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rabies ppt
1.
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
4.
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.
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.
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
19.
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.
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
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
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.
Editor's Notes
Autonomic features: hypersalivation, gooseflesh, cardiac arrhythmias, and priapism in males.
SLIDE 61
OTHER ADVERSE REACTIONS TO US LICENSED RABIES VACCINES FOR HUMANS
Most vaccine-related adverse events following administration of rabies vaccines for human use licensed by the FDA are transient mild to moderate responses, involving either local reactions at the injection site, or systemic symptoms such as headache, muscle pain, or fatigue. Severe neurologic or anaphylactic reactions are very rare; fewer than 1 per 1,000,000 doses of US-licensed vaccines have been reported.