* Rabies is a zoonotic disease (a disease that is transmitted from animals to humans) that is caused by a virus. * Nearly half of those bitten by suspect rabid animals are children under 15 years of age. * Rabies is spread to people through close contact with infected saliva via bites or scratches. * Most of the deaths occur in the absence of post- exposure prophylaxis

Element of paralysis is dominating, animal is quiet,timid and shy

* Rabies is caused by RNA virus of genus Lyssavirus * Family-Rhabdoviridae * Bullet shape * Neurotropic virus * New species discovered in bats

Virus is transmitted through saliva of infected animal * Bites * scratch * Licks on injured skin * Licks on mucous membranes * Aerosols (bats in caves) Uncommon routes * Transplants of infected organs * Bite of a rabid human being

 Incubation period Varies from few days to years Average days Depends upon site, degree and virus load, number of wounds Provides opportunity to start treatment

Sr. NoDistrict/AreaNo. of Rabies Patients TreatmentTime between bite and rabies 1.Lahore01Not receivedOne month 2.Lahore01Not received20 days 3.Lahore01Not receivedone and a half month 4.Lahore01Not received3 months 5.Shakargarh (Narowal)01Not receivedone and a half month 6.Chakwal01Not receivedone and a half month 7.Rahim Yar Khan01Not received3 months 8.Khushab01Not receivedone and a half month 9.Shraqpur Sharif01Not received2 months 10.Okara01Not received5 months 11.Muridke01Partly receivedOne month 12.Daska01Not received2 and half month 13Sialkot01Not received3 months 14.Qadirabad01Not receivedOne year 15.Sargodha01Not received3 months 16.DG gkan01Not received2.5 years

 Prodromal Phase (2-10 days) Fever, flu like symptoms, headache, anorexia, lethargy, itching or abnormal sensation at the site of wound  Acute Neurological Phase (2-7 days) Anxiety, confusion, aggression or lack of aggression, hyper salivation, muscular spasm, difficulty in swallowing leading to hydrophobia, photophobia, aerophobia

 Coma and Death Symptoms progress towards paralysis and coma in both furious and dumb rabies Death usually occurs from respiratory paralysis within days after onset of symptoms

* Wounds should be washed/flushed and disinfected immediately. Vaccine and immunoglobulin therapy (when required for the latter) instituted as soon as possible, * If rabies immunoglobulin is not available on first visit its use can be delayed by a maximum of 7 days from date of first vaccine injection, * Initiation of PEP should not await the results of laboratory diagnosis or be delayed by dog observation when rabies is suspected, * Pregnancy and infancy are never contraindications to PEP, * Persons who present for evaluation and rabies post-exposure prophylaxis even months after having been bitten should be dealt with in the same manner as if the contact occurred recently.

* Category I :  touching, feeding of animals or licks on intact skin no exposure  therefore no prophylaxis if history reliable * Category II:-  minor scratches or abrasions without bleeding or and nibbling of uncovered skin  use vaccine alone * Category III:  single or multiple transdermal bites or scratches, licks on broken skin, contamination of mucous membrane with saliva (i.e. licks) and suspect contacts with bats:  use immunoglobulin plus vaccine

* Should be immediate * Is essential even if the person presents long after exposure Consists of: * Immediate washing and flushing for 15 minutes with soap and water, or water alone, * disinfection with ethanol (700ml/l) or iodine (tincture or aqueous solution).

* The 5 dose intramuscular regime: one dose of the vaccine should be administered on days 0, 3, 7, 14 and 28 in deltoid region or, in small children, into the antero-lateral area of the thigh muscle; * The regimen may also be used. Two doses are given on day 0 in the deltoid muscle, right and left arm. In addition one dose in the deltoid muscle on day 7 and one on day 21. * Vaccines should not be injected into the gluteal region;

* This vaccine is of sufficient potency to allow its safe use in one of the WHO recommended intradermal post-exposure regimens

* Immediate Case Notification. * Availability of Anti-Rabies Vaccine. * Special Dog killing campaigns launched by the districts. * Behavioural Change Campaigns. * World Rabies Day- 28 th September.