8/26/2019

WHAT IS RABIES
• Rabies may be one of the oldest infectious
diseases known to man. It has been known
RABIES since as early as 2000 BC

• Latin word rabere : to rage or rave.

Sanskrit word rabhas : to do violence.

Greeks called it lyssa or lytta : frenzy or

Dr. Jan Muhammed
Dr. Ahmed Ali Khan madness.

• Rabies is a viral infection attacking the central • It is usually spread through the bite or scratch
nervous system. of an infected animal. ( Domestic or Wild)

• It causes inflammation of the brain
(encephalitis). This causes pressure on various
areas of the brain, resulting in diverse
symptoms.
• The saliva of an infected animal contains high
concentrations of the virus
• It is a zoonotic disease (a disease that is
transmitted to humans from animals).

CAUSATIVE ORGANISM
• Once symptoms of the disease develop, rabies is • It is caused by Single-Strand, Negative Sense,
nearly always fatal. Ran Virus.

• RABIES IS 100% FATAL BUT 100% PREVENTABLE! • Family : Rhabdoviridae

Genus : Lyssavirus
• Popular Saying ‘’Prevention is the best medicine’’ Species : Rabies Virus

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TRANSMISSION
• Dogs cause > 90% of the Human cases. Other
• Human-to-Human transmission also occurs.
animals responsible include bats, foxes,
Direct or Indirect.
raccoons, skunks, cats
1. Direct : bite ; contact with saliva or other
body fluids of infected person

2. Indirect : transplant related e.g. corneal

transplant, transplantation of solid organs or
vascular conduits

INCUBATION PERIOD
• In dogs & cats, the virus may be present in the
saliva for 3-4 days before the clinical onset & • The closer the site of bite is to the brain, the
during the course of illness till death. shorter the incubation period.

• It is highly variable in man, commonly 3-8

weeks following exposure.
• It can take any where from a few days to even
a few years before symptoms show; but on
average it takes between 30-90 days.
• Rabies virus travels 1 cm per day (inside the
nervous system).
• The virus replicates in the muscle at bite site

SIGNS & SYMPTOMS

• The rabies virus first connects to the receptors In the Animal
on the muscle cells of the bite wound before it
binds itself to the nervous tissue.
Two Forms :

• Other factors that influence incubation period

1. Paralytic Type (20-25% cases)
include : the number of bites, the amount of
transmitted virus, age and health of the 2. Furious Type (75-80% cases)
victim.

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1. Paralytic Type :

Also referred to as ‘Dumb Rabies’
Weakness and loss of coordination, followed
by paralysis
2. Furious Type :
Extreme behavioral changes, including overt
aggression, attack behavior
It is also possible, a rabid animal exhibit both
types.
Some animals die due to the infection
without displaying any major symptoms.
It is important to observe the animal for at
least 10 days, if it has not displayed any
signs, to be certain.

Therefore, following signs should be looked for in

a suspected animal : In the Human
• Show no fear for humans
• Bite Marks - Pain or tingling at the site of the
• Act very agitated (without provocation) bite

• Make strange noises • Headache, Fever, Sore throat

• Foaming at the mouth ( due to paralysis of throat
and jaw muscles) • Bizarre behavior

• Disorientation, Incoordination and Staggering

( due to paralysis in the legs) • Nervousness, Confusion , Agitation

• Hallucinations (Seeing things that are not really • Afraid of water - Hydrophobia (even sight or
there ) sound of water disturbs the patient)

• Seizures (Hydrophobia in Rabies is described as “Fear

of water" due to spasms in the throat)
• Paralysis
• Coma, Respiratory arrest and Death
• Difficulty in drinking (due spasms of pharynx,
which produces choking) (Death occurs in 1 - 6 days after signs appear)

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DIAGNOSIS
• Testing the animal :

• Testing the animal In order to do the test, the animal must be

euthanized and tissue samples are taken from
• Labs & Tests the brain. On microscopy, ‘Negri Bodies’ are
• Imaging identified.

Test results are usually ready within 24 to 72

hours.

• Labs & Tests

No single test is considered sufficient in • Imaging

diagnosing rabies in a living person,

Certain imaging tests can aid in the diagnosis

• Lumbar Puncture (for CSF analysis)
of rabies encephalitis (i.e., acute inflammation
• Saliva Direct Fluorescence Antibody Test of the brain resulting from rabies infection)
(DFA test)
• ELISA, RT-PCR
• Head MRI
The presence of antibodies to rabies virus • Head CT Scan
indicates an infection.

MANAGEMENT 1. Before Symptoms Have Appeared :

There is no known treatment of Rabies.

Management is based on Post-Exposure
Treatment (PET).
PET is divided into two phases :
1. Before Symptoms Have Appeared
2. After Symptoms Have Appeared
• Local wound treatment, Wash lesions well with
soap and water (tetanus booster)
• Avoid suturing wounds. Don’t apply ointment,
cream or wound dressing
• Apply alcohol, povidone iodine or any antiseptic
• Tetanus Vaccine

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2. After Symptoms Have Appeared :

• Infiltrate rabies immune globulin (20 IU/kg)
into and around the margin of the bites.
( for immediate passive immunity, until active • Once symptoms start, treatment is supportive.
immunity begins 7-10 days after vaccination )
• It should center on comfort care, in an
• Administer Anti-rabies vaccine on days appropriate medical facility. Patient should be
0,3,7,14, and 28. (Post-Exposure Prophylaxis) admitted in a quiet, draft-free, isolation room.

• Prophylactic Antibiotics for high-risk wounds,

or people with immune deficiency. • Supportive care includes :
( e.g. Amoxicillin, Cloxacillin or Cefuroxime )

• using sedation ( e.g. Diazepam, Midazolam,

Haloperidol + Dipenhydramine) • Doctors, nursing staff & relatives in contact
with the patient should wear proper personal
• avoidance of intubation (invasive procedures protective equipment (gown, gloves, mask,
must be avoided ) goggles)

• life support measures

COUNSELLING PREVENTION & CONTROL

• Provide suitable emotional support

• Discuss & provide important information to • PRE-EXPOSURE PROPHYLAXIS

relatives concerning transmission of disease &
indication for PET of contacts • POST-EXPOSURE PROPHYLAXIS
• WHO CATEGORISATION OF EXPOSURE
• Honest gentle communication concerning
prognosis should be provided to relatives of
patient

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PRE-EXPOSURE VACCINATION POST-EXPOSURE PROPHYLAXIS

• Provided to subjects at risk before occupational • Provided to subjects after rabies exposure.
or vocational exposure to rabies.

• Consists of :
• Subjects include diagnosticians, laboratory &
vaccine workers, veterinarians, cavers, hikers, etc.
a. Wound care
• Simplifies post exposure management.
b. Rabies immune globulin
c. Anti-rabies vaccine
d. Prophylactic Antibiotics
• Only vaccines used.

TREATMENT ACCORDING TO WHO

WHO CATEGORISATION OF EXPOSURE
CATEGORIES OF EXPOSURE

DOSAGE SCHEDULE
Intramuscular Schedule ( Deltoid/ Thigh ) Intradermal Schedule (Updated 2-Site Regimen)

1. Essen Schedule (Day 0, 3, 7, 14, 28 )
One Dose per Visit. Total 5 Visits.
2. Zagreb Schedule ( Day 0, 7, 21 )
Two Doses on First Visit, Then One Dose per
Visit. Total 3 visits.
• Day 0, 3, 7, 28 – Two doses per visit. Total 4 Visits
Pre-Exposure Schedule
• Day 0, 3, 7, 21/ 28 – IM or ID. One Dose per Visit.
Total 3 Visits.

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VACCINES USED COMPLICATIONS

• HDCV ( Human Diploid Cell Vaccine) Rabivac
• PVRV ( Purified Vero Cell Rabies Vaccine )
Verorab
• PCECV ( Purified Chick Embryo Cell-Culture
Vaccine) Rabipur
• Always fatal, once symptoms of the disease
develop. Very poor prognosis.
• Complications If not Treated or Treatment
Failure : Death is Certain
• Early initiation and proper treatment
increases the chances of survival.

General Safety Measures

• Be careful and act responsibly around stray

animals
• Get your pets vaccinated against rabies
• Learn how to recognize an animal with rabies
• Know how to avoid dog bites
• Learn about dog body language
• Contact Animal Control Services if you suspect
an animal of rabies or too many stray dogs in
the locality