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rabies

what you need to know about RABIES
by

mackie cajipe

on 12 September 2014

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Transcript of rabies

The most reliable test for rabies in patients who have clinical signs of the disease is
DIRECT IMMUNOFLUORESCENT STUDY
of a full thickness biopsy of the skin taken from the back of the neck above the hair line.
WHAT YOU NEED TO KNOW
RABIES 101
An acute infectious zoonotic disease of warm-blooded animals characterized by encephalitis and the involvement of the nervous system resulting in death.
RABIES
It is caused by the
RABIES VIRUS
, a rhabdovirus of the genus lyssavirus.
what causes it?
any group of rod-shaped RNA viruses with 1 important member, rabies virus, pathogenic to man. The virus has a predilection for tissue of mucus-secreting glands and the Central Nervous System. All warm-blooded animals are susceptible to infection with these viruses.
rhabdovirus
the particles of this virus have a distinctive bullet-like appearance, round on one end and flat on the other.
the family contains about 60 different viruses, but only the rabies
lysavirus
infects humans
any group of rod-shaped RNA viruses with 1 important member, rabies virus, pathogenic to man. The virus has a predilection for tissue of mucus-secreting glands and the Central Nervous System. All warm-blooded animals are susceptible to infection with these viruses.
rhabdovirus
HOW CAN YOU
GET ONE?
saliva of an
infected

mammal.
MEDIA OF TRANSMISSION
URBAN or CANINE RABIES
are transmitted by dogs.
SYLVATIC RABIES
are transmitted from wild animals and bats which sometimes spread to dogs, cats and livestock.
it is transmitted via bites, scratches or licks (on an open wound) from an
infected animal
.
infected animals show no fear in humans and act very agitated
what tests can be done?
There is yet no way of immediately segregating those who had acquired rabies infection from those who had been bitten by non-rabid sources. No tests are available to diagnose rabies in humans before the onset of clinical disease.
incubation period: 4 days to 2 years
pathophysiology
1-5 weeks is most common
The closer the bite to the brain, the shorter the incubation. the rabies virus travels 1cm per day.
the rabies quarantine is usually 10 days
Fever
Pain
Headache
Malaise
sore throat
Anorexia
Increased sensitivity
INVASION PHASE
EXCITEMENT PHASE
imitent thoracolumbar involvement
pupillary dilation
excessive perspiration
hydrophobia
muscular tremor
mania and halucinations
convulsions
increased thick saliva production/ foaming
PARALYTIC PHASE
the spasms are manifested due to the paralysis of the esophagus
death
coma
Vertigo
Facial and masseter palsy
Loss of tendon reflex
neck stiffness
Diminished local sensation
Incoordination
Disappearance of hydrophobia
Difficultly in swallowing
is often due to convulsion or respiratory paralysis
1.
a rabid animal bites or scratches a human.
2.
the virus replicates in the muscle near the wound area and affects the CNS
3.
the virus travels to the spinal cord and affects other organs, including the salivary glands
4.
the virus reaches the brain and causes a fatal encephalitis
is used to measure rabies-neutralizing antibodies in serum. This test has the advantage of providing results within 24 hours. Other tests of antibodies may take as long as 14 days.
RAPID FLUORESCENT FOCUS INHIBITION TEST
samples are taken from the nape of the neck since the virus occurs in the cutaneous nerves at the base of the hair follicles. Rabies virus is sometimes found in corneal impressions or eye
wash fluid
For diagnosis before death, it requires multiple test such as reverse transcription PCS wherein saliva samples are used. Yet, it must be accompanied with detection or antibodies to the virus in the serum or spinal fluid. Also, skin biopsies are used.
Unfortunately, there are no tests available, as of the moment, in diagnosing rabies virus before the onset of clinical disease
Many Filipinos eat dogs especially in the dish called kilawin. Kilawin or kinilaw is a Filipino style of "cooking" raw meat, fish or other ingredients by immersing them in vinegar.
did you know?
what is
the treatment?
Rabies is one of the few infectious diseases for which a
combination of passive and active post-exposure immunization
is required
98% of human deaths from rabies comes from dogs
2% only from cats.
1.
the wound should be scrupulously washed with soap

2.
debridement and application of an antiseptic such as alcohol or peroxide.

3.
go to the nearest hospital.
1.
there are people who apply merthiolate to their wound
2.
in rural areas, garlic and vinegar are used.
3.
faith healers are using carabao horns to suck the virus or with the use of batong-buhay.
thiomersal
tincture
is an organomercury compound. It is well established as anantiseptic and an antifungal agent.
Initially, the wound is infused with
human rabies immune globulin (HRIG)
to impede the spread of the virus, and globulin is also injected intramuscularly to provide immediate systemic protection.
aims to induce the body to develop antibodies and T-cells against rabies up to 3 years. It induces an active immune response in 7-10 days after vaccination, which may persist for one year or more provided primary immunization is completed
ACTIVE IMMUNIZATION
Putting garlic and vinegar on the wound may only cause more complications such as swelling and irritation. There is also a high risk of further introducing dirt into the bite wound.
which consists of local treatment of the wound, followed by vaccine therapy (with or without rabies immunoglobulin) should be initiated immediately
Post-exposure treatment
category I

touching or feeding animals, licks on the skin
no treatment

category II

nibbling of uncovered skin, minor scratches or abrasions without bleeding, licks on broken skin
vaccine only

category III

single or multiple transdermal bites or scratches, contamination of mucous membrane with saliva from licks; exposure to bat bites or scratches
vaccine and RIG
The indication for post-exposure vaccination with or without rabies immune globulin depends on the type of contact with the rabid animal.
Human Diploid Cell rabies Vaccine (HDCV)
is the current vaccine of choice for rabies. It is a potent inactivated vaccine in cultured human embryonic fibroblasts.
manufactured by SANOFI-PASTEUR
The routine is post-exposure vaccination which involves intramuscular or intradermal injection. Five doses of HDCV or RVA have to be given on the day of the bite, at 3, 7, 14 and 28 days. The WHO recommends a 6th dose 3 months after the bite and an additional 2 boosters are administered
Rabies Vaccine Absorbed
a vaccine that can be in combination with the rabies immunoglobuline (=RIG)
a discontinued vaccine in the US
Purified Chick Embryo Cell vaccine (PCEC)
however, Most of the new developed
Equine Rabies Immunoglobuline (ERIGs)
are potent, highly purified, safe and considerably less expensive than HRIG
The purified Vero cell rabies vaccine uses the attenuated Wistar strain of the rabies virus, and uses the Vero cell line as its host.
manufactured by SANOFI-PASTEUR
a newly developed less expensive vaccine coming from a chick embryo as its source
manufactured by CHIRON
ESSEN REGIMEN
A
Two-site regimen
that

uses of only 0.1ml PVRV (Sanofi Pasteur) and PCECV (Chiron) is approved by the World Health Organization. Wherein a 2-2-2-0-1-1 schedule is followed; administered on the upper arm over each deltoid. It is given on the day of the bite, at 3, 7, 14 and 28 days. The WHO recommends a 6th dose 3 months after the bite
Eight – site regimen
that uses of only 0.1ml HDCV (Sanofi Pasteur) and PCECV (Chiron) is approved by the World Health Organization. Wherein it follows an 8-0-4-0-1-1 site injection. It is given on the day of the bite, at 3, 7, 14 and 28 days. The WHO recommends a 6th dose 3 months after the bite
Thai Red-cross Regimen
Oxford Regimen
PURIFIED VERO CELL RABIES VACCINE
The eating of raw dog meat leaves Filipinos open to the deadly risk of rabies.
Though the virus is destroyed when dog meat is thoroughly cooked, there is still a chance of the virus being retained. The person cutting the dog may also get infected if the dog’s fluids happen to go to his eyes or lips.
In 2006, two people in the Philippines reportedly died of rabies after eating dog meat.
aims to provide
IMMEDIATE PROTECTION
against rabies which should be administered within the first 7 days of active immunization. The effect of the immune globulin is only short term. Rabies antibodies are introduced before it is physiologically possible for the patient to begin producing his own antibodies after vaccination. Some of the RIG is infiltrated around the site and the rest is given intramuscularly.
PASSIVE IMMUNIZATION
1.
The early signs of rabies typically include behavioral changes -- the animal may appear anxious, aggressive or more friendly than normal.
for animals, the incubation period is from 14 - 60 days
2.
As the disease progresses, animals develop hypersensitivity to light and sound. They may also have seizures and/or become extremely vicious.
3.
The final stage of rabies is typified by paralysis of the nerves that control the head and throat -- the animal will hypersalivate and lose the ability to swallow. As it progresses, the animal eventually goes into respiratory failure and dies.
This vaccine was first used on a human on
July 6, 1885, on nine-year-old Joseph Meister
(1876–1940), who had been mauled by a rabid dog,

Meister was bitten by a rabid dog after provoking it by poking it with a stick.

Pasteur decided to treat the boy with a rabies virus grown in rabbits and weakened by drying, a treatment he had earlier tried on dogs. The treatment was successful and the boy did not develop rabies.
Louis Pasteur and Emile Roux, developed the first rabies vaccination in 1885.
did you know?
In 1979 the Van Houweling Research Laboratory of the Silliman University Medical Center in the Philippines, then headed by Dr. George Beran, developed and produced a dog vaccine that gave a three-year immunity from rabies.
The development of the vaccine resulted in the elimination of rabies in many parts of the Visayas and Mindanao Islands.
The successful program in the Philippines was later used as a model by other countries, such as Ecuador and the Yucatan State of Mexico, in their fight against rabies conducted in collaboration with the World Health Organization.
DOG VACCINATION
In November 1905, in Hackettstown, NJ, a child’s death triggered a “war.” The mayor appointed three dog hunters to wipe out all the dogs and cats. The mayor himself carried a revolver. All in all, 70 were dogs killed.
human-dog war
The New York Times lists rabies victims in 1903.
Rabies was considered a scourge for its prevalence in the 19th century. In France and Belgium, where Saint Hubert was venerated, the "St Hubert's Key" was heated and applied to cauterize the wound; by an application of magical thinking, dogs were branded with the key in hopes of protecting them from rabies.
st. hubert's key
RABIES
the Latin rabies, "
madness
"
Sanskrit rabhas, "to do violence"
The Greeks derived the word lyssa, from lud or "
violent
";
this root is used in the name of the genus of rabies Lyssavirus.
let's go to statistics
in 2006,
2 people died from eating dog meat
By merely touching one’s eyes or lips when they have placed their hands on the dog’s traces of fluids, they may be able to transmit the virus.
in 2007,
281 Filipinos have died from rabies.
Reported Rabies Cases in the Philippines for 2007 were 833 (with a rate of 1 per 100,000 population
Region IV-A had the highest incidence of rabies (in 2007),
Region III ranked 3rd in national rabies morbidity in 2007 with 190 cases, (rate of 2 per 100,000 population)
Bulacan had the highest number of reported rabies cases for 2007 with a total of 126 but the rate was lower at 6.4.
Tarlac ranked second at the regional level with an incidence of 30 and a rate of 3.2.
in 2008,
•There were 644 cases of rabies acc. to NSCB.
the Philippines ranks 4th with respect to the number of cases worldwide acc. to NCBI
88% of infections are caused by pet dogs while 2% by pet cats acc. to DOH
in 2011
DOH recorded 209 deaths
with the highest incidence in Region 4A (28 deaths), Region 5 (25 deaths), Region 3 (23 deaths), Region 12 (21 deaths) and Region 11 (19 deaths).
government programs
Small rodents like squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, and mice) and lagomorphs including rabbits and hares are almost never found to be infected with rabies and have not been known to transmit rabies to humans; since they have natural immunity to the virus
take note!
laws and regulation
Anti-Rabies Law of 2007 or
REPUBLIC ACT NO. 9482
The Animal Welfare Act of 1998 or
REPUBLIC ACT NO. 8485
AO 2009-0027
or The Revised Guidelines on Management of Animal Bite Patients
programs
Pinoy Responsible Owner of Dog
(PRO-DOG)
effective national intersectoral rabies control program
rabies-free Philippines by 2020
Animal Bite Treatment;
Board Resolution No. 1585 s. 2012
treatment centers
Bureau of Animal Industry, DA, Visayas Avenue, Quezon City
Research Institute for Tropical Medicine (RITM) Alabang, Muntinlupa
San Lazaro Hospital, Rizal Ave, Sta Cruz, Manila
animal bite treatment center
rabies approved diagnostic labs
Unciano Medical Center, Sta Mesa, Manila
Manila Health Department, Division of Preventable Diseases, Manila City Hall
Research Institute for Tropical Medicine (RITM), Alabang Muntinlupa
San Lazaro Hospital, Rizal Ave, Sta Cruz Manila
world rabies day
september 28
rabies awareness month
march 1-30
antimicrobials:
amoxicillin
cloxacillin
cefuroxime
medications:
diazepam
midazolam
haloperidol + diphenhydramine
The Philippines ranks 6th worldwide
among countries which still have reported cases of rabies, with India as the first with 17,000+ deaths.
however, human-to-human transmission can also occur from cornea and organ transplants
ages
5-14 years old
are the most affected population with 53% cases.
philippines
sri lanka
thailand
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