for MBBS phase II students 29th July 2021 with videos and pictures For educational use only and NOT FOR PROFIT www.consortiumagainstrabies.com Credit: Dr Anurag Agarwal (Gen Secretary, Consortium Against Rabies)

1. Rabies
Amir Maroof Khan, MD, FAIMER (CMCL)
Professor of Community Medicine
University College of Medical Sciences and GTB Hospital
Delhi
29th July 2021 MBBS 2019 admission year cohort

2. Question
• A 18 year old boy calls you on a Saturday night and tolds that he has
got a dogbite. What will you do?

3. Video 1 – Rabies (discretionary viewing advised)

4. What is Rabies:
Rabies is a zoonotic disease that is caused
by lyssa viruses of the
family Rhabdoviridae.
Lyssaviruses are RNA viruses that are
highly neurotropic and cause fatal
encephalitis when the virus gains access to
the central nervous system (CNS).
http://vir.sgmjournals.org/content/87/9/2663.full

5. Rabies is caused By:
All warm-blooded
vertebrates including Man
are susceptible to Rabies.
Reservoirs consist of the
Carnivorous such as dog,
cat, mongoose, bat etc.

6. Transmission and Pathogenesis:
Incubation period
Ranges from few days to
several months, and can be
more than 1 year.

7. Factors that influence development
of rabies:
• Type of exposure/severity of bite
• Amount of rabies virus introduced
• Animal responsible for the bite
• Type of Rabies virus
• Immune status of the victim

8. Clinical Manifestations:
Furious rabies(most common form of
human rabies)
Paralytic

9. Prevalence:
•No. of deaths worldwide per year: >
55,000
•No. of deaths in India per year: 18,000
to 20,000 (36% of global deaths)
http://www.who.int/bulletin/volumes/92/4/14-136044/en/
http://www.who-rabies-bulletin.org/About_Rabies/What_is_rabies.aspx

10. Awareness Level in India:
Only 70% of the people have ever heard of
rabies.
Only 30% know to wash the wounds after
animal bites .
Of those who get bitten, only 60% receive a
vaccine.
http://www.who.int/bulletin/volumes/92/4/14-136044/en/

11. Symptoms:
The first symptoms are flu- like.
Human patients complain of feeling tired with pain and
stiffness.
Soon afterwards, symptoms begin to include neurological
dysfunction (problems with the brain and nerves).
This may include slight paralysis, anxiety, sleeplessness,
paranoia, and delirium.

12. Rabies – A Dreadful Disease:
Death occurs in 3 to 5 days due to
respiratory paralysis or cardiac arrest.

13. Management Of Rabies:
• Pre exposure
• Post exposure (We will focus on this today)

14. Category Of Exposures:
Category
Type of contact with a suspected or confirmed
rabid domestic or wild animal, or animal
unavailable for observation
Recommended
treatment
I
• Touching or feeding of animals.
• Licks on intact skin
None, if reliable case
history is available
II
• Nibbling of uncovered skin
• Minor scratches or abrasions without bleeding
Administer vaccine
immediately.
III
• Single or multiple transdermal bites or
scratches
• Licks on broken skin
• Contamination of mucous membrane with
saliva
• Exposure to bats
Administer RIG and
vaccine immediately.
WHO Recommendations ( based on category of
Animal bites):

15. Post-Exposure Treatment:
* Center for Disease Control and Prevention (CDC); Human Rabies Prevention —Recommendations of the Advisory Committee on Immunization
Practices; May 2008
Treatment Schedule
Wound Washing with soap and running water for
20 min
Dosing regimen for post-exposure treatment:
IM
Day 0
ID
Day 0
RIG (HRIG 20 IU/Kg or ERIG 40
IU/Kg)
+
Rabies Vaccine
Day 3 Day 3 Rabies Vaccine
Day 7 Day 7 Rabies Vaccine
Day 14 * Rabies Vaccine
Day 28 Day 28 Rabies Vaccine

16. Post-Exposure Prophylaxis:
Wound cleansing
 Immediate gentle irrigation
with water or a dilute
Povidone-Iodine solution
decrease the risk of infection.
Passive immunization
HRIG – Immediate
protection
Active immunization
Vaccine – 0, 3, 7, 14, 28. Takes 2 to 4
weeks for producing protective titer levels

17. Wound washing and RIG
Pics courtesy: Dr Anurag Agarwal, Hony Secretary, Consortium Against
Rabies

18. RIG administration – video 1
Discretionary viewing advised

19. RIG administration – video 1
Discretionary viewing advised

20. ARV (Anti Rabies vaccine) administration

21. Rabies Immunoglobulins:
Types of rabies immunoglobulins:
Human Rabies Immunoglobulin (HRIG)-
Effective against multiple rabies viruses
Equine Rabies Immunoglobulin (ERIG)
Monoclonal Antibody- effective against
single or specific rabies virus.

22. Dosage:
Human Rabies Immunoglobulin 20 IU per
kg of body weight.
Equine RIG 40 IU per kg of body weight
Maximum dosage for HRIG 1500 IU and of
ERIG is 3000 IU

23. Administration Of RIG
Infiltrated as much as possible in and around
all wounds.
Remaining HRIG/ERIG, it should be given
intramuscularly on the anterolateral thigh
region or deltoid region.

24. Advantages of HRIG:
 Lesser dose require 20 IU/kg body weight.
 Can be given in pregnancy and lactation.
 can be given to patient having history of
Antisera administration (e.g. Anti snake, AGGS,
etc.)
 No Sensitivity test require.
 HRIG is Safe and more efficient as compare to
monoclonal as have broad coverage.

25. Acknowledgement
• Dr Anurag Agarwal (General Secretary, Consortium Against Rabies)