RABIES

Provincial Government
HUMAN RABIES
 Human rabies is most common in people
aged under 15, although all age groups are
susceptible
 Once clinical symptoms have occurred, the
disease is almost always fatal.
 Reported incidence of human rabies cases
is often incomplete and the estimated
50,000 deaths per year may be
underestimated
TRANSMISSION
 In almost all cases

Due to a bite, scratch or even lick on mucous membrane

from from animals (DOGS) whose saliva contains the virus

 In very exceptional cases

By inhaling virulent aerosol (laboratory experiment,

exploration of enclosed caves inhabited by bats)

By transmission from man to man

Indirectly: transplantation of infected tissues
Directly: from a bite or through saliva of an infected
person
Animal Bite Management

CATEGORY I
 Licks on intact skin
 Touching or feeding of animals
 Management:
 Wash exposed skin with soap and water
(10-15 mins. Running water)
 No vaccine or immunoglobulin required
 May give Pre Exposure Prophylaxis
CATEGORY II
 Nibbling of uncovered skin
 Minor scratches/ abrasions without
bleeding (includes wounds that are
induced to bleed)
 Licks on broken skin
 Management:
 Local wound treatment
 Start vaccine immediately (Active)
 Antibiotics, Anti-tetanus
Category II

•includes wounds

that are induced to bleed

Local Wound Care

Wounds should be immediately and

vigorously washed and flushed with
soap and water preferably for 10
minutes
Local Wound Care
 Apply antiseptic
(alcohol, tincture of iodine
etc)

 Give antibiotics for:

 All frankly infected wounds
 All category III cat bites
 All other category III bites that are either deep,
penetrating, multiple or extensive or located on
the hand/face/genital area
 Drugs of choice: Amoxicillin/clavulanic OR
Cloxacillin OR Cefuroxime axetil
Local Wound Care
 Anti-tetanus immunization should be
given since animal bites are
considered tetanus prone wounds
Type of Non- Immune Immune
injury immune/ Booster > 5 Booster < 5
Incomplet yrs yrs
e
Clean DPT/DT / DPT/DT None
minor TT /TT
wounds
Tetanus DPT/DT/TT DPT/DT/TT None
prone + TIG/ATS
wounds
Neglected DPT/DT/T DPT/DT/TT DPT/DT/TT
Local Wound Care: Don’ts

TANDOK COIN

BAWANG
BATO
SUCKING THE
BITE WOUND
Local Wound Care: Don’ts
 If possible, suturing of wounds should be
avoided (as it may inoculate virus deeper
into the wound)
 Wounds may be coaptated using sterile adhesives
strips
 However, if suturing is necessary, anti-
rabies immunoglobulin should be infiltrated
around and into the wound before suturing
 If suturing is unavoidable, it should be delayed
for at least 2 hrs after administration of RIG to
allow diffusion of the RIG to occur through the
tissues
CATEGORY III
 Single or multiple transdermal bites or
scratches
 Contamination of mucous membrane with
saliva (ie. Licks)
 Exposure to a rabid human through bites,
contamination of mucous membrane with
saliva/fluids through splattering, mouth-to-
mouth resuscitation, licks of eyes, lips, vulva
 Handling of infected carcass or ingestion of
raw infected meat
 All Category II exposures on the head and
neck area
Category III
CATEGORY III
 Management:
 Local wound treatment
 Start Vaccine and RIG immediately
( Active and Passive Immunization)
 Antibiotics and Anti Tetanus treatment
 OBJECTIVES OF POST EXPOSURE
TREATMENT
 To reduce the quantity of rabies virus
at the bite site
 To ensure a high titer of neutralizing
antibodies early and maintain it as
long as possible
 POST-EXPOSURE TREATMENT

 First Aid Treatment: Wash with soap

and running water for at least 10
minutes.
 Medical Treatment:
 Active Immunization
 Passive Immunization
 VACCINES
Active Immunization
 Egg Embryo Vaccines
 Purified Duck Embryo Vaccine (PDEV)
 Purified Chick Embryo Vaccine (PCEV)

 Cell Culture Vaccines

 Purified Vero Cell Vaccine (PVRV)
 Human Diploid Cell Vaccine (HDCV)
 ACTIVE IMMUNIZATION
 Intramuscular schedule
 Given on Day 0, 7, 21
 2-1-1 Regimen
 Given IM
 Day 0 – 2 doses
Day 7 - 1 dose
Day 21 – 1 dose
 Regimen used in health facilities where only a
few animal bite patients are seen everyday
ACTIVE IMMUNIZATION
 Intradermal Schedule
 Given on Days 0,3,7,30,90
 2-2-2-1-1
 Given Intradermally using Insulin syringe
 Vaccines should be used within 8 hours
 Used in Animal Bite Centers where many
patients are seen everyday and
personnel are trained on ID
administration of vaccine
PASSIVE IMMUNIZATION
(Rabies Immunoglobulin)
 Human Rabies Immunoglobulin
(HRIG)
 0.133 / KBW = amount given in ml
 No need for testing
 Equine Rabies immunoglobulin (ERIG)
 0.2 / KBW = amount in ml
 Skin testing needed
PRE EXPOSURE PROPHYLAXIS
 Recommended for persons who have
high risk of exposure
 1-1-1 on Days 0, 7, 21
 IM (1 vial) or ID (0.1 / 0.2 ml)
 Booster every 1-2 years
Dogs are friendly
rabies is deadly
 THANK YOU AND
 GOD BLESS