RABIES

PRESENTED BYSoumya ranjan parida

.

DEFINITION

• Rabies is an acute, progressive encephalomyelitis or highly fatal viral disease.

• It is an Epizootic disorder.

• The case to fatality rate is the highest of any infectious disease.

HISTORY• The first written record of Rabies is in the

Mesopotamian civilization (1930 BC), which dictates that the owner of a dog showing symptoms of Rabies should take preventive measure against bites.

DISTRIBUTION

Rabies is distributed on all continents (with the exception of Antarctica).

Occurs in more than 150 countries & territories.

Globally more than 55,000 people die of rabies every year.

Every year, more than 15 million people worldwide receive a post-exposure preventive regimen which is estimated to prevent 3,27,000 cases annually.

EPIDEMIOLOGY

AGENTRabies is caused by RNA viruses belong to the family Rhabdoviridae, genus Lyssavirus.It is a bullet shaped neurotropic RNA containing virus.

HOST & RESERVOIR

Mammals are the natural hosts of rabies.

All warm-blooded vertebrates including Man are susceptible to Rabies.

Reservoirs consist of the Carnivorous such as dog, cat, mongoose, bat etc.

Source of Infection

The source of infection to man is the saliva of rabid animals.

In dogs & cats, the virus may be present in the saliva for 3-4 days before the clinical onset & during the course of illness till death.

Cause > 90% of the Human cases

3 – 5% of Human cases

MODE OF TRANSMISSION

INCUBATION PERIOD

• It is highly variable in man, commonly 3-8 weeks following exposure.– The closer the bite to the brain, the shorter

the incubation.– Rabies virus travels 1 cm per day.

PATHOGENESIS

CLINICAL FEATURESMainly neurologic;

–Early signs (non-specific)•Fever, headache, weakness, achy muscles

–Late signsi.Incoordination, confusion, strange behaviorstrange behavior

ii.ii.Attacking and biting moving at stationary Attacking and biting moving at stationary objectsobjects

iii.Salivation (can’t swallow, like choking)

iv.Hydrophobia, Photophobia, Aerophobia

v.Paralysis, Seizures

–Death within 2 weeks of showing Death within 2 weeks of showing signssigns

RABIES RECOVERY?WORLDWIDE

• Five historical human case recoveries, after vaccination, but before illness onset.

• Only one documented unvaccinated human survivor after clinical presentation.

DIAGNOSIS

PREVENTION

• PRE EXPOSURE PROPHYLAXIS

• POST EXPOSURE PROPHYLAXIS

Pre Exposure Prophylaxis

• Provided to subjects at risk before occupational or vocational exposure to rabies.

• Subjects include diagnosticians, laboratory & vaccine workers, veterinarians, cavers, etc.

• Simplifies post exposure management.

• Only vaccines used.

PEP (Post Exposure Prophylaxis)

• Provided to subjects after rabies exposure.

• Consists of wound care, rabies immune globulin, and vaccine.

• Cleansing• Chemical Treatment• Suturing• Anti-Rabies Serum• Antibiotics & anti-tetanus

measure• Observe the animal for 10 days.

POSTEXPOSURE PROPHYLAXIS

• Wash lesions well with soap and water (tetanus booster)

• Infiltrate rabies immune globulin (20 IU/kg) into and around the margin of the bites.

• Administer vaccine on days 0,3,7,14, and 28. (90)

RABIES VACCINE

1. Nervous Tissue Vaccine (NTV)

2. Duck Embryo Vaccine (DEV)Purified Chick Embryo Cell RabAvert® (PCEC)

3. Cell-culture Vaccine (HDC)Human Diploid Cell Vaccine Imovax® (HDCV)

VACCINE ADMINISTRATION

Class of treatment

ADULT CHILDREN Duration of Treatment

Class I 2ml 1ml 7days

Class II 3ml 3ml 10days

Class III 5ml 3ml 10days

(Dosage schedule by Pasture institute, Coonoor)

CLASS –I (Slight risk)CLASS—II (Moderate risk)CLASS– III (Severe risk)

Vaccine Administration

1. Intramuscular Schedules 6 doses scheduleReduced multisite intramuscular

regimen (2-1-1)

2. Intradermal Schedules2-Site Intradermal schedule(2-2-

2-0-1-1)8-Site intradermal schedule(8-0-

4-0-1-1)

RABIES IMMUNoGLOBULIN

• Two Human Rabies Immunoglobulins are available;

HyperRabTM S/D

Imogam® Rabies-HT

• Both supplied in vials at ~ 150 IU/ml

ONLY IN PEP

ADVERSE REACTIONS

• PEP should not be interrupted because of local or mild systemic adverse reactions.

• Use of anti-inflammatory, antihistaminic, and antipyretic agents suggested.

• Serious systemic, anaphylactic, or neuroparalytic reactions are rare.

CASE MANAGEMENTThe patient should be isolated in a quite

room i.e. protected from external stimuli.Relieve anxiety & pain by the use of

sedatives.Morphin in doses of 30-45 mg may be given

repeatedly.Ensure hydration & diuresis.Respiratory & cardiac support.

Nursing RESPONSIBILITY

Nursing personnel should be warned against possible risk of contamination.

They should wear masks, gloves, goggles & aprons to protect themselves.

Nurses having bruises, cuts or open wounds should not be entrusted to look after the patient.

Pre- exposure prophylaxis with 2-3 doses of HDC vaccine is recommended.

SUMMARIZATION

OPEN DISCUSSION

REFERENCES

• Gulani K. K., Community health nursing,second edition,Delhi: Kumar publishing house,2012.

• Park K, Preventive and social medicine, 21st edition, Jabalpur: M/s BanarasiDas Bhanot Publisher,2011, p(226-234)

• Advisory Committee on Immunization Practices (ACIP), 1999 MMWR 48: RR-1

• Center for Disease and Prevention: www.cdc.gov• NASPHV Compendium of Animal Rabies Prevention & Control,

2007, MMWR 56:RR-3• World Health Organization Expert Consultation on Rabies,

Geneva, Switzerland, 2005, Tech Rep Ser 931:1-88