Oporto, Kaye Marie N.

BSN-3E
Group #1
NCM501201A
Topic Researched: Communicable Disease: (National Tuberculosis Control Program,
Leprosy Control Program, Schistosomiasis Control Program, Filariasis Control
Program, Malaria Control Program, and Rabies Control Program)

Communicable Diseases:
1.) National Tuberculosis Control Program
Nature of Disease:
Signs and Symptoms:
 Cough of two weeks or more
 Fever
 Chest or back pains not referable to any musculo-skeletal disorders
 Hemoptysis or recurrent blood-streaked sputum
 Significant weight loss
 Other signs and symptoms such as sweating, fatigue, body malaise and
shortness of breath
Source:
Mycobacterium tuberculosis and M. Africanum primarily from humans, and M. bovis
primarily from cattle.
Mode of Transmission:
♥ Airborne droplet method through coughing, sneezing or singing.
♥ Direct invasion through mucus membranes or breaks in the skin may occur,
but is extremely rare.
♥ Bovine tuberculosis results from exposure to tuberculosis cattle, usually by
ingestion of unpasteurized milk or dairy products. Extrapulmonary
tuberculosis, other than laryngeal, is generally not communicable, even if
there is draining sinus.
Primary Prevention:
 Prompt diagnosis and treatment of infectious cases
 BCG vaccination of newborn, infants and grade 1/school entrants
 Educate the public in mode of spread and methods of control and th
importance of early diagnosis
 Improve social conditions, which increase the risk of becoming infected,
such as overcrowding
 Make available medical, laboratory, and x-ray facilities for examination of
patients, contacts and suspects, and facilities for early treatment of cases
and persons at high risk of infection and beds for those needing
hospitalization
 Provide public health nursing and outreach services for home supervision
of patients to supervise therapy directly and to arrange for examination and
preventive treatment of contacts
Secondary Prevention:
• Direct Sputum Smear Microscopy (DSSM) shall be the primary
diagnostic tool in National Tuberculosis Control Program (NTP) case finding.
 • Screening tests: The purpose of screening individuals for TB is to (1)
identify infected individuals who are at high risk for TB disease, (2) identify
persons with TB disease who need treatment, and (3) identify persons with
TB disease in places where risk of transmission is high.

There are four components in diagnosing TB disease:

• Interview, Medical History and Physical Examination

• Tuberculin Skin Test
• Chest Radiograph
• Bacteriologic Examination (of sputum)*

*The definitive test for diagnosing pulmonary TB disease is a positive M.

tuberculosis culture.

• Preventative therapy accomplish secondary prevention efforts.

Implementation of preventative therapy (treatment with anti-tuberculosis
drugs) reduces the risk that TB infection will progress to TB disease. A
description of these drugs is provided at the end of this section. Generally,
persons under the age of 35, with no known risk factors for TB, are evaluated
for preventative therapy if his or her PPD reaction is 15 mm.

Children under six months of age are at high risk for developing TB disease, if
infected, and may have a false negative skin test reaction. If a child under the age
of six months is exposed to infectious TB, the pediatrician is likely to begin
preventive therapy, regardless of his or her lack of skin test reaction. Before
starting preventive therapy, a physician must rule out current or previous TB
disease and contraindications to isoniazid (an anti-tuberculosis drug). Isoniazid
(INH) is considered the primary anti-tuberculosis drug. The standard regimen for
preventive therapy is daily isoniazid INH (INH) for a minimum of six continuous
months for adults or six to nine months for children and adolescents. It is likely that
INH therapy will continue for 12 months in individuals who are HIV-infected or
immunosuppressed.

Individuals who may not adhere to the regimen undergo directly observed
treatment shortcourse (DOTS). This means a health care worker watches the
patient swallow the medication. If an individual is resistant or intolerant to isoniazid,
rifampin is used. The health provider monitors individual adherence to the
prescribed regimen and possible side effects related to therapy.

Tertiary Prevention of Tuberculosis

Medical Treatment

Current treatment regimens can successfully treat individuals with active TB

disease.

The success of treatment depends on:

 • Behaviors of patients and health care providers,
• Personal and social characteristics of patients and health care providers,
• Health care infrastructure,
• Extent of patient's knowledge about TB,
• Quality of training health care providers have received, and
• Economic, political, legislative and cultural influences.

An individual with active TB is infectious. Special precautions or isolation may be

necessary to keep the individual from transmitting TB to others. Once the individual
begins treatment and continues to follow the prescribed regimen, the individual is
usually noninfectious within days or weeks.

Four anti-tuberculosis drugs: isoniazid, rifampin, pyrazinamide, and either

ethambutol or streptomycin are used as initial treatment for most patients. The
drug regimen is adjusted if side effects occur or after drug susceptibility tests are
available.

First-line Drugs

Isoniazid- is used alone for preventive therapy or in combination with other

antituberculosis drugs for treatment of active disease. It is considered the primary
preventive TB drug. Up to 20% of individuals taking isonoazid will develop liver
abnormalities. The risk of developing liver problems while taking this drug increases
with alcohol use, chronic liver disease and use of injected drugs. It is bactericidal,
very active against M. tuberculosis, penetrates all body fluids, and inexpensive.

Rifampin-is considered nontoxic and is bactericidal for M. tuberculosis. It may

accelerate clearance of drugs metabolized in the liver.

Pyrazinamide-this tuberculocidal drug works on mycobacteria within the

macrophages.

Ethambutol-this drug is considered bacteriostatic on M. tuberculosis.

Streptomycin-is an Aminoglycoside. Aminogycosides treat a variety of severe

bacterial infections. Injection of this drug is necessary because it is not absorbed
from the gut.

Second-line Drugs

• Para-aminosalicylic acid
• Ethionamide
• Cycloserine
• Capreomycin
• Kanamycin

Surgical Intervention
 The use of corticosteroids and surgery is more common in cases of extrapulmonary TB. Surgery
enables access to diseased sites to obtain specimens of infected fluids.

2.) Leprosy Control Program

Nature of Disease:
Signs and Symptoms:
a.) Early Signs and Symptoms:
 Change in skin color-either reddish or white
 Loss of sensation on the skin lesion
 Decrease/loss of sweating and hair growth over the lesion
 Thickened and/or painful nerves
 Muscle weakness or paralysis of the extremities
 Pain and redness of the eyes
 Nasal obstruction or bleeding
 Ulcers that do not heal
b.) Late Signs and Symptoms:
 Loss of eyebrow-madarosis
 Inability to close eyelids-lagophthalmos
 Clawing of fingers and toes
 Contractures
 Sinking of the nosebridge
 Enlargement of thr breast in males or gynecomastia
 Chronic Ulcers
Source:
Mycobacterium leprae, an acid fast, rod-shaped bacillus which can be detected by
Slit Skin Smear (SSS)
Mode of Transmission:
♥ Airborne-inhalation of droplet/spray from coughing and sneezing of untreated
leprosy patient
♥ Prolonged skin-to-skin contact

Primary Prevention:
 Avoidance of prolonged skin-to-skin contact especially with a lepromatous
case
 Children should avoid close contact with active, untreated leprosy case
 BCG vaccination especially of infants and children
 Good Personal Hygiene
 Adequate Nutrition
 Health Education of patients, families and the community on the
nature of the disease, symptomatology, and its transmission
Secondary Prevention:
• Ambulatory chemotherapy through use of Multi-drug therapy
• Domiciliary treatment as embodied in R.A. 4073 which advocates
home treatment.
• In response to the increased incidence of dapsone resistance, the WHO
introduced a multidrug regimen in 1981 that includes rifampicin, dapsone,
and clofazimine. Some clinical studies have also shown that certain
 quinolones, minocycline, and azithromycin have activity against M leprae.
The WHO recently recommended single-dose treatment with rifampin,
minocycline, or ofloxacin in patients with paucibacillary leprosy who have a
single skin lesion. However, the WHO still recommends the use of the long-
term multidrug regimens whenever possible because they have been found
to be more efficacious.

Multidrug Therapy Plan Recommended by the WHO

Table

Type of Daily, Self- Monthly Months of

Leprosy Administered Supervised Treatment
Paucibacillary Dapsone 100 mg Rifampicin 600 6-12
mg
Multibacillary Dapsone 100 mg, Rifampicin 600 24
Clofazimine 50 mg mg,
Clofazimine 300
mg
Pediatric Dapsone 2 mg/kg, Rifampicin 10 Same as in adults
Clofazimine 1 mg/kg mg/kg,
Clofazimine 6
mg/kg
Type of Daily, Self- Monthly Months of
Leprosy Administered Supervised Treatment
Paucibacillary Dapsone 100 mg Rifampicin 600 6-12
mg
Multibacillary Dapsone 100 mg, Rifampicin 600 24
Clofazimine 50 mg mg,
Clofazimine 300
mg
Pediatric Dapsone 2 mg/kg, Rifampicin 10 Same as in adults
Clofazimine 1 mg/kg mg/kg,
Clofazimine 6
mg/kg

• Paucibacillary leprosy should be treated for 6-12 months with dapsone

100 mg/day unsupervised plus rifampin 600 mg/month supervised.
This regimen should be followed by treatment with dapsone as
monotherapy for 3 years in patients with tuberculoid leprosy or 5 years
in patients with borderline lepromatous leprosy.
• Multibacillary leprosy should be treated for 24 months with dapsone
100 mg/day unsupervised, clofazimine 50 mg/day unsupervised, and
rifampin 600 mg plus clofazimine 300 mg/month supervised.
• Corticosteroids have been used to treat nerve damage associated with
leprosy, but a recent review of 3 randomized controlled trials shows no
significant long-term effect.8 Prednisolone is believed to minimize pain
 and acute inflammation. The recommended initial dose is prednisolone
40 mg daily.

3.) Schistosomiasis Control Program

Nature of Disease:
Signs and Symptoms:
 Diarrhea
 Bloody Stools
 Enlargement of abdomen
 Spleenomegaly
 Weakness
 Anemia
 Inflamed liver
Source:
Schistosoma mansoni, S. haematobium and 51: japonicum are the major species
causing the human disease. Schistosoma japonicum is endemic in the Philippines.
Mode of Transmission:
♥ Infection occurs when skin comes in contact with contaminated fresh water in
which certain types of snails that carry schistosomes are living. It is the freee
swimming larval forms (cercariae) of the parasite that penetrate the skin.
♥ Fresh water becomes contaminated with Schistosoma eggs when infected
people urinate or defecate in the water. The eggs hatch, and if certain types
of snails are present in the water, the parasite grow and develop inside the
snails. The parasite leaves the snail and enters the water where it can survive
for about 48 hours. Schistosoma parasites can penetrate the skin of persons
who are wading, swimming, bathing, or washing in contaminated water.
Within several weeks, worms grow inside the blood vessels of the body and
produce eggs. Some of these eggs travel to the bladder or intestines and are
passed into the urine or stool.
Primary Prevention:
 Educate the public in endemic areas regarding mode of transmission
and methods of protection
 Dispose of feces and urine so that viable eggs will not reach bodies of
fresh water containing intermediate snail host. Control of animals infected
with S. japonicum is desirable but usually not practiced.
 Improve irrigation and agriculture practice: reduce snail habitats by
removing vegetation or by draining and filling.
 Treat snail-breeding sites with molluscicides (cost may limit use of
these agents)
 Preventive exposure to contaminated water (e.g. use of rubber boots)
to minimize cercarial penetration after brief or accidental water exposure,
towel dry, vigorously and completely, skin surfaces that are wet with
suspected water. Apply 70% alcohol immediately to the skin to kill surface
cercariae.
 Provide water for drinking, bathing and washing clothes from sources
free of cercariae or treatment to kill them Effective measures for inactivating
cercariae include water treatment with iodine or chlorine, or the use of paper
filters. Allowing water to stand 48-72 hours before use is also effective.
  Treat patients in endemic areas to prevent disease progression and to
reduce transmission by egg passage.
 Travelers visiting endemic areas should be advised of the risks and
informed about preventive measures.
Secondary Prevention:
• Specific treatment: Praziquantel (Biltricide) is the drug of choice
against all species. Alternative drugs are Oxamniquine for S. mansoniand
metrifonate for haematobium
• Epidemic measures: Examine for schistosomiasis and treat all
who are infected, but especially those with moderate to heavy intensities of
egg passage; pay particular attention to children
• Motivate people in these areas to have annual stool examination

4.) Filariasis Control Program

Nature of Disease:
Signs and Symptoms:
Asymptomatic Stage
 Characterized by presence of microfilariae in the peripheral blood
 No clinical signs and symptoms of the disease
 Some remain asymptomatic for years and in some instances for life
 Others progress to acute and chronic stages
 Microfilariae rate increases with age and then levels off
 In most endemic areas including the Philippines, men have higher
micronlariae rate than women.

Acute Stage:
Starts when there are already manifestations such as:
 Lymphadenitis (inflammation of the lymph nodes)
 Lymphangitis (inflammation of lymph vessels)
 In some cases, the male genitalia is affected leading to funiculitis, epidymitis,
or orhitis (redness, painful and tender scrotum)
Chronic Stage:
 Develop 10-15 years after the onset of the attack
 Hydrocoele (swelling of the scrotum)
 Lymphedema (temporary swelling of the upper and lower extremities)
 Elephantiasis (enlargement and thickening of the skin of the lower and/or
upper extremities, scrotum, breast)
Source:
Human Lymphatic Filariasis-is a chronic parasitic infection caused by nematode
parasites known as Wuchereria bancrofti, Brugia malayi and/or Brugia timori. The
young and adult worms live in the lymphatic vessels and lymph nodes while the
microfilariae is usually found in the blood. The lifespan of the adult parasites is
about 10 years (but a 40-year-lifespan has been reported) while the microfilariae
live for about a year at most.
Mode of Transmission:
♥ The disease is transmitted to a person through bites from an infected female
mosquito primarily Aedes poecilius that bites at night
 Primary Prevention:
 A. Measures aimed to control the vector:
- Environmental sanitation such as proper drainage and cleanliness of
surroundings
- Spraying with insecticides (may also produce harmful effects)
 B. Measures aimed to protect the individual and families in endemic
areas
- Use of mosquito nets
- Use of long sleeves, long pants and socks
- Application of insect repellants
- Screening of houses
- Health education
Secondary Prevention:
• Diagnosis:
- Physical examination is done in the main health center or during scheduled
survey bites in the community.
- History taking
- Observation of the major and minor signs and symptoms
• Laboratory Examinations:
- Nocturnal Blood Examination (NBE) – blood are taken from the patient at the
patient’s residence or in the hospital after 8:00 pm
- Immunochromatographic Test (ICT) – it is the rapid assessment method. It is
an antigen test that can be done at daytime
• Treatment:
-The treatment of cases in endemic communities is the most effective way to
reduce or prevent morbidity and transmission. Health workers must
emphasize the importance of compliance to the prescribed treatment
regimen.
- The community must be informed of the objective of treatment which is to
reduce and interrupt transmission of infection
- Diethylcarbamazine Citrate (DEC) or Hetrazan, kills almost all microfilaria
and a good proportion of adult worms. Drug is given to patients with clinical
manifestation and/or microfilariae
• Side effects and contraindications of DEC (Hetrazan):
- There are two types of side reactions, general and local, both with or
without fever. The systemic reactions are manifestations due to host
inflammatory responses to parasites antigens liberated by the rapid death of
the microfilariae while the localized adverse reactions are induced by their
death
• Mass treatment
- Distribution to all population
- Endemic and infected or not infected with filariasis in established endemic
areas
The dosage is 6mg/kg body weight taken as a single dose per year
• Surgical Treatment:
-Chronic manifestation such as elephantiasis and hydrocoele can be handled
through surgery. This is usually referred to hospitals for management
- Mild cases of lymphedema can be treated by lymphovenous anastomosis
distal to the site of the lymphatic destruction.
 - Chyluria is operated on by ligation and stripping of the lymphatics of the
pedicle of the affected kidney while hydrocoeles can be managed by
inversion or resection of the tunica vaginalis
• Supportive care for filariasis:
- Filariasis patients are advised to observe personal hygiene by washing the
affected areas with soap and water at least twice a day or prescribed
antibiotics or anti-fungals for super infection.

5.) Malaria Control Program

Nature of Disease:
Signs and Symptoms:
 Recurrent chills
 Fever
 Profuse sweating
 Anemia
 Malaise
 Hepatomegaly
 Spleenomegaly
Source:
Malaria is produced by intraethrocytic parasites of the genus Plasmodium. Four
plasmodia produce malaria in humans: Plasmodium falciparum, P. vivax, P. ovale
and P. malariae.
Mode of Transmission:
♥ Bite from the salivary gland of a female Anopheles mosquito.
Primary Prevention:
 Sustainable Preventive and Vector Control measures refer to the
adoption of measures for the prevention and control against the malaria
parasite and the mosquito vector. Such measures being affordable,
applicable and appropriate are under our local conditions so that these
measures can be sustained throughout the duration of malaria control
operations. Objective of this measure is to reduce the source of infection in
the human population; man-vector contact, and the density of the mosquito
vector population.
a.) Insecticide-Treatment of Mosquito Net
- This involves the soaking of the mosquito net in an insecticide solution and
allowed to dry. Such treated net is used as a protective measure against the
vector mosquito during sleeping time at night. Insecticide-treated curtains
may be used in areas where they are more culturally acceptable than
mosquito nets.
b.) House Spraying
- This is the application of insecticide on the indoor surfaces of the house
through spraying.
c.) On Stream Clearing
- This involves the construction of bio-ponds for fish propagation which shall
be the responsibility of the LGUs and their corresponding communities. The
numbers of bio-ponds to be constructed as sources of larvivorous fish, for
each malaria-endemic municipality, will depend on the number of streams to
be seeded with the propagated larvivorous fish. To be effective, about 2-4
 fish per sq.m. is needed for an immediate impact and about 200-400 fish per
ha. is needed for a delayed effect.
d.) On Stream Cleaning
- This is the cutting of the vegetation overhanging along stream banks to
expose the breeding stream to sunlight, rendering it unsuitable for mosquito
vector habituation
 Wearing of clothing that covers arms and legs in the evening
 Avoiding outdoor night activities, particularly during the vector’s peak biting hours
from 9PM to 3AM
 Using mosquito repellents such as mosquito coils, soap lotion or other personal
protection measures advocated by the DOH/MCS-Malaria Control Service
 Planting of Neem tree or other herbal plants which are (potential)
mosquito repellents as advocated by the DOH/MCS-Malaria Control Service
 Zooprophylaxis-the typing of domestic animals like the carabao, cow,
etc., near human dwellings to deviate mosquito bites from man to these
animals.
Secondary Prevention:
• Early diagnosis is the identification of a patient with malaria as
soon as he/she is seen, through clinical and/or microscopic method
Clinical method is based on the signs and symptoms of the patient and the history
of his/her having visited a malaria-endemic area
• Microscopic Method is based on the examination of the blood
smear of the patient through a microscope
• This shall be done by a Medical Technologist or Microscopist at
the Main Health Center where there are microscopy facilities during regular
consultations. She should take smear of patients with fever or with history of
recent fever with one month and are residing or have stayed in malaria-
endemic areas, of clinically diagnosed patients and of patients who did not
respond to appropriate anti-malarai treatment.
• CHEMOPROPHYLAXIS-only Chloroquine drug should be given. It
must be taken at weekly intervals, starting from 1-2 weeks before entering
the endemic area. In pregnant women, it is given throughout the duration of
pregnancy.
• Recommended Anti-Malaria drugs”:
- Chloroquine phosphate 250 mg (150 mg base/tablet)
- Sulfadoxine (or Sulfalene) 50 mg – pyrimethamine 25 mg/tablet
- Quinine sulfate 300 mg tablet
- Quinine hydrochloride 300 mg/ml, 2ml ampule
- Tetracycline hydrochloride 250 mg/capsule
- Quinidine sulfate 200 mg/durules
- Quinidine glucolate 80 mg (50 mg base) ml, 1 ml vial

6.) Rabies Control Program

Nature of Disease:
Signs and Symptoms:
 Sense of apprehension
 Headache
 Fever
 Sensory change near site of animal bite
  Spasms of muscles or deglutition on attempts to swallow (fear of
water/hydrophobia)
 Paralysis
 Delirium and convulsions
 Without medical attention, the rabies victim would usually last only for 2 to 6
days. DEATH is often due to respiratory paralysis
Source:
Rhabdovirius of the genus lyssavirus. There are two kinds: urban or canine rabies-
transmitted by dogs while sylvatic rabies-a disease of wild animals and bats which
sometimes spread to dogs, cats and livestock.
Mode of Transmission:
♥ Usually by bites of a rabid animal whose saliva has the virus. The virus may
also be intoducedinto a scratch or in fresh breaks in the skin (very rare).
Transmission from man to man is possible. Airborne spread in a cave with
millions of bats have occurred, although rarely. Organ transplant (corneal)
taken from person dying of diagnosed central nervous system disease have
resulted in rabies in the recipients.

Primary Prevention:

 Immediately clean the animal bite wound - use soap and water, or just water
if no soap.
 Seek immediate medical attention - after a bite or exposure.
 Rabies vaccine shots - taken as a safeguard or as a preventive treatment
after a bite or exposure.
 Avoid wild animals
 Pet vaccination
 Livestock vaccination
 Seal house animal entry points
 Be a responsible pet owner:

• Keep rabies vaccinations up to date for all dogs, cats, and ferrets. This is
important not only to keep your pets from getting rabies, but also to provide
a barrier of protection for you, if your animal is bitten by a rabid animal such
as a bat. Seattle and King County regulations require that all dogs, cats and
ferrets be vaccinated for rabies by 4 months of age and booster shots be kept
current.
• Keep your pets under direct supervision so they do not come in contact with
wild animals. If your pet is bitten by a wild animal, seek veterinary assistance
for the animal immediately and call Public Health for further advice.
• Call your local animal control agency to remove any stray animals from your
neighborhood. They may be unvaccinated and could be infected with rabies.
• Spay or neuter your pets to help reduce the number of unwanted pets that
may not be properly cared for or regularly vaccinated.

 Avoid contact with unfamiliar animals:

• Enjoy wild animals like bats, raccoons, skunks, foxes, and coyotes from afar.
Do not handle, feed, or unintentionally attract wild animals with open
garbage cans, uncovered compost bins, or pet food left outside.
• Never adopt wild animals or bring them into your home. Do not try to nurse
sick animals to health. Call animal control, an animal rescue agency or
wildlife rehabilitator like PAWS for assistance.
• Teach children never to handle unfamiliar animals, wild or domestic, even if
they appear friendly. "Love your own, leave other animals alone" is a
good principle for children to learn.
• Prevent bats from entering homes or occupied spaces in churches, schools,
and other similar areas where they might come in contact with people and
pets. If a person or pet has any exposure to a bat, including finding a
bat in the house, it is very important to call Public Health for advice.
• When traveling abroad, avoid contact with wild animals and be especially
careful around dogs in developing countries. Rabies is common in parts of
Asia, Africa, and Latin America where many dogs are infected with rabies.
Tens of thousands of people die of rabies each year in these countries. Before
traveling abroad, consult with a health care provider, travel clinic, or your
health department about your risk of exposure to rabies, if you should be
immunized against rabies before you go, and how you should handle an
animal exposure, should it arise.

Secondary Prevention:

• Before the onset of rabies symptoms, both passive and active immunizations
are effective for preventing progression to full-blown rabies.
• Vaccines :
o Human diploid cell vaccine (HDCV, Pasteur Merièux)
o Rabies vaccine, adsorbed (RVA, Michigan State Department of Health)
• Optimal results require the following:
o Immediate vigorous wound cleansing with a solution of 1 part soap and
4 parts water
o Passive immunization
 No prior vaccination with HDCV or RVA - Human rabies
immunoglobulin (HRIG)
 Prior vaccination - No HRIG
o Active immunization
 No prior vaccination with HDCV or RVA - Primary series HDCV or
RVA
 Prior vaccination - Booster series HDCV or RVA
• A neutralizing antibody (NAb) titer greater than or equal to 0.5 IU/mL (or
complete neutralization at a serum dilution of 1:5) is considered an
acceptable antibody response for protection against rabies. Of 7 patients
infected with HIV who had CD4 counts less than 200 cells/µL, 3 had a poor or
even undetectable NAb response to vaccination. Patients infected with HIV
who had higher CD4 lymphocyte counts had a good antibody response to
postexposure rabies vaccination. If an acceptable antibody response is not
achieved, a second double-dose series of rabies vaccine should be
administered in an attempt to successfully mount an adequate antibody
response.
• Elderly patients (>50 y) produce antibody titer levels 52% lower than
younger patients. Whether this equates to reduced protective efficacy
remains unclear.
• Do not administer immunoglobulin and vaccine with the same syringe or in
the same site.
• Passive antibody provides protection for 1-2 weeks until the vaccine elicits
protective antibody.
• In exposures to high-risk species, initiate treatment immediately pending
laboratory examination of the animal, if it is caught.
• Therapy can be stopped if results from the animal's brain examination are
negative.
• The median duration of rabies illness in dogs, cats, and ferrets is less than 10
days, and viral shedding in saliva occurs within a few days of onset of illness
and death. Because of the exceedingly low prevalence of rabies in domestic
animals in the United States, healthy unvaccinated domestic dogs, cats, and
ferrets may be observed for 10 days for signs of illness. If the animal remains
healthy, administer no treatment; otherwise, begin treatment on the exposed
individual pending necropsy results of the animal. Treatment can be
discontinued if examination of the animal's brain is negative for rabies.
Vaccinated animals in the United States have not transmitted rabies; outside
the United States, rare instances of transmission occur. Species other than
the above should be managed in conjunction with the local health
department, taking into account whether viral shedding periods are known
for the species, the animal's history and risk for rabies exposure, and local
epidemiology.
• Consult the local health department because the risk of rabies differs
geographically based on local endemicity and immunization practices. Some
countries and limited areas in US territories are considered rabies-free, and
no prophylaxis is administered.
• Note that an assessment of whether a bite was provoked is subjective and
does not significantly affect the chances that the animal is rabid. Therefore,
this is probably not helpful in determining the need for prophylactic
treatment.
• Intensive cardiopulmonary supportive care is the only treatment available for
patients with symptomatic rabies.
• Regardless of treatment, symptomatic rabies is invariably fatal, resulting
from autonomic dysfunction that leads to cardiac arrhythmia and
hypotension. Only 6 recorded cases of survivors exist, 5 of whom received
some level of preexposure or postexposure prophylaxis in the asymptomatic
phase and subsequently developed rabies. The use of ribavirin and induced
coma has yet to be reproduced or validated in the one survivor who did not
receive preexposure or postexposure prophylaxis; however, some role for
combination therapies including ribavirin, interferon, ketamine, and
immunomodulatory therapies has been proposed and may be considered in
future cases under investigational protocols. The rarity of human rabies
hinders timely testing for effective therapies. Immunomodulatory therapies
such as rabies immunoglobulin, rabies vaccine, and interferon have not
altered outcomes in trials.
• Pregnancy is not a contraindication to postexposure prophylaxis against
rabies, which is warranted to protect the life of the fetus and mother. No
 adverse pregnancy outcomes have been documented with postexposure
prophylaxis. No mother-to-fetus transmission has been described; thus,
neither rabies exposure nor diagnosis of rabies in the mother is an indication
for pregnancy termination.
• Steroids, which are usually indicated in the treatment of local vaccine
reactions or cerebral edema, are contraindicated because of increased
mortality noted in animal studies and because they reduce the response to
the vaccine.

Consultations

• Local health department personnel

• Infectious diseases specialist
• Neurologist