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:CONTENTS
(What is rabies? (DEFINITION & ETIOLOGY
Is an acute infectious disease of warm-blooded animals and •
humans characterized by an involvement of the nervous system
. resulting in death
It is caused by the RABIES VIRUS, a rhabdovirus of the genus •
.lyssavirus
Rabies is a serious disease. Each year, it kills more than
50,000 people and millions of animals around the world.
Rabies is a big problem in Asia, Africa, and Central and South
America. In the United States, rabies has been reported in
every state except Hawaii. Any mammal can get rabies.
Raccoons, skunks, foxes, bats, dogs, and cats can get rabies.
Cattle and humans can also get rabies. Only mammals can get
rabies. Animals that are not mammals -- such as birds,
snakes, and fish -- do not get rabies. Rabies is caused by a
virus. An animal gets rabies from saliva, usually from a bite of
an animal that has the disease.
The Rabies Virus
RV – a neurotropic filterable virus present in the
Rod-shaped rabies
saliva of rabid animals. It has a preferrence for viruses colored for
nerve tissues.
effect
Rhabdoviridae family
genus
vesiculovirus ephemerovirus novirhabdovirus
cytorhabdovirus nucleorhabdovirus
lyssavirus
species
Rabies virus
How do you get rabies? (MODE & MEDIA OF TRANSMISSION, IMMUNITY)
Wild animals may move slowly or may act as if they are tame. Some wild animals •
(foxes, raccoons, skunks) that normally avoid porcupines, may even try to bite these
. prickly rodents
.A pet that is usually friendly may snap at you or may try to bite •
How do you know if one has
(DIAGNOSIS)
?rabies
•There is yet no way of immediately knowing who had acquired
rabies virus. No tests are available to diagnose rabies in humans
before the onset of clinical disease.
•The most reliable test for rabies in patients who have clinical signs
of the disease is a DIRECT IMMUNOFLUORESCENT STUDY of a
full thickness biopsy of the skin taken from the back of the neck
above the hair line.
WORLDWIDE:35, 000-
50, 000 cases/ year
(WHO)
parts of Africa and Asian continents and many parts of South America are endemic for
rabies
•
UK and most of Western Europe are rabies free due to success of coordinated wildlife
oral vaccination programs
•
INVASION
(0 – 10 days)
EXCITEMENT
(2 – 7 days)
COMA
PARALYTIC (5 – 14 days) DEATH
RABIES CLASSIFICATION
ANIMAL RABIES
There are two common types of rabies. One type is "furious" rabies. Animals with this type are hostile, may •
bite at objects, and have an increase in saliva. In the movies and in books, rabid animals foam at the mouth.
. In real life, rabid animals look like they have foam in their mouth because they have more saliva
The second and more common form is known as paralytic or "dumb" rabies. The dog pictured below has this type.
An animal with "dumb" rabies is timid and shy. It often rejects food and has paralysis of the lower jaw and
.muscles
.Another two types of rabies. One type is “urban” rabies. The type of rabies in domestic dogs and cats •
The other type is called “ sylvatic” rabies. These type came from wild animals such as bats, weasels, skunks and
.moles & voles
HUMAN RABIES
Humans also have a “furious” type, the classic foaming of the mouth, aggression, apprehension & •
.hydrophobia, and the “dumb” type, progressive paralysis of the body until they couldn’t breathe anymore
DIFFERENT STAGES OF RABIES
INFECTION C B
A A
T T
D S S
O
G
S
VIRUS IN SALIVA INHALED AEROSOLS
VIRUS IN SALIVA
INVASION PHASE
INVASION PHASE
PARALY
SIS
EXCITEMENT
PARALY
SIS
DEATH DEATH
MANAGEMENT
PREVENTION
Responsible pet ownership •
a) pet immunization, esp. cats, usually starting at 3 months of age and every year thereafter
b) don’t allow pets to roam around the streets
c) take care of your pets, keep them in good health – bathe, feed with clean adequate food and
provide clean sleeping quarters
Thoroughly clean ALL BITES AND SCRATCHES made by any animal with strong •
.medicinal soap or solution
Responsible awareness. Report immediately rabid or suggestive of rabies •
domestic or wild animals to proper authorities (local government clinic,
(.veterinarians or community officials
Pre-exposure to high risk individuals. Veterinarians, hunters, people in contact •
with animals (zoo), butchers, lab-staff in contact with rabies, forest
.rangers/caretakers
DOH Standard Protocol •
If dog is apparently healthy, observe the dog for 14 days. If it dies or show signs suggestive or rabies, •
.consult a physician
If the dog shows signs suggestive of rabies, kill the dog immediately and bring head for lab examination. •
.Submit for immunization while waiting for results
If the dog is not available for observation (killed, died or stray), submit for •
.immunization
ACTIVE IMMUNIZATION – 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
(MEDICAL AGENT: Human Diploid Cell rabies Vaccine (HDCV
(KNOWLEDGE DEFICIT (about the disease, cause of infection and preventive measures •
.assess patient’s and family’s level of knowledge on the disease including concepts, beliefs and known treatment
:Provide pertinent data about the disease
organism and route of transmission
treatment goals and process
community resources if necessary
allow opportunities for questions and discussions
ALTERED BODY TEMPERATURE: FEVER RELATED TO THE PRESENCE OF INFECTION. Since fever is •
.continuous, provide other modes to reduce discomfort
…If patient is still well oriented, Inform the relation of fever to the disease process. The presence of virus in the body
Monitor temperature at regular intervals
.Provide a well ventilated environment free from drafts and wind
DEHYDRATION related to refusal to take in fluids secondary to throat spasms and fear of spasmodic •
. attacks
.Assess level of dehydration of patient
Maintain other routes of fluid introduction as prescribed by the physician e.g. parenteral routes
.Moisten parched mouth with cotton or gauze dipped in water but not dripping
:OBJECTIVES
To provide new policy guidelines and procedure to •
ensure an effective and efficient management for
eventual reduction if not elimination of human
rabies
To increase voluntary pre-exposure coverage •
among high risk group (animal handlers, field
workers, health staff working in rabies unit, rabies
diagnostic lab staff, children ↓ 15 yo living in
.endemic areas
SPECIFIC GUIDELINES AND
:PROCEDURES
Management of
Potential Rabies
Exposure
CATEGORIES OF 3
EXPOSURE
CATEGORY I
Feeding/ touching an animal •
Licking of intact skin (w/ reliable history and •
(thorough physical examination
Exposure to patient with signs and symptoms of •
*rabies by sharing of eating or drinking utensils
Casual contact to patient with signs and •
*symptoms of rabies
:MANAGEMENT
MEDICATIONS 1.
Diazepam b.
Midazolam c.
Haloperidol + Dipenhydramine d.
SUPPORTIVE CARE. 2
Pts w/ confirmed rabies should receive -
adequate sedation & comfort care in an
.appropriate medical facility
Once rabies diagnosis has been confirmed, a.
invasive procedures must be avoided
Provide suitable emotional and physical b.
support
Discuss & provide important info. to c.
relatives concerning transmission of dse. &
indication for PET of contacts
Honest gentle communication concerning d.
prognosis should be provided to relatives
of pt
INFECTION CONTROL. 3
Patient should be admitted in a a.
quiet, draft-free, isolation room
HLCR workers & relatives in contact b.
w/ pt should wear proper personal
protective equipment (gown, gloves,
(mask, goggles
Tick me!
This racoon is eating a special bait which
contains a vaccine against rabies.
How do I keep my pet from getting rabies?
The best way to prevent rabies is to make sure your pets
!! get and stay vaccinated against rabies
:Other ways to prevent rabies in your pets •
Walk your dog on a leash. Never let them roam freely
. where wildlife may be present
. Consider keeping your pets indoors
Call animal control to take wild or stray animals away,
. especially if you see an animal acting strangely
If an animal bites your pet, handle your pet carefully
so you do not get bitten. Get a rabies booster
vaccination for them. Even if they have had the rabies
vaccination, a booster shot will help them fight off
. the disease better
Get your pets spayed or neutered. Pets that are fixed
are less likely to leave home, become strays, and make
. more stray animals
Make sure your pet gets and wears their rabies
vaccination tags. They should also wear a tag with
their name and your address and phone number. Keep
.them in a fenced yard or on a leash
QUESTION:
Is an increase in the incidence
of rabies r/t El Niño?
: ANSWER
A. Immediately wash the bite wound •
B. Consult physician/ ABTC •
C. Consult a vet for mgt of biting dog •
QUESTION: •
Do we need to kill the dog immediately?
Tick
me!
EXCITATION STAGE
Also called ACUTE NEUROLOGICAL PHASE; •
hyperactivity
DAYS 10 – 2 •
Imminent thoraco-lumbar involvement (SNS): •
pupillary dilation, lacrimation increased thick
saliva production / foaming of mouth, excessive
perspiration, increased HR
Anxiety: increased nervousness, insomnia, •
apprehension; a strong desire to be up, wandering
aimlessly about, and Fear: a sense of impending
doom
Hydrophobia (perhaps, SNS stimulation: •
depresses GI activity > inhibits esophageal,
gastric & intestinal function) > violent expulsion of
fluids, drooling (in attempt not to swallow) >
dehydration and parched mouth & tongue
Pronounced muscular stimulation & general tremor •
Mania (tearing of clothes & bedding, cases of •
biting & fighting rare but may occur) and
Hallucinations with lucid intervals (normal mental
function in which patient is well-oriented &
( answers questions intelligently
Convulsions( besides r/t pronounced muscular •
stimulation, further precipitated by sensory
stimuli – sight, sound, name of water > throat
spasms > choking > apnea, cyanois, gasping
in some cases, patient shows period of recovery, this apparent remission is followed by
progressive