PRACTICAL RABIES

NEHAL VAIDYA

MBBS, DCH.

POOJAN HOSPITAL BHUJ

RAPID FIRE

1

• The rabies virus is passed on by contact with what part of an infected animal?

• A. Skin

• B. Saliva

• C. Blood

• D. Claws

• E. B and C

ANSWER

• The correct answer is B. Saliva .

• The rabies virus is transmitted to others through the saliva of the infected animal. All mammals can carry the virus. Humans can contract the virus through a bite from the infected animal, or from a scratch, scrape, open wound, or mucous membrane that comes in contact with the saliva. It is not possible to contract the virus by petting a rabid animal or through contact with the blood, urine, or feces of a rabid animal, the CDC says.

2

• How soon do symptoms typically appear after a person is infected with the rabies virus?

• A. 48 hours

• B. 1 week

• C. 1 month

• D. 1 year

A

• The correct answer is C. 1 month .

• Symptoms usually appear 30 to 90 days after exposure. Depending on the severity of the bite and the place on the body that was bitten, symptoms may appear more quickly. In rare cases, however, a person may not develop symptoms until a year or more after exposure.

3

• SUTURING WOUND PROTECTS

• -TRUE

• - FALSE

A

• FALSE

• The wound should be cleaned with plenty of soap and water and should be kept open

• Suturing or bandaging can help virus replication

4

Recently instead of five doses a one dose vaccination schedule is available.

- True

- False

A

• False

• The vaccination schedule for post exposure is 0,3,7,14,28.

5

• In non serious cases, you can give anti rabies serum and wait for 7 days before starting vaccination

• True

• false

A

• False

• Both should be started

HOW RABIES REACHES BRAIN

Event symptoms Clinical phase Duration Pathogenesis

ExposureBite or scratch from, or mucosal contact

with, a rabid animal

Fever, malaise, chills, fatigue, insomnia, anorexia, headache, anxiety, irritability

Incubation20–90 days

1. Virus inoculation2. Virus replicates in the muscle3. Virus binds to nicotinic

acetylcholine receptors

Paralytic rabiesFlaccid muscle

weakness

Furious rabiesPain, paraesthesia or

pruritus at the wound site

Non-specific prodromal

phase

2–10 days

Ascending spread of flaccid muscle

weakness, muscle fasciculations,

bilateral weakness of facial muscles,

sphincter Involvement

Arousal, hyper excitability periods

of confusion,hallucinations,agitation andhydrophobia

First neurological

signs> 10 days

4. Virus travels within the axonsin peripheral nerves

Onset of coma

Acute neurological

phase2–7 days

5. Infection of the brain neurons causing neuronal dysfunction

6. Centrifugal spread along nerves to salivary glands, skin, corneas and other organs

DeathComa

0–14 days*

RAPID LEARNING

Category

Type of contact with a suspect or

confirmed rabid domestic or wild animal, or

animal unavailable for testing

Recommended post-exposure

prophylaxis

ITouching or feeding animals, licks on

intact skin (i.e. no exposure)No prophylaxis

IINibbling of uncovered skin, minor scratches or

abrasions without bleeding

• Anti-rabies vaccine immediately

• Stop treatment if animal remains

healthy throughout an observation

period of 10 days

III

Single or multiple transdermal bites or

scratches, licks on broken skin, contamination

of mucous membrane with saliva from licks,

exposures to bats

• Anti-rabies immunoglobulin

immediately

• Anti-rabies vaccine immediately.

• Stop treatment if animal remains

healthy throughout an observation

period of

10 days*

RAPID LEARNING

•Observation Period, should depend on availability of animal for observation and laboratory testing. • In developing countries like India, the vaccination

status of the implicated animal alone should not be considered when deciding whether to give or withhold PEP eg: Stray or Pet dog exposure

• Treatment may be modified if animal involved (dog or cat) remains healthy throughout the observation period of 10 days by converting post-exposure prophylaxis to pre-exposure vaccination by skipping the vaccine dose on day 14 and administering it on day 21 or 28 while using Essen Schedule

DON’Ts AND DOs

Magical , religious practicesdo not help (e.g. witchcraft, turmeric

powder etc.)

Wash the woundthoroughly with plenty of

water and soap

Apply an antiseptic(povidone iodine) or

alcoholDo not cover or Suturethe wound

DON’TAT HOME or

CLINICAT CLINIC

Cat II & III

Cat III

RAPID LEARNING

WHO recommended Essen (5-dose) intramuscular regimen

Injected into deltoid (adults) or anterolateral area of thigh (children <2 years)

PEP: Passive Immunization for Category III exposure

RIG administration is must for category III exposure

• RIG infiltrated in & around wound/s

• Two types of RIG

– Human RIG

– dose 20 IU/kg of body weight

– Equine RIG

– dose 40 IU/kg of body weight

• RIG provides passive immunity

– Immediate access to rabies virus-

neutralizing antibodies (RVNA)

– Provides protection until active

immunity begins

– 7-10 days post-vaccination

Source: 1. WHO Rabies Report 2010; 2. NCDC Rabies report 2007, Govt. of India

20

Re-exposure prophylaxisOnly 2 doses to be given to pre-vaccinated (PrEP or PEP) victims

x1 x1

Day 0 3

One dose (IM) is administered on Days 0 & 3

No RIG is required

• In instances where the biting dog or cat is healthy, vaccinated and available for an

observation period of 10 days, one may ensure a proper wound management and defer

booster vaccination if the PrEP or previous PEP was completed in the last 3 months.

Source: 1. WHO 2004. Rabies Technical Report Series 931; 2. WHO Rabies Report 2010; 3. NCDC Rabies report 2007, Govt. of India; 4. Rabipur PI

Injected into deltoid (adults) or anterolateral area of thigh (children <2 years)

PRE EXPOSURE PROPHYLAXIS

• COURSE

• 0, 7, 28.

• BOOSTERS EVERY 3 YRS

CATEGORY?

CATEGORY?

HOW TO FACE AN ATTACKING DOG?

ATTACK IF YOU ARE ATTACKED

THANK YOU