This document discusses rabies, including who is at risk, symptoms, diagnosis, prevention, and control. Rabies remains a threat in rural areas with limited access to vaccines and immunoglobulin. Symptoms in humans include hydrophobia and paralysis. Diagnosis is based on a history of animal bite and testing of skin biopsies or saliva. Post-exposure prophylaxis includes wound cleaning and vaccination, while prevention involves vaccination of at-risk groups like veterinarians and pre-exposure prophylaxis. Rabies in dogs is usually furious or dumb, and control relies on eliminating strays and mass dog immunization along with public education.

1. By
Jini P. Abraham

2. CONTENTS
 Hydrophobia
 Rabies in dogs
 Laboratory Diagnosis
 Prevention and Control

3. WHO’S AT RISK??
 People most at risk live in rural areas where
human vaccines and immunoglobulin are not
readily available or accessible.
 Although all age groups are susceptible, rabies is
most common in children aged under 15.
 On average 40 % of post-exposure prophylaxis
regimens are given to children aged 5–14 years,
and the majority are male.
 Anyone in frequent or increased danger of
exposure to rabies virus – either by nature of their
residence or occupation – is also at risk.
 Travellers with extensive outdoor exposure in rural,
high-risk areas

4. HYDROPHOBIA
 80% - 90% cases
 Prodormal symptoms – headache, malaise,
sore throat, slight fever
 CNS affected – sensory, motor, sympathetic
and mental systems
 Stage of paralysis
 Duration of illness – 2 to 3 days (exceptional
cases – 5 to 6 days)

6. DIAGNOSIS
 Basis of history of bite by a rabid animal
 Characteristic signs and symptoms
 Confirmed in patients by antigen detection
using immunoflorescence of skin biopsy and
virus isolation from saliva and from other
secretions.

7.  NO TREATMENT
 Isolation in a quiet room
 Relieve anxiety and pain by sedatives
 Spastic muscle contractions
 Rehydration and osmotic diuresis
 Respiratory and cardiac support
 Medical attendants – Warned against possible risk
of contamination
 Pre – exposure prophylaxis immunization
MANAGEMENT

8.  Post – exposure prophylaxis
 Pre – exposure prophylaxis
 Post – exposure treatment of persons who
have been vaccinated previously
PREVENTION OF HUMAN RABIES

9.  Persons bitten by a suspected rabid animal
 To neutralize the inoculated virus before it enters
the nervous system
 Combined administration of a single dose of
antirabies serum with a course of vaccine, together
with local treatment of wound
 2 components –
 Local treatment of wound
 Immunization
POST – EXPOSURE PROPHYLAXIS

10.  Aim –
Elimination of virus from the wound
 Prevent infection of the nerve endings
 Measures –
 Cleansing
 Chemical treatment – Virucidal agents like
alcohol (400 – 700ml/ litre), tincture, 0.01% aq
solution of iodine
 Suturing – 24 to 48 hours later
 Anti – rabies serum
 Antibiotics and anti – tetanus measure
WOUND TREATMENT

11.  Observe the animal for 10 days
 Change of behaviour
 Running amuck
 Excessive salivation
 Change in the tone of bark
 Death of animal
 If animal shows symptoms of rabies, it should be
humanely killed and sent to laboratory for rabies
examination

12. Category Type of contact with a
suspect or confirmed
rabid domestic or wild
animal, or animal
unavailable for testing
Type of
exposure
Recommended post –
exposure prophylaxis
I Touching or feeding of
animals
Licks on intact skin
None None, if reliable case
history is available
II Nibbling of uncovered
skin
Minor scratches or
abrasions without
bleeding
Minor Administer vaccine
immediately
Stop treatment if animal
is healthy throughout an
observation period of 10
days or if animal is
proven to be negative of
rabies by a reliable
laboratory, using
appropriate diagnostic
techniques

13. III Single or
multiple
transdermal
bites or
scratches, licks
on broken skin
Contamination
of mucous
membrane with
saliva
Severe Administer rabies
immunoglobulin and vaccine
immediately.
Stop treatment if animal
remains healthy throughout
an observation period of 10
days, or if animal is found to
be negative for rabies by a
reliable laboratory using
appropriate diagnostic
techniques

14. PRE – EXPOSURE PROPHYLAXIS
 Persons who runs a high risk of repeated
exposures –
 Laboratory staff working with rabies virus
 Veterinarians
 Animal handlers
 Wildlife officers
 Dose of cell – culture vaccine, given either as 1ml
im or 0.1ml id on days 0, 7 and 28
 Booster injections administered at intervals of 2
years as long as exposed person remains at risk

15. POST – EXPOSURE TREATMENT OF PERSONS WHO
HAVE BEEN VACCINATED PREVIOUSLY
 Three 1ml intramuscular doses of HDC vaccine are
recommended on days 0, 3, 7
 If bite is not severe, 2 doses are needed (days 0 to 3)

16. RABIES IN DOGS
 Incubation period – 3 to 8 weeks
 Clinical picture –
 Furious rabies
 Dumb rabies

17. FURIOUS RABIES
 80% – 90% of cases
 Early prodormal stage
 Later changes –
 Change in behaviour – Cardinal sign
 Running amuck
 Change in voice
 Excessive salivation
 Paralytic stage
 Death
 Mortality rate – 100%

18. DUMB RABIES
 10% - 20% of cases
 Opposite to those of furious rabies
 Excitative or irritative stage is lacking
 Predominantly paralytic
 Lapse into stage of sleepiness
 Dies in 3 days

19. LABORATORY DIAGNOSIS
 Head of animal is cut off and sent to nearest
laboratory, duly packed in ice in an air – tight
container
 Brain may be removed with anti - septic precautions
and sent in 50% glycerol – saline for examination
 Laboratory examination –
 Fluorescent Antibody test
 Microscopic Examination
 Mouse Inoculation test
 Corneal Test

20. CONTROL OF URBAN RABIES
 Elimination of stray and ownerless dogs, combined
with programme of swift mass immunization
 Others methods –
 Registration and licensing of all domestic dogs
 Restraint of dogs in public places
 Immediate destruction of dogs and cats bitten by
rabid animals
 Health education of people regarding the care of
dogs and prevention of rabies