RABIES

Hydrophobia, Lyssa
PART 2
Prevention
Prevention…
•Education of the public…
•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
animals.
• 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…
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
• 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.
 Primary Vaccinations

Type Name Route Indications

Human Diploid
Pre-exposure or
Cell Vaccine Imovax® Rabies Intramuscular
Post-exposure
(HDCV)
Purified Chick
Pre-exposure or
Embryo Cell RabAvert® Intramuscular
Post-exposure
Vaccine (PCEC)

PPT- 22
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
• 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.
 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.
ØEffective treatment soon after exposure to rabies can
prevent the onset of symptoms and death.

ØPost-exposure prophylaxis (PEP) management

depends on :
• Type of contact with with suspect rabid animal
• Vaccination status of individual:
Categories of contact and recommended post-exposure prophylaxis (PEP)

Post-exposure prophylaxis
Categories of contact with suspect rabid animal
measures
Category I – touching or feeding animals, licks on intact
None
skin

Category II – nibbling of uncovered skin, minor Immediate vaccination and local

scratches or abrasions without bleeding treatment of the wound

Category III – single or multiple transdermal bites or Immediate vaccination and

scratches, licks on broken skin; contamination of administration of rabies
mucous membrane with saliva from licks, contacts with immunoglobulin; local treatment of the
bats. wound
ØAll 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.
 Rabies post-exposure prophylaxis (PEP) schedule
Vaccination status Intervention Regimen*
All PEP should begin with immediate thorough cleansing of all
Not previously wounds with soap and water. If available, a virucidal agent
Wound cleansing
vaccinated (e.g., povidine-iodine solution) should be used to irrigate the
wounds.
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
Human rabies immune anatomical site (intramuscular [IM]) distant from vaccine
globulin (HRIG) 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.
Human diploid cell vaccine (HDCV) or purified chick embryo
Vaccine cell vaccine (PCECV) 1.0 mL, IM (deltoid area†), 1 each on
days 0,§ 3, 7 and 14.
All PEP should begin with immediate thorough cleansing of all
Previously wounds with soap and water. If available, a virucidal agent
Wound cleansing
vaccinated** 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
Vaccine
and 3.
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.
 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.
- Specific treatment: for clinical rabies, intensive supportive
medical care.
 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.
Why we couldn’t make
eradication for Rabies ??
THANK YOU