INTRODUCTION

• Rabies is caused by Lyssa Virus.

• It is spread when an Infected animal
scratches or bites another animal or
human.
• Saliva from an Infected animal can also
transmit rabies if the saliva comes into
contact with the eyes, mouth, or nose,
treatment is almost never effective and
mortality is over 99%
 Rabies Progresses in Five Distinct
Stages:
1. Incubation
2. Prodrome
3. Acute Neurologic period
4. Coma
5. Death
 Incubation Period:
• This is the time before symptoms appear.
• The incubation period is typica lly 1-3 months in
humans.
• Incubation periods as short as four days and
longer than six years have been documented,
depending on the location and severity of the
contaminated wound and the amount of virus
introduced.
• The closer the bite is to the brain, the sooner
the effects are likely to appear.
 Prodrome:
Early, flu -like symptoms including:
• A fever of 100.4°F/38°C or above.
• Headache
• Anxiety
• Feeling generally unwell
• Sore t hroat and a cough
• Nausea and vom iting
• Discomfort may occur at the site of the bite
These can last f rom 2 to 10 days, and they worsen over
time.
 Acute Neurologic Period:
Neurologlc symptoms develop, Including:
• Confusion and aggression
• Partial paralysis, involuntary muscle twitch ing, and rigid neck muscles
• Convulsions
• Hyperventilation and difficulty in breathing
• Hypersallvatlon or producing a lot of saliva, and possibly frothing at the
mouth
• Fear of water, or hydrophobia, due to difficulty in swallowing
Hallucinations, nightmares, and insomnia
• Priapism, or permanent erection, in males
• Photophobia, or a fear of light
• Toward the end of this phase, breathing becomes rapid and Inconsistent.
 Coma and Death

• If the person enters a coma,death will occur

with in a matter of hours,unless they are
attached to a ventilator.
 HYDROPHOBIA
• It Is the historic name for rabies
• It refers to a set of symptoms in the later stages of an
infection In which the person has difficulty In swallowing,
shows panic when presented with liquids to drink, and

•
cannot quench their thirst.
Any mammal Infected with the virus may demonstrate
I
hydrophobia.
• Saliva production Is greatly Increased, and attempts to
drink, or even the Intention or suggestion of drinking, may
cause excruciatingly painful spasms of the muscles in the
throat and larynx
• This can be attributed to the fact that the virus multiplies
and assimilates In the salivary glands of the Infected
animal with the effect of further transmission through
biting.
• The ability to transmit the virus would decrease
significantly if the Infected individual could swallow saliva
and water.
 Prevention Immunization in people

1. Pre Exposure Prophylaxis

2. Post Exposure Prophylaxis
 Pre Exposure Prophylaxis
• Human rabies vaccines exist for pre-exposure
immunization.
• Pre-exposu re vaccination may be offered to high
risk groups like laboratory staff handling the virus
and infected material, clinicians and persons
attend ing to human rabies cases, veterinarians,
animal handlers and catchers, w ildlife wardens,
quarantine officers and travelers from rabies free
areas to rabies endemic areas.
• The Indian Academy of Pediatrics (IAP) has
recommended pre-exposure prophylaxis of children.
Tissue culture vaccine: 1dose IM or 0.1 ml ID

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Day O 7 21 28
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Approach to Post Exposure Prophylaxis

1. Management of animal bite wound

2. Passive immunization with Rabies
lmmunoglobulin {RIG)
3. Active immunization with Anti-Rabies Vaccines
{ARV)
 Management of Animal Bite Wound

1. Wound Washing -15 mins

2. Iodine containing topical preparations.
3. Suturing X
4. If unavoidable adequate RIG given .
5. Minimal and loose sutures.
 Passive Immunization
Types of RIGS:
A. Equine Rabies lmmunoglobulin (ERIG) :
ERIGG is of heterologous origin produced by hyperimmun•isation of horses.
The dose of ERIG is 40 IU per kg body weight of patient
B. Human Rabies lmmunoglobulln (HRIG):
HRIG are of hom ologous origin and are relatively free from the side effects
encountered in a serum of h eterologous origin.
The dose of the HRIG is 20 IU per kg body weight.

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 Administration
• The RIG should be brought to room temperature (25"C to 30°C) before administration to the patient.
• As much of the calculated dose of RIG as Is anatomically feasible should be Infiltrated Into and around
the wound.
• Multiple needle Injections Into the wound should be avoided •
• The tolill recommended dose of RIG must not be exceeded as It may suppress t he antibody production
stimulated by t he anti-rabies vaccine.
• Rabies immunoglobulln for passive lmmunitalion is administered only once. preferably within 24 hours
after the e•posure (on day o along wit h the first dose of anti rabies vaccine).
• If RIG was not administered when ARV was begun, It can be administered up to t he seventh day after
the administration of the first dose of ARV
• Beyond the seventh day (after 3 doses of vaccine have been administered). RIG Is not Indicated since
an antibody response to ARV would have occurred and administration of RIG at t his stage can supress
the Immune response of the patient to the ARV received.
• Rabies lmmunoglobulln should never be admlnlst11red In tho same syringe or at the same anatomical
,ite as vac::c:ine.
• The dose is 0.5 ml of 0.1 percent solution (1 in 1000, lmg/ml) for adults and O.Olml/kg body weight
for chlldren, Injected subcutaneously or IM.
• RIG mU5t riever be given Intravenously.
• A full course of ARV should follow thorough wound cleansing and passive Immunization.
 Active Immunization

• Th e first live attenuated injectable rabies

vaccine, develo ped by Louis Pasteur and
Emile Roux, was first tested in a human bite
victim in 1885 .
 • I •

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 Post Exposure Prophylaxis

• Intra-muscular (IM) Regimen:

• A. Ce ll Culture Vaccines:
1. Human Diploid Cell Vaccine (HDCV)-1 ml
2. Purified Chick Embryo Cell Vaccine (PCECV)-
lml
3. Purified Vero Cell Rabies Vaccine (PVRV), 0.5ml
and 1ml
• B. Purified Duck Embryo Vaccine (PDEV), 1ml
A Post-exposure prophylaxls administered lnttamuecular1y

Essen schedule IS-dose)

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Zagreb schedule 14-dose, 2-siteJ
v-in, tJootlow

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lntradermal Regimen

Namt al Rtgilllt'II 0\ford Rc-gm1co 111al Rrd C

8 Silt lntrudrnnal
Regimtn Regimen
N11111 of Vacrine HOCV / PCEC\' • 0 I ml PVRV /PCECV -0 I ml
med widl dose or PCEC\' -01 ml

RtgiflM'JI (8-0-4-0-1-1) (2-2-2-0-2)

0.1 x8sitcs• dayO 0.1 X2Sitts • IU) 0
DIiie and day
0.1 x4 sites- day 7 0.\ X2 silCS • da~ 3
0.1 a1 I site - day 28 0.1 x 2silCS -da) l
0.1 al I site - day 90 0.1 X 2 siltS • day 28