RABIES

2021
 RABIES
• Primarily a Zoonotic disease of warm
blooded animal
• such as :-
• Dogs,
• wild cats,
• Jackals,
• wolves etc.
• It is caused by the Neurotropic RNA virus belongs to
Rhabdoviridae type I (LYSSAVIRUS type I) is Bullet
shaped virus
• It is an acute
• Highly fatal viral dis: of CNS
Transmitted to man by:
• Bites
OR
• Licks of rabid animals
 Agent Factors:

Agent

(LYSSAVIRUS type I)
Rhabdoviridae type I
Bullet shaped
• History of Rabies Virus
• Man described the disease in 2300 B.C.

• The origin “rabhas”, meaning “to do

violence” comes from ancient Indian
Sanskrit dating 3000 B.C.
 History of the Rabies Virus
•Outbreak of rabies in Europe

in 20th century spawned the

Vampire myth- linked to bats.
•Rabies epidemic in 13th
century France may have
spurred Werewolf myth as
well- linked to wolves.
•Rabies is commonly spread
by bats and wolves and other
wildlife like foxes
 History of the Rabies Virus
• Since Roman times, man established the
link between the infectivity of a rabid dogs
saliva and the spread of the disease.
• Because there is no cure for rabies, those
that had been bitten by a rabid dog would
commonly commit suicide to avoid the
painful death that would inevitably follow.
 History of the Rabies Virus
• Louis Pasteur was the first person to
diagnose that rabies targeted the CNS.
• Also determined that nervous tissue of an
infected human or animal also contained
the virus.
• In 1890 created the rabies vaccine and
saved 9 year old Joseph Meister after he
had been bit by a rabid dog.
 Epidemiology
87 countries contain Rabies, but more
cases are reported in Asia.
In Indo-Pakistan rabies is a major
public health problem mainly due to
presence of a large no: of stray dogs.

More than 30,000 people died of

Rabies every year in Asia. Every year
10 million people require treatment
and protection from Rabies which is
great Financial loss.
• Estimated Annual Human Rabies Cases
2005

• North America 4 - 8
• Europe 10 - 20
• Latin America 200 - 400
• Africa 500 - 1,000
• Asia 30,000 - 40,000
• FREE RABIES ZONE:

• Australia,
• China,
Iceland,
• Ireland,
• Japan,
• New Zealand etc
 Types of Rabies virus
STREET VIRUS FIXED VIRUS
Definition: the virus Definition: the virus
recovered from which has a short, fixed
naturally occurring and reproducible
cases of rabies is incubation period is
called “street virus” called “fixed virus

Sources: it is naturally Sources: it is prepared

occurring virus. It is by repeated culture in
found in saliva of brain of rabbit such that
infected animal. its I.P. is reduced &
(continue) fixed
 Features Features
1. It produces Negri 1. It does not form Negri
bodies bodies
2. Incubation period is 2. Incubation period is
long i.e. 20 to 60 days constant between 4-6
3. It is pathogenic for all days
mammals 3. It can pathogenic for
humans under certain
4. Cannot be used for conditions
preparation of vaccine 4. Is used for preparation of
antirabies vaccine
 RESERVOIR OF INFECTION
1) URBAN RABIES:

From Dogs and

cats.
2) WILD LIFE RABIES:
From jackals and foxes.
3) BAT RABIES:
Vampire bats which live on the blood of animals and
men. These are one of the main causes of the death of
bovine, around 0.5 to 1 million per year.
 Source of Infection

• Saliva of Rabid animal

 Host Factors

• All warm blooded animals including man.

• Rabies in man is a dead-end infection.

 Mode of Transmission
1. ANIMAL BITES
2. LICKS
3. AEROSOL
4. PERSON TO PERSON
• INCUBATION PERIOD:

• normally it is 3 - 8 wks

• may be short that is 4 days

• or may be prolonged for years.

 PATHOGENESIS
Replicate in muscle and C.T. ---
attach to nerve ending --- CNS ---
than centrifugally in peripheral
nerve to many tissue including
Skeletal muscle, heart, adrenal
gland and skin --- salivary gland
 CLINICAL PICTURE
1. Prodromal symptoms
Headache, malaise, sore throat, low
fever, pain at the site of bite
2. Excitation Symptoms
sensory sys: involvement
Aero phobia, excitation of N.S.
Motor sys: inv:
increase reflexes, muscle spasm,
Symp:inv: dilatation of Pupils. increase perspiration, salivation,
and Lacrimation,
Mental changes: fear of death, anger, irritability and depression
Hydrophobia ( Fear of water)
sight or sound of water may produce
spasm of degulation
the duration of illness is 2-3 days may
be prolonged to 5-6 days
Stage of paralysis & coma

DEATH / Recovery
 (summary)
Transmission of Rabies
Cl:Picture

• The rabies infection and the symptoms that

accompany it is classified by five stages:
1. Incubation (1-3 months)
2. Prodromal, where first symptoms occur
3. Acute neurological phase
4. Coma
5. Death or recovery
 DIAGNOSIS
1. History
2. Sign and symptom
3. Examination
4. Detection of Antigen by taking Skin
Biopsy using Immunofluorescence
by virus isolation from Saliva &
other secretions.
 Control Measures
• Notification
• Isolation
• Disinfection
• Immunization
 Prevention of human rabies
post Exposure prophylaxis

1. General consideration:- Aim is to neutralize virus before entering CNS

2. LOCAL WOUND TREATMENT

a, Cleansing of wound(soap & water)

b, Chemical treatment:
• Either Alcohol 400-700 ml /liter
• Tincture Iodine
• No more treatment with Ammonium
compound
• No Carbolic acid and Nitric acid as it leave
very bad scar
c, Suturing
d, Anti Rabies Serum
e, Antibiotic and ATS
f, Observe the animal for 10 days
• 3, Immunization
• 1,NERVOUS TISSUE VACCINE (NTV
2, Human diploid cell vaccine
(HDCV)
Vaccines for immunization
Definition:
it is fluid or dried preparation of
Rabies “Fixed” virus grown in the
Neural tissue of
Rabbits,
Sheep,
Goats,
Mice or Rats
OR in embryonated duck eggs
OR in cell culture
 Nervous Tissue Duck embryo Cell culture
vaccine vaccine vaccine
preparation From fixed virus grown in
brain of sheep or other
animals
potency Low or variable Eliminate Neuroparalytic More potent
factors more safer
Doses Large nos: are required Fewer doses of small
volume
Side effects Severe & fatal reactions Allergic risks Fewer

Uses Exposed subjects Used in UK,USA in past 1, (HDC) safe, potent

Pre & post
expos:Immunization
Suckling mouse brain V Now purified DEV 2Tissue culture 2nd G
Devoid of Neuroparalytic developed (Non-human)
effect Improvement over adult Potent, low cost
Used in Latin America animal nervous tissue V WHO recommendatio
Improvement over adult Not available in India &
animal nervous tissue V Pakistan
 Type of Vaccine
NERVOUS TISSUE VACCINE (NTV)
a. Derived from adult animal nervous
tissue eg. Sheep
b. Derived from suckling mouse brain
Type: Killed viral vaccine
Dose: 2.5 ml S/C (Ant. Abdominal
wall)
Schedule: 14 doses
Type of Vaccine (conti)
Duck Embryo Vaccine (DEV)

Type: Killed viral vaccine

Dose: 1 ml S/C ( Ant. Abdominal
wall)
Schedule: 14 doses OD
not available in Pakistan
 Type of Vaccine (conti)
CELL CULTURE VACCINES
a. Human diploid cell vaccine (HDCV)
b. Second generation tissue culture
vaccine (non- Human)
Type: Killed viral vaccine
Dose: 1 ml IM
Schedule: on 0, 3, 7, 14, 28 day,
booster on day 90
 PASSIVE IMMUNIZATION
• Horse Anti Rabies serum: 40 iu / kg at
0 day
• Human rabies immunoglobin (HRIG):
20 iu / kg around the wound and rest in
IM on 0 day
• Booster doses are essential whenever
anti rabies serum is given with the
vaccine
 Classification Of Exposures
1. Class I (slight Risk) 07 injection
a. Licks on healthy unbroken skin.
b. Scratches without oozing of blood.
2. Class II (Moderate Risk) according to the Schedule plus
one booster dose after 3 week
a. Licks on fresh cuts.
b. Scratches with oozing of blood.
c. All bites except those on head, neck, face, palms and fingers.
d. Minor wounds less than 5 in number.
3. Class III (Severe Risk) according to the Schedule plus Two
booster dose one after one week and another 2 week
a. all bites or scratches with oozing of blood on neck,
head, face, palms and fingers.
b. Lacerated wounds on any part of the body.
c. Multiple wounds 5 or more in number.
d. Bites from wild animals.
 IMMUNITY
• Duration of Immunity is upto 06 month
• If again bite by rapid animal than dose
according to blood titre
if more than 0.5 i.u. / ml than only two
dose 0, 3 day
if less than 0.5 i.u. / ml than 0, 3, 7 day
 General measures
• Regist:,licensing & taxation of dog.
• Muzzling of dogs
• Yearly mass vaccination of dog
• Destruction of stray dogs
• Facilities for diagnosis of rabies in dogs
• Destruction of wildlife where the animals
are known to be the reservoir of infection.
• Publicity
 Pre-Exposure Prophylaxis
• It is done in persons who have high risk of
repeated exposures.
Animal Handlers
Wildlife officers
Veterinarians
Lab: staff working with rabies virus
Protected by:- Cell-culture vaccine 1ml I/M
OR 0.1ml I/D ( 0,7& 28day)
Post-exposure R/ of persons
(who have been vaccinated previously)
HDC vaccine (1ml I/M 0,3 & 7 day 0
 Rabies in Dogs
• Incubation period: 3-8 wks.
• Clinical features: Rabies in dogs may manifest itself
in two forms.
a. Furious Rabies.
This the typical mad-dog syndrome characterized by.
i. change in behavior.
ii. Tendency to run away from home, wander aimlessly
and biting humans and animals.
iii. Change in voice due to paralisis of laryngeal muscles.
iv. Excessive salivation & foaming at the angle of the
mouth.
v. Paralysis of the whole body leading to coma & death.
b. Dumb Rabies.
i. The excitative or irritative stage is
lacking.
ii. The disease is predominantly paralytic.
iii. Dog withdraws itself from being seen or
disturbed.
iv. It elapses into a stage of sleepiness and
dies in about 3 days.