1. RABIES
Hydrophobia, Lyssa

2. Rabies is an infectious acute viral encephalomyelitis disease that is almost always fatal following the onset of clinical signs.
Most often transmitted through the bite of a rabid animal

3. Rabies virus A rhabdovirus of the genus Lyssavirus bullet-shaped;
nm in diameter; nm long.

5. Rabies is a vaccine-preventable viral disease which occurs in more than 150 countries and territories.
40% of people who are bitten by suspect rabid animals are children under 15 years of age.
Immediate wound cleansing with soap and water after contact with a suspect rabid animal can be life-saving.
Every year, more than 15 million people worldwide receive a post-bite vaccination. This is estimated to prevent hundreds of thousands of rabies deaths annually.

6. Symptoms
The initial symptoms of rabies are fever and often pain or an unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site.
As the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops.
headache
Excitation
Agitation
Hyper-salivation
Difficulty swallowing
Hydrophobia
After a few days, death occurs by cardiorespiratory arrest.

7. Epidemiology
Occurrence: World wide disease with an estimated deaths, almost in developing countries particularly Asia…
Reservoir Wild and domestic animals including:
dogs
Skunks
Bats
Foxes , Wolves
Raccoons

8. Transmission …
Virus-laden saliva of rabid animal introduced through a bite or scratch…
People are usually infected following a deep bite or scratch by an infected animal. Dogs are the main host and transmitter of rabies. They are the cause of human rabies deaths in Asia and Africa in more than 95% of all cases.
Bats are the source of most human rabies deaths in the Americas. Bat rabies has also recently emerged as a public health threat in Australia and western Europe.

9. Transmission can also occur when infectious material – usually saliva – comes into direct contact with human mucosa or fresh skin wounds.
Human-to-human transmission by bite is theoretically possible but has never been confirmed.
Rarely, rabies may be contracted by inhalation of virus-containing aerosol or via transplantation of an infected organ. Ingestion of raw meat or other tissues from animals infected with rabies is not a confirmed source of human infection.

10. Types of Exposure
Bite
Any penetration of the skin by teeth constitutes a bite exposure
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
PPT- 10

11. Incubation period
The incubation period usually 3-8 weeks… rarely as short as 9 days or as long as 7 years; depend on:
Wound severity
Wound site as relation to nerve supply, distance from the brain.
Amount and strain of virus.
Protection provided by clothing and other factors.

12. Period of communicability
In dogs and cats 3-7 days before onset of clinical signs and throughout the course disease.
Bats shed virus for 12 days before evidence of illness..
Skunks shed virus for at least 8 days before onset of clinical signs…

13. Diagnosis
No tests are available to diagnose rabies infection in humans before the onset of clinical disease, and unless the rabies-specific signs of hydrophobia or aerophobia are present, the clinical diagnosis may be difficult. Human rabies can be confirmed post mortem by various diagnostic techniques aimed at detecting whole virus, viral antigens or nucleic acids in infected tissues (brain, skin, urine or saliva).

14. Prevention

15. Prevention Eliminating rabies in dogs
Rabies is a vaccine-preventable disease. Vaccinating dogs is the most cost-effective strategy for preventing rabies in people.
Maintain active surveillance for rabies in animal.
Detain and clinically observe for 10 days any health – appearing dog or cat known to have bitten a person (unwanted dogs & cats may be sacrificed immediately and examined for rabies by fluorescent and microscopy)
Immediately sacrifice unimmunized dogs and cats bitten by known rabid animal…

16. Pre-Exposure Vaccination
Individual at high risk( veterinarians, work with rabies in laboratory settings , animal control and wildlife officers are just a few of the people who should consider rabies pre-exposure vaccinations
If you are traveling to a country where rabies is widespread, you should consult your doctor about the possibility of receiving pre-exposure vaccination against rabies

17. Although pre-exposure vaccination does not eliminate the need for additional therapy after a rabies exposure, it simplifies management by eliminating the need for rabies immune globulin and decreasing the number of doses of vaccine needed.

18. Primary Vaccinations Type Name Route Indications
Human Diploid Cell Vaccine (HDCV)
Imovax® Rabies
Intramuscular
Pre-exposure or Post-exposure
Purified Chick Embryo Cell Vaccine (PCEC)
RabAvert®
PPT- 22

19. Primary Vaccination Three 1
Primary Vaccination Three 1.0-mL injections of HDCV or PCEC vaccine should be administered intramuscularly (deltoid area) -- one injection per day on days 0, 7, and 21 or 28

20. Frequent Risk
Persons in the frequent risk group should have a serum sample tested for rabies antibody every 2 years; if the titer is less than complete neutralization, the person also should receive a single booster dose of vaccine.

21. Post-exposure prophylaxis (PEP)
Post-exposure prophylaxis (PEP) means the treatment of a bite victim that is started immediately after exposure to rabies in order to prevent rabies from entering the central nervous system which would result in imminent death.
This consists of:
local treatment of the wound, initiated as soon as possible after exposure;
A course of potent and effective rabies vaccine that meets WHO standards;
The administration of rabies immunoglobulin (RIG), if indicated.

22. Effective treatment soon after exposure to rabies can prevent the onset of symptoms and death.
Post-exposure prophylaxis (PEP) management depends on :
Type of contact with with suspect rabid animal
Vaccination status of individual:

23. Categories of contact with suspect rabid animal
Categories of contact and recommended post-exposure prophylaxis (PEP)
Categories of contact with suspect rabid animal
Post-exposure prophylaxis measures
Category I – touching or feeding animals, licks on intact skin
None
Category II – nibbling of uncovered skin, minor scratches or abrasions without bleeding
Immediate vaccination and local treatment of the wound
Category III – single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks, contacts with bats.
Immediate vaccination and administration of rabies immunoglobulin; local treatment of the wound

24. All category II and III exposures assessed as carrying a risk of developing rabies require PEP. This risk is increased if:
The biting mammal is a known rabies reservoir or vector species;
The animal looks sick or displays an abnormal behaviour;
A wound or mucous membrane was contaminated by the animal’s saliva;
The bite was unprovoked;
The animal has not been vaccinated;
In developing countries, the vaccination status of the suspected animal alone should not be considered when deciding whether to initiate prophylaxis or not.

25. Rabies post-exposure prophylaxis (PEP) schedule
Vaccination status
Intervention
Regimen*
Not previously vaccinated
Wound cleansing
All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent (e.g., povidine-iodine solution) should be used to irrigate the wounds.
Human rabies immune globulin (HRIG)
Administer 20 IU/kg body weight. If anatomically feasible, the full dose should be infiltrated around and into the wound(s), and any remaining volume should be administered at an anatomical site (intramuscular [IM]) distant from vaccine administration. Also, HRIG should not be administered in the same syringe as vaccine. Because RIG might partially suppress active production of rabies virus antibody, no more than the recommended dose should be administered.
Vaccine
Human 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.
Previously vaccinated**
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.
HRIG
HRIG should not be administered.
HDCV or PCECV 1.0 mL, IM (deltoid area†), 1 each on days 0 and 3.
Rabies post-exposure prophylaxis (PEP) schedule  

26. Local treatment of the wound
This involves first-aid of the wound that includes immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.

27. Control of patients and contacts
Report to local health authority..
Isolation: Contact isolation for respiratory secretion for duration of illness.
Concurrent disinfection: OF saliva and articles.
Immunization of contacts: Contacts who have an open wound or mucus membrane exposure to patient’s saliva must received specific anti-rabies treatment.
Investigation of contacts and source of infection.

28. WHO & Elimination of Rabies
Rabies, a zoonotic disease, requires close co-ordination between animal and human health sectors at the national, regional and continental levels.
In December 2015, a global framework to reach zero human rabies deaths by 2030 was launched by WHO and the World Organisation for Animal Health (OIE), in collaboration with the Food and Agriculture Organization of United Nations (FAO) and the Global Alliance for Rabies Control. This initiative marks the first time that the human and animal health sectors have come together to adopt a common strategy against this devastating but massively neglected disease.

29. THANK YOU