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    Rabies

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    Adindapaulia
    Rabies is caused by RNA viruses in the Lyssavirus genus. It causes acute viral encephalitis with a nearly 100% fatality rate if left untreated. An estimated 55,000 people die from rabies globally each year, with transmission primarily through animal bites. Post-exposure prophylaxis consists of thorough wound cleansing, rabies immunoglobulin administration, and a multi-dose vaccination series. While recovery from clinical rabies is extremely rare, prevention and control relies on animal vaccination programs and public health education.

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    Rabies

    Uploaded by

    Adindapaulia
    157 views25 pages
    Rabies is caused by RNA viruses in the Lyssavirus genus. It causes acute viral encephalitis with a nearly 100% fatality rate if left untreated. An estimated 55,000 people die from rabies globally each year, with transmission primarily through animal bites. Post-exposure prophylaxis consists of thorough wound cleansing, rabies immunoglobulin administration, and a multi-dose vaccination series. While recovery from clinical rabies is extremely rare, prevention and control relies on animal vaccination programs and public health education.

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    Rabies is caused by RNA viruses in the Lyssavirus genus. It causes acute viral encephalitis with a nearly 100% fatality rate if left untreated. An estimated 55,000 people die from rabies globally each year, with transmission primarily through animal bites. Post-exposure prophylaxis consists of thorough wound cleansing, rabies immunoglobulin administration, and a multi-dose vaccination series. While recovery from clinical rabies is extremely rare, prevention and control relies on animal vaccination programs and public health education.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    157 views25 pages

    Rabies

    Uploaded by

    Adindapaulia
    Rabies is caused by RNA viruses in the Lyssavirus genus. It causes acute viral encephalitis with a nearly 100% fatality rate if left untreated. An estimated 55,000 people die from rabies globally each year, with transmission primarily through animal bites. Post-exposure prophylaxis consists of thorough wound cleansing, rabies immunoglobulin administration, and a multi-dose vaccination series. While recovery from clinical rabies is extremely rare, prevention and control relies on animal vaccination programs and public health education.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    The key takeaways are that rabies is a fatal viral disease transmitted primarily through animal bites, it has distinct stages of infection in humans including prodromal, neurological and recovery/death phases, and post-exposure prophylaxis involves thorough wound cleansing and rabies vaccine/immunoglobulin administration.

    The main transmission routes of rabies are bites or scratches from an infected animal, inhalation of aerosolized virus particles from bats, and very rarely through transplanted tissues or corneas from an infected donor.

    The stages of rabies infection in humans are the initial prodromal phase with non-specific flu-like symptoms lasting 1-10 days, followed by the neurological phase with symptoms like anxiety, hydrophobia, paralysis and eventually death if left untreated.

    Rabies

    Rabies Virus
    Rabies is caused by RNA viruses in
    the family Rhabdoviridae, genus
    Lyssavirus

    At least 7 Lyssavirus species or


    genotypes cause rabies (disease)

    Recently, 4 new Lyssaviruses


    collected from Eurasian bats have
    been described

    Bullet-shaped, RNA virus


    Rabies Disease
    Acute, progressive viral encephalitis
    Highest case fatality of any infectious

    disease
    One of the most ancient diseases

    described
    Model zoonosis
    Rabies

    Global Disease

    Estimated >55,000 deaths


    annually
    Three possible vectors

    1. The bite or scratch of an infected animal


    2. Aerosol transmission from an infected

    animal (usually a bat)


    3. Tissue transplants only six recorded

    cases

    The virus concentrates in the salivary


    glands, which explains why bites cause
    approx 99% of rabies cases worldwide
    Rabies
    Animal reservoirs maintain and transmit different rabies
    virus variants
    Dog, cat, bat, human;
    wild carnivore, e.g.: fox, skunk, raccoon, jackal; mongoose
    ce: http://www.rbe.fli.bund.de/About_Rabies/Epidemiology.aspx
    The infection cycle
    4. Massive
    replication Infection
    in brain 3. Spread to Incubation very
    central variable
    nervous Neuronal
    system2. Uptake transport
    into
    5. Spread to peripheral CNS replication
    salivary nerves Salivary gland
    glands and 1. replication
    excretion in Inoculation Virus excretion
    saliva by bite
    Clinical signs
    Death
    Rabies infection
    The average incubation period is one
    to three months, but can range from
    several days to one year after
    exposure

    The incubation period is shorter in


    patients with an exposure that occurs
    in richly innervated areas, such as the
    face, compared with the extremities.
    Signs of rabies in animals

    Abnormal Behavior :
    Nocturnal animals acting sick or
    active during daylight hours.
    Staggering, trembling, weakness,
    paralysis, agitation, confusion,
    hypersalivation, unprovoked
    aggression, abnormal
    vocalization, glazed eyes,
    choking.

    **Grounded bats.
    Variable symptoms
    Rabies in humans
    prodromal phase, which starts with non-specific
    symptoms, such as low-grade fever, chills,
    malaise, myalgias, weakness, fatigue, anorexia,
    sore throat, nausea, vomiting, headache, and
    occasionally photophobia.
    This stage lasts from a few days to

    approximately one week


    If a bite wound is present, reported paresthesias

    radiating proximally from the site of the wound


    would be suggestive of rabies infection
    Localised pain or paresthesia
    Change in behaviour,
    anxiety, fear,
    Aerophobia, Pharyngeal
    spasms
    Hydrophobia
    Hyperactivity,
    hypersalivation, lacrimation,
    sweating
    Paralysis, coma, death

    Full recovery extremely rare


    Treatment must rely on
    palliative care
    Anxiolytics, pain relief
    Counselling of family
    Recovery from Rabies

    Recovery from
    human rabies
    extremely rare and
    has resulted in
    profound disability

    Recent case of more


    complete recovery
    in unvaccinated
    teenage girl in USA
    Lab Tes (Pre mortem)
    Saliva include reverse transcriptase polymerase chain reaction
    (RT-PCR) for the detection of virus RNA and viral culture for the
    isolation of infectious virus.
    Skin biopsy : RT-PCR and immunofluorescence staining for viral

    antigen.
    Serum and cerebrospinal fluid

    If no vaccine or rabies immune globulin has been given, the


    presence of antibody to rabies virus in serum is diagnostic of
    infection.
    A patient who has been immunized will have rabies antibodies in
    serum. a second specimen should be obtained a few days later
    to see if antibody titers are rising, which would be indicative of
    infection
    ` However, antibody to virus in a CSF specimen, regardless of the
    immunization history, suggests virus infection.
    Lab Test (post mortem)
    Both for animals and people.

    Negri body in a Immunofluorescence


    brain section of brain stem cells
    Children are more likely to be bitten in high-
    risk sites, such as the head and neck
    Treatment
    no proven antiviral therapy and no
    licensed anti-viral drugs for rabies
    suggested therapeutic interventions

    designed to protect the brain from


    injury, while waiting for the host
    immune response to clear the virus
    Milwaukee protocol
    Induction of therapeutic coma to reduce
    putative excitotoxicity : ketamine, a
    dissociative anesthetic agent; at high
    concentrations, ketamine may also inhibit
    rabies virus replication in vitro or in animal
    models. Benzodiazepines and barbiturates
    have also been used in this protocol
    Intensive supportive care
    Use of drugs with potential antiviral activity
    (eg, ribavirin, amantadine)
    Therapeutic blockade of cerebral artery spasm
    Rabies Post-Exposure
    Prophylaxis (PEP)
    Vaccine supply has been limited:
    reserve for truly exposed
    Cleanse wound immediately.
    When needed, administer PEP as

    soon after exposure as possible.


    Rabies immunoglobulin: one dose
    5 doses of rabies cell culture

    vaccine
    Animal Bites: Wash wounds and seek
    medical consultation - especially those
    from bats, wild animals and foreign dogs

    Control rabies in pets:


    Vaccinate pets
    Keep pets away from wildlife (bats, raccoons..)
    Follow leash laws
    Control strays

    Wildlife:
    Avoid contact with sick
    and injured wild animals.
    Dont feed, handle or translocate wildlife
    Rabies immunoglobulin :"passive immunization";
    rabies vaccine: "active immunization".

    Vaccine alone is given for preexposure prophylaxis


    Postexposure rabies prophylaxis, in previously

    unimmunized persons, should always include both


    passive and active immunization.
    Vaccine alone is indicated in persons who have had

    preexposure prophylaxis with rabies vaccinewith a


    documented neutralizing antibody response.
    Wound care
    Thorough washing of bite wounds,
    scratches, and non-bite exposures with
    soap and water is recommended, if
    feasible.
    When available, a virucidal agent such

    as povidone-iodine should also be used.


    In animal studies of rabies, wound

    cleansing alone reduced the likelihood of


    rabies up to 90 percent
    Vaccine
    Human diploid cell vaccine (HDCV) & Purified chick embryo
    cell vaccine (PCECV)
    WHO guidelines still recommend a five-dose schedule for

    intramuscular rabies immunization for category 2 or 3


    exposures (days 0, 3, 7,14, 28) but now cite the four-dose
    intramuscular schedule (days 0, 3, 7 and 14) as an
    alternative for exposed people who receive wound care
    plus high-quality RIG plus rabies vaccine.
    Another alternative four-dose regimen (two doses on day 0,

    and one dose on days 7 and 21) is sometimes used for


    category 2 exposures, when postexposure treatment does
    not include administration of RIG.
    five-dose schedule in immunocompromised hosts
    TERIMA KASIH

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