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What system of the body does Rabies virus mainly affect?

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What kind of nucleic acid does a Rabies virus contains in its core?

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Rabies
Click to edit Master Rolle style Dr. May Grace N. subtitle DFCM Resident 6/24/12

RABIES

A fatal zoonotic viral disease of the central nervous system (CNS) that is transmitted to humans by infected animals.

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Etiology

Rabies virus is a member of the genus Lyssavirus in the family Rhabdoviridae. Rhabdos, meaning "rodlike," refers to the distinctive elongated shape of these viruses. enveloped virions - single-

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RABIES

A neglected disease that is 99.9% fatal but 100% preventable Globally it is the 10th leading cause of death due to infection in humans China- Leading cause of infectious disease mortality in 2006 Predominant affects poor people in developing countries 60,000 deaths annually, mostly in Asia and Africa - 99% in developing countries - 50% are children <15 years old

Rabies and Animal bites in the Philippines

Rabies continues to be a public health problem in the Philippines

Philippines- 6th in rabies incidence in the world 200- 300 deaths per year (269 in 2007)

Majority of bite victim are children under the age of 15 years old

Dogs remain the principal cause of animal bites and rabies cases in 2006 in 6/24/12 2007 (90%)

BITE VICTIMS VS RABIES CASES

150,0 00

120,0 00

BITE VICTIMS

90,00 0 70,00 0 20,00 0 10,00 0 500 450 400 350 300 1992

RABIES CASES

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1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004 2005

Animal Bite Consults for 2008 and 2010

10 9 8 No. Of Patients 7 6 5 4 3 2 1 0

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Transmission
Transmitted to humans following a bite from an infected animal. Rabies virus is the form carried by dogs and accounts for most human rabies globally. Non-bite exposures are also possible and include being scratched, being 6/24/12

Pathophysiology
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Negri Body

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Rabid Animal
Refers to biting animal with clinical manifestation of rabies and/or confirmed laboratory finding of rabies.

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Animals that can transmit rabies

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DEFINITION OF TERMS

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DEFINITION OF TERMS

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Active Immunization:
Refers to the administration of a vaccine to induce protective immune response

Passive Immunization:
Refers to administration of pre- formed antibodies (immune globulins or passive immnunization products) to provide immediate protection. These antibodies come from either human or animal source 6/24/12

Immunocompromised Host refers to patients receiviing immunosuppressive drugs such as systemic steroid (not topical or inhaled) and chemotherapeutic drugs for cancer, patients taking chloquine, AIDS and HIV infected patients. These 6/24/12 patients are expected to

CATEGORIZATION OF RABIES EXPOSURE

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CATEGORY I
Feeding / touching an animal Licking of intact skin (with PRE-EXPOSURE reliable history and PROPHYLAXIS thorough PE) Exposure to patient with signs and symptoms of rabies by sharing of eating or drinking utensils Casual contact (talking to, 6/24/12

Pre-exposure Prophylaxis

Vaccination of School 6/24/12 Children

PRE-EXPOSURE PROPHYLAXIS

?
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Approved TCV
Generic Name Preparation Purified vero cell rabies 0.5 ml/vial vaccine (PVRV) Purified chick embryo cell 1 ml/vial vaccine (PCECV) 6/24/12 Dose ID 0.1 ml IM 0.5 ml ID 0.1 ml IM 1.0 ml

CATEGORY I

MANAGEMENT

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PrEP
Schedule

PVRV
Day 0 Day 7 Day 21/28 Day 0

PCECV
Day 7 Day 21/28

ID IM

0.1 ml 0.5 ml

0.1 ml 0.5 ml

0.1 0.1 0.1 0.1 ml ml ml ml 0.5 1 ml 1 ml 1 ml ml

TAKE NOTE: Give only at ONE SITE for all 6/24/12 vaccine types.

Pre-Exposure Prophylaxis
Consist of three doses of 0.1 ml of PCEC or PVRV given intradermally (ID) or 1 vial of 1 ml of PCEC or 0.5 ml of PVRV given intramuscularly (IM) on the following days: Day 0 Day 7
Day 21/28

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One booster dose every one to three years depending on risk exposure

CATEGORY II
Nibbling of uncovered skin with or without bruising/hematoma Minor scratches/abrasions without bleeding Minor scratches/abrasions which are induced to bleed All Category II exposures on the hand and neck are considered CATEGORY III 6/24/12

CATEGORY III
Transdermal bites (punctured wounds, lacerations, avulsions) or scratches/abrasions with spontaneous bleeding Licks on broken skin Exposure to a rabies patient through bites, contamination of mucous membranes or open skin lesions with body fluids through splattering and mouth-to-mouth resuscitation Handling of infected carcass or 6/24/12 ingestion of raw infected meat

Of Category II and III

MANAGEMENT
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CATEGORY II
MANAGEMENT

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Approved TCV
Generic Name Preparation Purified vero cell rabies 0.5 ml/vial vaccine (PVRV) Purified chick embryo cell 1 ml/vial vaccine (PCECV)
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Dose ID 0.1 ml IM 0.5 ml ID 0.1 ml IM 1.0 ml

SCHEDULE OF ACTIVE IMMUNIZATION

No. of doses on specified Dose days Regimen Day PVRV PCECV Day 0 Day 3 Day 7 28/30 Modified 0.1 2-site ID 0.1 ml 2 2 2 2 ml regimen Standard 0.5 IM 1.0 ml 1 1 1 1 ml regimen
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A2.2-site Intradermal Regimen Day (Modified TRC ID regimen: 2-2-2-0-2 )7 Day 3 Day
0

Day 30

ID dose = 0.1 ml PCECV/PVRV

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CATEGORY III
MANAGEMENT

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Passive Immunization WHO and DOH approved RIG

Generic Name Preparation Dose

HRIG ERIG
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150 U/ml (2ml/vial) 200 U/ml (5ml/vial)

20 U/kg 40 U/kg

Post Exposure Prophylaxis (PEP)

RIG Infiltration

Anti Rabies Vaccination

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Delay in dosing schedule

Delay in Day 3 dose If delay is 1-2 days from day 3 schedule, give day 3 dose upon visit and follow the original schedule of day7 and day28/30 If delay is 3-4 days, give day3 upon visit and adjust succeeding doses If delay is >4days, restart Delay in Day 7 dose If delay is < 7 days from day7, give day7 dose upon visit, give day28/30 as scheduled If >7-14 days, repeat day3 dose and revise accdgly If delay is >14days, restart Delay in Day 28/30 Give anytime on visit 6/24/12 dose

Updates on AO 2011-0002
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Can PEP be delayed for Category II exposures?

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Provided ALL of the following are satisfied:

Animal available for observation for 14 days. Vaccinated against rabies for the past 2 years: Must be at least 1 year and 6 months old and has updated vaccination certificate from a duly licensed vet for the last 2 years Last vaccination must be within the past 12 months

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* If biting dog/cat becomes sick or dies within the observation period, PEP should be started immediately

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PEP should be given immediately for ANY of the following conditions:

1. rabies exposure is category III;

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PEP should be given immediately for ANY of the following conditions:

2. The dog/cat is proven rabid/sick/ dead with no laboratory exam for rabies/not available before or during the consultation;

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PEP should be given immediately for ANY of the following conditions:

3. The dog/cat is involved in at least 3 biting incidents within 24 hours or

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PEP should be given immediately for ANY of the following conditions:

4. Dog/cat manifests the following behaviour changes suggestive of rabies before, during or after the biting incident:

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What do we do for previously immunized animal bite patients?

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PEP Schedule for previously immunized animal bite patients

PrEP / PEP History Give RIG MANAGEMENT

Completed PrEP on Give 0.1 ml ID dose at 1 site Days 0, 7, and 21/28 each on D0, D3 OR OR NO 1 vial IM dose at 1 site each Completed PEP on Days on D0, D3 0, 3, 7 of ID/IM dose DID NOT COMPLETE 3 doses of PrEP If OR indicate Give full course of PEP Received ONLY 1 or 2 d 6/24/12 ID/IM dose of PEP

Tetanus Prophylaxis
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Vaccination History 3 or more doses Indication for Unknown or <3 doses

TT immunization

Td* YES

TIG/ATS YES

Td* NO**

TIG/ATS NO

All Animal Bites

* Tdap for Td if patient has not received Tdap and is 10 years or older; DPT may be given for patients < 7 years old; TT if Td not available. ** YES, if more than 5 years since last dose.
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Routine Booster Doses for previously immunized individuals

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Booster dose

Involved PrEP Serologi With Personnel immunization c test exposur e All workers Recommende Every 6 1 in rabies d months booster labs each on D0 and D3

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Without definite exposure No booster if Ab titers > 0.5 IU/ml 1 booster if Ab titers fall below 0.5 IU/ml If no sero test, 1 booster dose every 5 years

Involved Personnel

PrEP immunization

Serologic test Every 2 years

Booster dose With Without definite exposure exposure 1 booster No booster if each on Ab titers > 0.5 D0 and D3 IU/ml 1 booster if Ab titers fall below 0.5 IU/ml If no sero test, 1 booster dose every 5 years

All vets, vet Recommended students, animal handlers (dog trainers, workers in pet shops, zoos, etc.)

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Involved Personnel

PrEP immunization

Serologic test None

Booster dose With Without definite exposure exposure 1 booster 1 booster dose each on every 5 years D0 and D3

HCW involved Recommended in care of rabies patients; involved in rabies control program; field workers; morticians

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Booster dose Involved PrEP Serologic Personnel immunization test General Not population recommended but may be considered as an option in young children and other 6/24/12 individuals None With exposure 1 booster each on D0 and D3 Without definite exposure None

Special Conditions
1. Pregnancy and infancy are not contraindications to treatment with TCV; 2. Avoid chloroquine, systemic steroids and heavy alcohol consumption during rabies immunization as they may interfere with the immune response. If this cannot be avoided, the standard IM regimen should be used
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Special Conditions
3. Immunocompromised individuals (HIV infection, cancer/transplant patients on immunosuppressive therapy etc) should be given vaccine using standard IM regimen and RIG for both Category II and III exposures

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Management of rabid patients

No cure once symptoms of rabies set in Recommended care

Adequate sedation Comfort care - appropriate medical facility with suitable emotional and physical support

Once rabies diagnosis has been confirmed, invasive procedures (intubation and life-support measures) should be avoided

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Management of rabid patients

Infection control

Patients should be admitted in a quiet, draft-free, isolation room. Healthcare workers and relatives coming in contact with patients should wear proper personal protective equipment (PPE) including gown, gloves, mask, goggles

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RABIS: Tuod ukon Indi Tuod

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Butangan ahos, kapayas, kag mga dahondahon ang pilas para dasig magayo.
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I D IN OD U T

MagpaTANDOK para maayo ang kinagtan ka ido kag para indi magka-RABIS.

I D IN OD U T

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Indi pwede maligo kung nakagat ka ido kay dasig malapta ang RABIS.
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I D IN OD U T

Obserbaran ang ido bag-o magpakonsulta sa duktor.

I D IN OD U T

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Kung naimmunize na ang ido, indi na kelangan magpaAntiRABIS .

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I D IN OD U T

Dapat magpakonsulta gilayon kon makagat ka sapat (ido, kuring, baboy, ukon amo).
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D O U T

Hugasan gilayon sang tubig kag habon ang kinagat ka sapat.

D O U T

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Ang gabusong kag mga lapsag pwede maImmunize pangontra RABIS.

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D O U T

Kon malatnan kaRABIS, may kaayuhan pa ini.

I D IN OD U T

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Mapatay ang isa ka tawo kon malatnan ka RABIS.

D O U T

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Ano obrahon kung magpakonsulta sa OPD?

Makuha NUMBER sa OPD Registration. Maghulat lawagon ang pangalan sa may RELEASING. MagpaKILO sa ANIMAL BITE CENTER sa babaw. Maghulat lawagon ang pangalan sa FAMILY MED 6/24/12

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In what category of Rabies exposure does a minor scratch / abrasion which are induced to bleed belong?

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In what category of Rabies exposure does handling of infected carcas or ingestion of raw infected meat belong?

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In what category of Rabies exposure does abrasion on the face with no spontaneous bleeding belong?

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In what category of Rabies exposure does licking of intact skin belong?

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Thank You

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