 From milk – no evidence but its presence is possible

20. Control of Rabies
• Urban - canine rabies accounts for more than 96% of all
human rabies. Control measures against canine rabies
include;
– stray dog control.
– Vaccination of dogs
– quarantine of imported animals
• Wildlife - this is much more difficult to control than
canine rabies. However, there are on-going trials in
Europe where bait containing rabies vaccine is given to
foxes. Success had been reported in Switzerland.

30. Milwaukee Protocol
http://www.jeannagiese.com/my-personal-story.html
I am Catholic. On Sunday September 12,2004, I attended mass with my mother at St. Pat's Church in Fond du Lac, WI. About 15 minutes from the end of mass, a little
bat started flying around the church and bothering the congregation. The bat flew to the back of the church and an usher hit it to the floor and left it where it fell on
the top of the steps.
Being the animal lover that I was, and still am today, I walked back to the bat with the intention of releasing it outside. When I reached the bat, I quickly noticed how
cute it was and assessed the situation: the bat was on its stomach with its back towards me. I crouched down and decided that the safest way to pick it up would be by
the tips of the wings, so I did so. As soon as I grabbed the bat, it let out a very loud screech, and kept doing it, so I straightened up and hurried outside. I reached the
door and pushed it open with my hip.
As soon as I stepped outside, the Silver-haired Bat stretched over and sank its top left fang into my left index finger. THAT HURT. Like a needle injecting acid into your
finger tip. I walked over to a nearby pine tree and let go, hoping the bat would fall into the tree. It didn't let go. So, I grabbed the bat, pulled it from my finger, threw it
hard into the tree, and casually walked back inside to resume my position next to my mom.
Those 30 seconds with the bat's fang in my finger would change my life forever.
On Wednesday October 13, 2004, I took the PSAT with the rest of my sophomore class at St. Mary's Springs High School. That day, I was extremely tired and felt sick.
The following day, Thursday October 14, I woke up almost too sick to move. However, we had a very important volleyball game that night that I wanted to play in, I
couldn't let my team down, so I went to school anyways and to the game that night. During warm-ups I got double vision really bad. I almost passed out a couple of
times so I told one of our coaches that I was too sick to play. He told me to just sit on the bench. That game was horrible for me-I cried because I couldn't play, I
didn't know what was wrong with me, and I actually fell asleep (or passed out) randomly throughout the game! After the game, I walked up to my mom and asked her if
she knew why I didn't play. "Because you didn't feel good" was her response. I answered, "No. I had double vision."
I don't remember anything after that apart from a few random events. That Saturday was the football homecoming game, but I was too sick to get out of bed. I
remember telling my mom to take lots of pictures of the parade floats for me. Saturday night I was so bad that she took me to the emergency room. I can't remember
much.
I remember sitting in a wheelchair, and throwing up on my mom's blanket that was keeping me warm. I remember the neurologist having me stand on one leg, but I
couldn't keep my balance. I remember that the doctor left the room, and I suddenly remembered the bat bite and told my mom, who then told the neurologist. He
looked at the spot on my finger where it had bit me, and said that it's nothing to worry about because it healed. I remember having my first MRI, after which I collapsed
in a chair and forgot my way back to the waiting room.
I was sent home. I then returned the next day, even worse. I was hospitalized and tested for everything from meningitis to lime's disease. All tests came back
negative. My left arm was jerking, I couldn't stand, I had excess saliva and couldn't talk. My parents were watching their only daughter die. My pediatrician, Dr.
Howard Dhonau, came into my room Monday morning to check on me. my mom suddenly told him about the bat bite. He immediately rushed out of the room and
called down to Children's Hospital of Milwaukee and told them that I am a possible rabies case.
I was sent down to Children's Hospital that Monday, October 18, 2004.
When I arrived, they tested a skin sample from the back of my head and sent it to the CDC in Georgia. Rabies was confirmed, and I had less than 4 hours left to live.
Dr. Rodney Willoughby was not ready to let me die. He researched the internet and found a few key phrases that helped him devise a treatment. He told my parents,
and then offered the choice of the experimental treatment. He told them that it has never been done before, and he doesn't know if it will work or if I would come out
braindead.
My parents looked at each other and told Dr. Willoughby to try the experiment. They knew that if I did not make it, doctors would be one step closer to finding a cure.
I was put into a coma to isolate my brain and allow my own immune system to fight off the virus. Seven days later, I was slowly taken out of the coma. It was
unknown whether I was actually alive, or if my soul had left my body. My mother and Dr. Willoughby decided that it was time to find out. Dr. Willoughby held my eyes
open because I was too weak to do it on my own. He let go of my eyelids, and I kept my eyes open. My mother and Dr. Willoughby took off their masks so I could see
their face. I wasn't looking around, so Dr. Willoughby told me to look over at my mom. I did, and held my gaze. They knew I was there.
I spent 11 weeks in the hospital. I had to take 15 pills every morning and 2 at night to replenish the everything my body needs that was lost in the battle. The most
important one was BH4, without it I would've died a few months after surviving. I was in rehab from the day I was put into a coma. I had to re-learn how to speak,
walk, stand, pick things up, point, eat, drink, everything a baby learns.
I missed my family. They visited me of course but it was a change from seeing them every day at home. I hated my mother whenever she left, and cried with joy when
she came back. I missed my friends. I missed my school. I missed my dogs. I missed my room. I was so isolated. But the nurses I had were great, they helped ease the
pain of not being home.
I didn't regain my memory until Thanksgiving Day (November 26th). By not re-gaining my memory, I do not mean all past was lost. I mean that I cannot remember
what took place during that time only. In my mind, there is over a month of nothing.
On January 1, 2005, I was able to go home. My dad wheeled me out of the hospital doors, with my mom and 3 brothers walking beside and one of my many stuffed
animals in my lap, into a wall of cameras. There were so many cameras, every news stations wanted shots of The Rabies Survivor going home.

31. Jeanna Giese

32. Ketamine 2 mg/kg/hr
Midazolam 1-3.5 mg/kg/hr
Heparin 10 U/Kg/hr
Oxygen optimized by Blood
transfusion maintaining Hb
@ 10 gm/dl
CDS scientist-----Animal study-------------Ribavirin in CNS
Amantadine-------for Antiexcitotoxic effect
Benzodiazepine & Barbiturates for Burst
suppression
Ab found on 8th day of Hospitalization