Practical rabies
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Transcript of Practical rabies
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.
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
5
• In non serious cases, you can give anti rabies serum and wait for 7 days before starting vaccination
• True
• false
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)