Rabies Monica Cardenas, MD, PGY1 4/18/14. AB is a 10 year old boy presents to the ED after being bit by his neighbors dog in the left lower extremity.

Slides:



Advertisements
Similar presentations
Don't Get Bit Rabies Education James R. Ginder, MS, NREMT,PI,CHES,NCEE
Advertisements

Bloodborne Pathogens In the School Setting Julie A. Strunk, RN BSN
Feb 2011 Dr Guada Lopez Marti Pediatric Infectious Diseases Marshall University.
Ebola Facts October 28, /28/14 Identify, Isolate, Inform: ED Evaluation and Management The following diagram provides guidance on evaluation and.
Rabies Supplemental Information for Law Enforcement Officers
What you should know about RABIES?
Page Up to Reverse  Employee Health  Page Down to Advance  Employee Health 
How to Protect Yourself after Body Fluid Exposure
701 airmen identified for animal exposure 640 (91%) individuals contacted (644 WBQ completed: 4 individuals with more than one exposure) 16 (2%) individuals.
OSHAs blood borne pathogens standard A written exposure control plan designed to eliminate or minimize worker exposure Compliance with universal precautions.
Section 22.4 Protecting Yourself From HIV and AIDS Objectives
Biology and Epidemiology of the Rabies Virus
Current WHO Guide – Rabies
Rhabdoviruses. Rhabdoviridae Rhabdos (greek)rod Pathogens of mammals, birds, fish, plants.
Rabies.
* 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.
Safe Needle Techniques Annual Congress of The American Academy of Ozonotherapy Dallas, TX March 29 th 2014 Shawn Naylor, DO.
Rabies enquiries in Cheshire & Merseyside Dr Alex Stewart CCDC Dr Katie Whiteway F2.
Systematic review of the health impacts of mass earth movements PREVENTION OF RABIES IN HUMANS HUMAN DISEASE IS FATAL BUT IS PREVENTABLE BY POST EXPOSURE.
BLOOD BORNE PATHOGEN EXPOSURE Management – What you need to know about Needlesticks and Splashes Amy J. Behrman, MD Occupational Medicine Dept of Emergency.
Rabies Control Program
Occupational Safety and Health Administration (OSHA) Training BLOOD BORNE PATHOGENS 2/26/2014.
1 Roseann Mulligan DDS, MS University of Southern California Pacific AIDS Education and Training Center HBV, HCV, and HIV in the Dental Office: Prevention.
Rabies Free Philippines 2020 Inform, Educate and Empower People through Responsible Pet Ownership and Vaccinations.
RABIES Atilla Kiss M.D. Prepared by Kellie Zaylor D.O. January 4, 2006.
Page Up to Reverse  Employee Health  Page Down to Advance  Employee Health 
Hepatitis B.
Part F Blood and fluid exposure Exposure? Injury with sharp object. Contamination of open wound with blood or body fluid. Eye or mucosal splash with.
OCCUPATIONAL SAFETY AND HEALTH ADMINSTRATION This is a branch of the US Department of Labor, responsible for protecting the health and safety of workers.
Rabies. The infectious path of Rabies virus Just the Facts Possible in any mammal. Occurs mostly in wild animals like raccoons, skunks, bats, and foxes.
1 Occupational Exposure to HIV: Universal Precautions and PEP HAIVN Harvard Medical School AIDS Initiative in Vietnam.
1 Occupational Exposure to HIV: Universal Precautions and PEP HAIVN Harvard Medical School AIDS Initiative in Vietnam.
Postexposure Care and Prophylaxis for Providers. Risk of HIV Infection after Occupational Exposure If 300 people receive needle-stick or sharp-instrument.
Deadly Bloodborne Diseases Hepatitis B (HBV) Hepatitis C (HCV) Human Immunodeficiency Virus (HIV)
Rhabdoviruses. Rhabdoviridae Rhabdos (greek)rod Pathogens of mammals, birds, fish, plants.
Rabies Ashley Vargas Sean McGee Giovanni Perez.
Charles-Miller Wabeno, MPH student Walden University PUBH Instructor: Dr. Howard Rubin Spring, 2010.
BLOOD TYPES. Blood Types Austrian Karl Landsteiner discovered human blood groups Even animals have blood types.
Rabies. Symptoms flu-like symptons (couple days initially)  general weakness, discomfort, fever, headache discomfort or itching at bite location later.
16/3/20091Dr. Salwa Tayel. 16/3/20092Dr. Salwa Tayel Viral Hepatitis.
Dania Jaradat Tiffany Chang.  Family: Rhabdoviridae  Enveloped (-) ssRNA virus  Rod or “bullet” shaped  Approximately 70x180 nm  Coiled nucleocapsid.
US$ 40 in Africa US$ 49 in Asia PhP The study described the epidemiological characteristics of animal bite cases consulting at the Anti-Rabies.
Rabies.
By Dr. Victoria J. Cabrera DVM.  Is a lethal encephalitis cause by a virus in the family Rhabdoviridae genus Lyssavirus  Exposure occurs through the.
Rabies: What We need to know! Developed for Public Information by Tibet Charity Animal Care Center Temple Road, P.O. McLeod Ganj Dharamsala, Distt.
Learning to Make Rabies History!
Rabies Lecture 6 Dr. Paul Bartlett, MPH., DVM., Ph.D.
PPT- 1 Rabies. PPT- 2 Rabies Defined: Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal Return.
E:/2000/LACTS/CAMPBELL SOUP/BLOODBORNE.PPT 1 Campbell Soup Company Bloodborne Pathogens.
Needlesticks & Exposures 600,000 to one million needle-stick injuries happen every year in the United States. 600,000 to one million needle-stick injuries.
RABIES Hydrophobia, Lyssa.
PUBH_224_Basic Medical Care in Primary Care Unit Topic Rabies Benjawan Nunthachai.
1 Kansas Spine & Specialty Hospital 2016 Clinical Competency.
Epidemiology of the Rabies Virus
Rabies and Tetanus Post Exposure Prophylaxis Patrick J. Ivory, MPAS, PA-C.
Annual Report 2012 Sharp Injuries and Body Fluid Exposure:- NumberPercentage Physicians2736% Nursing Staff3546.7% Technicians56.6% HK Staff810.7% TOTAL75***
Managing Occupational Risks for Hepatitis B & C Transmission in the Health Care Settings BY DR:
Department of Community Health Nursing Annammal College of Nursing
Human rabies virus immune globulin
Rabies.
101, Prevention, Stages, & Treatment
POST EXPOSURE PROPHYLAXIS IN HCW
Rabies Updates Environmental Health Directors Oct 2018
Mustansiriyah University College of science Biology Dept
Needlesticks & Exposures
Clinical Scenario A 40 years old man presented in emergency with aggressive behaviour and froth coming from mouth. He could not give any history of his.
Rabies: FAQs. o The rabies virus is very sensitive to heat. Cooking dog meat will kill the virus o If eaten, the rabies virus is also killed by the acids.
Presentation transcript:

Rabies Monica Cardenas, MD, PGY1 4/18/14

AB is a 10 year old boy presents to the ED after being bit by his neighbors dog in the left lower extremity. His brother states that the dog was playing and sniffing them when AB got scared and ran away. The dog was jumping and sniffing at him when he bit his leg. His mother brought him immediately to the emergency room. On exam vitals are stable and the bite is about 4cm in diameter localized to posterior calf muscle. Exam is otherwise WNL. His mom reports that the owner stated the dog was healthy and fully immunized but could not produce papers to support it. She wants to know if he needs to get any shots today. What do you tell her? a. He will require a combination of rabies immunoglobulin and rabies vaccine. b. He will only require rabies immunoglobulin c. He will only require rabies vaccine d. He will not require rabies vaccine or immunoglobulin as long as the dog can be observed for 10 days for signs of rabies

AB is a 10 year old boy presents to the ED after being bit by his neighbors dog in the left lower extremity. His brother states that the dog was playing and sniffing them when AB got scared and ran away. The dog was jumping and sniffing at him when he bit his leg. His mother brought him immediately to the emergency room. On exam vitals are stable and the bite is about 4cm in diameter localized to posterior calf muscle. Exam is otherwise WNL. His mom reports that the owner stated the dog was healthy and fully immunized but could not produce papers to support it. She wants to know if he needs to get any shots today. What do you tell her? a. He will require a combination of rabies immunoglobulin and rabies vaccine. b. He will only require rabies immunoglobulin c. He will only require rabies vaccine d. He will not require rabies vaccine or immunoglobulin as long as the dog can be observed for 10 days for signs of rabies

What type of exposure occurred?  Rabies is transmitted only when the virus is introduced into a bite wound, open cuts in skin, or onto mucous membranes such as the mouth or eyes.  Bite  Any penetration of the skin by teeth constitutes a bite exposure. All bites, regardless of body site, represent a potential risk of rabies transmission  Bites by some animals, such as bats, can inflict minor injury and thus be difficult to detect.  Was the bite from a provoked or an unprovoked attack? Bites inflicted on a person attempting to feed or handle an apparently healthy animal should generally be regarded as provoked.  If it was an unprovoked attack, that's more likely to indicate that the animal is rabid.

What type of exposure occurred?  Nonbite  The contamination of open wounds, abrasions, mucous membranes, or theoretically, scratches (potentially contaminated with infectious material from a rabid animal) constitutes a nonbite exposure.  Nonbite exposures from terrestrial animals rarely cause rabies. However, occasional reports of rabies transmission by nonbite exposures suggest that such exposures should be evaluated for possible postexposure prophylaxis administration.  Other contact by itself, such as petting a rabid animal and contact with blood, urine, or feces of a rabid animal, does not constitute an exposure and is not an indication for postexposure vaccination.

According to the CDC…

According to CDC and AAP… Vaccination Status InterventionRegimen* Not previously vaccinated Wound cleansingAll PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent (eg, povidine-iodine solution) should be used to irrigate the wounds. Human rabies immune globulin (HRIG) Administer 20 IU/kg body weight. VaccineHuman diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL, IM (deltoid area†), 1 each on days 0, 3, 7 and 14.

According to CDC and AAP… Vaccination Status InterventionRegimen* Previously vaccinated Wound cleansing All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as povidine-iodine solution should be used to irrigate the wounds. HRIGHRIG should not be administered. VaccineHDCV or PCECV 1.0 mL, IM (deltoid area†), 1 each on days 0and 3.

HRIG  Human rabies immune globulin (HRIG) is administered only once, at the beginning of anti-rabies prophylaxis, to previously unvaccinated persons.  The full dose should be thoroughly infiltrated in the area around and into the wounds. Any remaining volume should be injected intramuscularly at a site distant from vaccine administration.  HRIG should never be administered in the same syringe or in the same anatomical site as the first vaccine dose.  If HRIG was not administered when vaccination was begun, it can be administered up to seven days after the administration of the first dose of vaccine  Because HRIG can partially suppress active production of antibody, no more than the recommended dose should be administered. The recommended dose of HRIG is 20 IU/kg body weight.

You are seeing a 12 year old girl with perinatally acquired HIV as a follow-up for racoon bite at your clinic. Her HIV is well controlled on HAART therapy, viral load is suppressed to undetectable levels. She received appropriate post-exposure prophylaxis (PEP) and is here for her last dose of rabies vaccine on day 28. She has been asymptomatic without fever, weakness, or headache. What is the next step in management of this patient? a. No routine testing to document seroconversion is necessary after PEP b. She received a 5 dose regimen instead of the usual 4 dose regimen and therefore will not require routine testing for seroconversion c. She should be tested for for rabies-virus neutralizing antibody with rapid fluorescent focus inhibition test in 1-2 weeks d. She should be tested for rabies-virus neutralizing antibody with rapid fluorescent focus inhibition test in 4-6 weeks.

You are seeing a 12 year old girl with perinatally acquired HIV as a follow-up for racoon bite at your clinic. Her HIV is well controlled on HAART therapy, viral load is suppressed to undetectable levels. She received appropriate post-exposure prophylaxis (PEP) and is here for her last dose of rabies vaccine on day 28. She has been asymptomatic without fever, weakness, or headache. What is the next step in management of this patient? a. No routine testing to document seroconversion is necessary after PEP b. She received a 5 dose regimen instead of the usual 4 dose regimen and therefore will not require routine testing for seroconversion c. She should be tested for for rabies-virus neutralizing antibody with rapid fluorescent focus inhibition test in 1-2 weeks d. She should be tested for rabies-virus neutralizing antibody with rapid fluorescent focus inhibition test in 4-6 weeks.

Seroconversion  No routine testing to document seroconverion in healthy patients who have completed PEP is necessary  For persons with immunosuppression, rabies PEP should be administered by using 5 dose regimen (days 0,3,7,14 and 28). Patient should be tested for rabies virus-neutralizing antibody with the rapid fluorescent focus inhibition test 1-2 weeks after the 5 th dose of vaccine.  If an acceptable antibody response is not detected the patient should be managed in consultation with an expert in rabies.

References  CDC center for disease control and prevention.   Rabies-Prevention Policy Update: New Reduced-Dose Schedule. Pediatrics 2011; 127:785. March 28, 2011