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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

It is an acute Highly fatal viral dis: of CNS Transmitted to man by: Bites OR Licks of rabid animals

Agent Factors: Agent (LYSSAVIRUS type I) Rhabdoviridae type I

Bullet shaped

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.

History of the Rabies Virus


Outbreak of rabies in Europe

in 20th century spawned the


Vampire myth- linked to bats.

Rabies epidemic in 13th century France may have


spurred Werewolf myth as well- linked to wolves. Rabies is commonly spread by bats and wolves and other wildlife like foxes

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.

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 Joseph Meister after he had been bit by a rabid dog.

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.

Epidemiology

Estimated Annual Human Rabies Cases 2005 North America 4 - 8 Europe 10 - 20 Latin America 200 - 400 Africa 500 - 1,000 Asia 30,000 - 40,000

FREE RABIES ZONE: Australia, China, Iceland, Ireland, Japan, New Zealand etc

Types of Rabies virus


STREET VIRUS FIXED VIRUS

Definition: the virus recovered from naturally occurring cases of rabies is called street virus Sources: it is naturally occurring virus. It is found in saliva of infected animal. (continue)

Definition: the virus which has a short, fixed and reproducible incubation period is called fixed virus Sources: it is prepared by repeated culture in brain of rabbit such that its I.P. is reduced & fixed

Features

Features

1. It does not form Negri 1. It produces Negri bodies bodies 2. Incubation period is 2. Incubation period is long i.e. 20 to 60 constant between 4-6 days days 3. It is pathogenic for all 3. It can pathogenic for mammals humans under certain

4. Cannot be used for preparation of vaccine

conditions 4. Is used for preparation of antirabies vaccine

RESERVOIR OF INFECTION
1) URBAN RABIES: From Dogs and cats.

2) WILD LIFE RABIES: From jackals and foxes.

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.

Source of Infection

Saliva of Rabid animal

Host Factors
All warm blooded animals including man. Rabies in man is a dead-end infection.

Mode of Transmission 1. ANIMAL BITES 2. LICKS 3. AEROSOL 4. PERSON TO PERSON

INCUBATION PERIOD: normally it is 3 - 8 wks may be short that is 4 days

or may be prolonged for years.

PATHOGENESIS
Replicate in muscle and C.T. --attach to nerve ending --- CNS --than centrifugally in peripheral nerve to many tissue including Skeletal muscle, heart, adrenal gland and skin --- salivary gland

CLINICAL PICTURE
Prodromal symptoms Headache, malaise, sore throat, low fever, pain at the site of bite 2. Excitation Symptoms
1.
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, 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

(summary) Transmission of Rabies Cl:Picture


The rabies infection and the symptoms that accompany it is classified by five stages: 1. Incubation (1-3 months) 2. Prodromal, where first symptoms occur 3. Acute neurological phase 4. Coma 5. Death or recovery

DIAGNOSIS
1. 2. 3. 4. History Sign and symptom Examination Detection of Antigen by taking Skin Biopsy using Immunofluorescence by virus isolation from Saliva & other secretions.

Control Measures
Notification Isolation Disinfection Immunization

Prevention of human rabies post Exposure prophylaxis


1. 2. General consideration:- Aim is to neutralize virus before entering CNS LOCAL WOUND TREATMENT

a, Cleansing of wound(soap & water) b, Chemical treatment: Either Alcohol 400-700 ml /liter Tincture Iodine No more treatment with Ammonium compound No Carbolic acid and Nitric acid as it leave very bad scar

c, Suturing d, Anti Rabies Serum e, Antibiotic and ATS f, Observe the animal for 10 days

3, Immunization 1,NERVOUS TISSUE VACCINE (NTV 2, Human diploid cell vaccine (HDCV)

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

Nervous Tissue vaccine


preparation From fixed virus grown in brain of sheep or other animals Low or variable Large nos: are required Severe & fatal reactions Exposed subjects

Duck embryo vaccine Cell culture vaccine

potency Doses Side effects Uses

Eliminate Neuroparalytic factors

More potent more safer Fewer doses of small volume

Allergic risks Used in UK,USA in past

Fewer 1, (HDC) safe, potent Pre & post expos:Immunization 2Tissue culture 2nd G (Non-human) Potent, low cost WHO recommendatio

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

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

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

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

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

Classification Of Exposures
1. a. b. 2. a. b. c. d. 3. a. b. c. d. Class I (slight Risk) 07 injection Licks on healthy unbroken skin. Scratches without oozing of blood. Class II (Moderate Risk) according to the Schedule plus one booster dose after 3 week Licks on fresh cuts. Scratches with oozing of blood. All bites except those on head, neck, face, palms and fingers. Minor wounds less than 5 in number. Class III (Severe Risk) according to the Schedule plus Two booster dose one after one week and another 2 week all bites or scratches with oozing of blood on neck, head, face, palms and fingers. Lacerated wounds on any part of the body. Multiple wounds 5 or more in number. Bites from wild animals.

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

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

Pre-Exposure Prophylaxis
It is done in persons who have high risk of repeated exposures. Animal Handlers Wildlife officers Veterinarians Lab: staff working with rabies virus Protected by:- Cell-culture vaccine 1ml I/M OR 0.1ml I/D ( 0,7& 28day) Post-exposure R/ of persons (who have been vaccinated previously) HDC vaccine (1ml I/M 0,3 & 7 day 0

Rabies in Dogs
a. i. ii. iii. iv. v. Incubation period: Clinical features: in two forms. 3-8 wks. Rabies in dogs may manifest itself

Furious Rabies.
This the typical mad-dog syndrome characterized by. change in behavior. Tendency to run away from home, wander aimlessly and biting humans and animals. Change in voice due to paralisis of laryngeal muscles. Excessive salivation & foaming at the angle of the mouth. Paralysis of the whole body leading to coma & death.

b. i. ii. iii. iv.

Dumb Rabies. The excitative or irritative stage is lacking. The disease is predominantly paralytic. Dog withdraws itself from being seen or disturbed. It elapses into a stage of sleepiness and dies in about 3 days.