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37. Rabies (epidemiology (wild-life rabies (unidentified reservoir, jackal…
37. Rabies
etiology
rabies and 5 related viruses are from
Lyssavirus
inactivated by heat @ 56 degrees C (half life decreases)
acute viral infectious disease of mammals, CNS pathology, hyperactivity, paralysis, coma, death
epidemiology
enzootic in mammal populations in most countries
rabies free- Norway, Sweden, Iceland, Mediterranean islands, Australia, Borneo, New Guinea, Malaysia, Singapore, Japan, Taiwan
spread by bites, ingestion of infected pre, inhalation of aerosols
important reservoirs- skunks, foxes, raccoons, and some bats.
wild-life rabies
unidentified reservoir
jackal, fox, hyena,
mongoose in south africa
animals maintain cycle amongst themselves
transmitted to dogs, domestic animals
bat rabies
latin america, USA, vampire bat is host and vector of rabies
feed on blood of animals and man
kills 100000s cattle annually
urban rabies
90% of human cases worldwide
domestic dogs, sometimes cats
virus in saliva for 3-4 days before onset of symptoms
incidence
underreporting
50,000 human deaths in India per year
High death rate in Pakistan, Bangladesh, Sri Lanka, Thailand, Indonesia, Latin America
few rabies deaths are now reported in Europe
transmission
intact mucosa and broken skin
inoculation of saliva containing virus through a bite of a rabid dog
unusual routes
inhalation of nasal secretions of bats
vaccine-induced rabies (when the virus is not inactivated)
lab diagnosis
immunofluorescence of acetone-fixed brain or spinal cord impression smears
prevention and control
Pre-exposure prophylaxis
3 doses are given on days 0, 7 and 28.
booster 1 year later gives immunity for 5-8 years
pre exposure vaccine given to those at high risk in endemic ares
Post-exposure prophylaxis
clean wound after bite, scrubbed with soap, rinse for 5 minutes
foreign material and dead tissue removed under anaesthesia
wound irrigated with aqueous iodide or alcohol.
tissue culture vaccines
human diploid cell strain vaccine (HDCSV)
purified vero cell rabies vaccine (PVRV)
hyperimmune serum should be given at same time of first vaccine dose, half the dose should be infiltrated around bite, and the rest IM