1. Presented By,
Shubham Kumar Jha
IInd Yr. B.Sc.(N)
Manjushree College Of Nursing
Bangalore

2.  Rabies is a viral disease that causes acute
inflammation of the brain in humans and other
warm-blooded animals.Rabies is transmitted to
humans from other animals. Rabies can be
transmitted when an infected animal scratches or
bites another animal or human.

3.  Rabies, also known as hydrophobia is an acute, highly
fatal viral disease of the central nervous system,
caused by Lyssavirus type 1. It is primarily a zoonotic
disease of warm-blooded animals

4.  Rabies is an enzootic and epizootic disease of
worldwide importance
 Some countries have achieved "rabies free" status
by vigorous campaigns of elimination, while in
others the disease has never been introduced.
 Geographic boundaries seem to play an important
role here. Water appears to be the most effective
natural barrier to rabies.
 Water appears to be the most effective natural
barrier to rabies. Australia, China (Taiwan}, Cyprus,
Iceland, Ireland, Japan, Malta, New Zealand, the
U.K. and the islands of Western Pacific are all free
of the disease.

5.  Rabies occurs in more than 150 countries and
territories.
 Vast majority of the estimated 55,000 deaths
caused by rabies each year occur in rural areas of
Africa and Asia.
 In India, Union Territory of Lakshadweep and
Andman and Nicobar islands are free of the disease.
 In India alone, 20,000 deaths (that is, about 2 per
lac population at risk) are estimated to occur
annually.

6.  Agent
(Lyssavirus type 1 of Rhabdovirus family)
 Host
•Warm blooded animals
•Dog handlers
•Hunters
•Veterinarians
•Laboratory Staff
 Environment
• Rabid dogs
• Cats
• Vampire Bats
• Jackal
• Hyena
• Fox, etc.

7.  4.1.1) Agent:-
The causative agent is Lyssavirus Type I of
Rabdoviridiae-serotype I. Serotype II, III & IV are rabies
related but antigenically different.
 The virus is excreted through saliva of affected animals.
 4.1.2) Source of infection:-
Saliva of Rabid animals is source
of infection.
 Virus recovered or excreted from naturally occurring cases is
called street virus.

8.  4.1.3) Reservoir Of Infection:-
Rabies exist in three distinct forms:-
a) Urban Rabies
b) Wild-life Rabies
c) Bat Rabies

9.  Urban Rabies:-
Transfer of Rabies from wild life to domestic dogs
in creation of urban cycle of Rabies.
 Wild-Life Rabies:-
Wild-Life Rabies or Sylvatic form of Rabies presents
and intractable problem. It is perpetuated by Jackal, Fox, Hyena & other wild
animals, which are the main reservoir of infection.
 Bat Rabies:-
The vampire bats are main host and vector of rabies. They
feed exclusively on blood of Human & Animals. Rabies caused by Vampire bats is
thought to kill thousand of cattle. Humans are affected while sleeping outdoor.

10.  Warm blooded animals
 Dog Handlers
 Hunters
 Veterinarians
 Laboratory Staff working on Rabies virus

11.  Rabid dogs
 Cats
 Vampire bat
 Jackal
 Fox
 Hyena
• They are main Reservoir & Transmitter of rabies.

12.  Rabies is usually transmitted through a bite from an
infected anima
 Transmission can also occur when infectious material -
usually saliva -comes into direct contact with human
mucosa or fresh skin wounds.
 Human-to-human transmission by bite is theoretically
possible but has never been confirmed.
 Rarely, rabies may be contracted by inhalation of
virus-containing aerosol or via transplantation of an
infected organ.

13. .
 The incubation period in man is highly variable,
commonly 1-3 months following exposure but may
vary from 7 days to many years.
 The incubation period depends on the site of the
bite, severity of the bite, number of wounds,
amount of virus injected, species of the biting
animal, protection provided by the clothing and
treatment undertaken,etc.
 incubation period tends to be shorter in severe
exposures and bites on face, head, neck and upper
extremities and bites by wild animals.

14.  Fever
 Headache
 Nausea
 Vomiting
 Agitation
 Anxiety
 Confusion
 Hyperactivity
 Difficulty swallowing

15. As the infection progresses
 Insomnia
 Restlessness
 Excessive swallowing
 Hydrophobia
 Photophobia
 Severe muscular spasm
 Paralysis of lower legs
 Anxiety
 Irritability
 Difficulty swallowing

16.  Rabies in man is called hydrophobia.
 The disease begins with prodromal symptoms such as
headache, malaise, sore throat and slight fever lasting
for 3-4 days.
 The prodromal stage is followed by widespread
excitation and stimulation of all parts of nervous
system usually involving, in order, the sensory system,
the motor system.
 The patient is intolerant to noise, bright light or a cold
draught of air (sensory).

17.  Examination may show increased reflexes and muscle
spasms (motor) along with dilatation of the pupils and
increased perspiration, salivation and lachrimation.
 The symptoms are progressively aggravated and all
attempts at swallowing liquid become unsuccessful.
 At later stage the mere sight or sound of water may
provoke spasm of the muscles of deglutition. This
characteristic symptom of hydrophobia (fear of water) is
pathognomonic of rabies and is absent in animals.
 The duration of illness is 2 to 3 days, but may be
prolonged to 5-6 days in exceptional cases.
 The patient may die abruptly during one of the convulsions
or may pass on to the stage of paralysis and coma.

18. 1. History Collection
2. Physical Examination
3. Immunofluroscence Test
4. Skin Biopsy
5. Virus Isolation
6. ELISA

19. There is no specific treatment for rabies. Case
management includes the following procedure :
 The patient should be isolated in a quiet room protected as far as
possible from external stimuli such as bright light, noise or cold
draughts which may precipitate spasms or convulsions.
 Relieve anxiety and pain by liberal use of sedatives. Morphia in
doses of 30-45 mg may be given repeatedly.
 If spastic muscular contractions are present use drugs with
curare-like action.

20.  Ensure hydration and diuresis
 Intensive therapy in the form of respiratory and cardiac support
may be given.
NOTE:-
Patients with rabies are potentially infectious because the virus may be
present in the saliva, vomits, tears, urine or other body fluids. Nursing
personnel attending rabid patients should be warned against possible risk of
contamination and should wear face masks, gloves, goggles and aprons to
protect themselves.

21. This may be considered under 3 heads :
1. Post-exposure prophylaxis
2. Pre-exposure prophylaxis
3. Post-exposure treatment of persons who have been
vaccinated previously.

22. POST-EXPOSURE PROPHYLAXIS
 General considerations :
The vast majority of persons requ1rmg anti-
rabies treatment are those who were bitten by a
suspected rabid animal. The aim of post-exposure
prophylaxis is to neutralize the inoculated virus before it
can enter the nervous system. Every instance of human
exposure should be treated as a medical emergency.

23.  Local Treatment of Wound :
1. Cleansing
2. Chemical treatment
3. Suturing
4. Antibiotics & Anti-tetanus methods

24.  Immunization –
Pre-exposure prophylaxis
consists of three 1.0 mL doses Rabies vaccine {Cell
culture Vaccine/Human dioloid cell
vaccine/Embryonated egg cell
vaccine}administered using a sterile needle and
syringe, one injection per day on Days 0, 7, and 21
or 28.
SITE :- Deltoid/Thigh
ROUTE :- IM/ID

25. Pre Exposure Prophylaxis
 PrEP may be performed with any of the modern cell-
derived vaccines and is recommended for anyone at
increased risk of exposure to rabies virus.
 PrEP schedule requires intramuscular doses of lml or
0.5 ml, depending on the vaccine type, or intradermal
administration of 0.1 ml volume per site (one site each
day) given on days 0, 7 and 21 or 28.

26. Post-exposure Treatment of Persons
Who Have Been Vaccinated Previously
 For rabies-exposed patients who can document
previous complete pre-exposure vaccination or
complete post-exposure prophylaxis with a CCEEV, 1
dose delivered intramuscularly or a CVV delivered
intradermally on days 0 and 3 is sufficient

27. .
In developing countries over 90% of human deaths
from rabies are caused by dog bites and dog rabies
control is the key that can lock the door against
human rabies.
. INCUBATION PERIOD
 The incubation period in dogs ranges from 3-8
weeks, but it may be as short as 10 days or as long
as a year or more.

28. CLINICAL PICTURE
Rabies in dogs may manifest itself in two forms Furious
rabies and Dumb rabies.
 Furious Rabies :-
This is the typical "mad-dog syndrome",
characterized by
(i) a change in behaviour
(ii) running amuck
(iii) change in voice
(iv) excessive salIvation
(v) Paralytic stage

29.  Dumb rabies :-
In this type, the excitative or irritative
stage is lacking. The disease is predominantly paralytic.
The dog withdraws itself from being seen or disturbed. It
lapses in to a stage of sleepiness and dies in about 3
days.

30. 1. FLUORESCENT ANTIBODY TEST
2. MICROSCOPIC EXAMINATION
3. MOUSE INOCULATION TEST
4. CORNEAL TEST

31. Prophylactic vaccination of dogs against rabies is one of the
most important weapons in rabies control.
All dogs should receive primary immunization at the age of 3-4
months and booster doses should be given at regular intervals,
according to the type of vaccine used.
1. BPL inactivated nervous tissue vaccine (Single dose) : This is
based on 20% suspension of infected sheep brain. The dose is 5 ml
for dogs and 3 ml for cats. Revaccination is advised after 6
months, and subsequently every year.

32. 2. Modified live virus vaccine : This is based on 33% chick embryo
suspension infected with modified virus. The dose is 3 ml by
single injection, and boosters every 3 years.

33.  Since dog is the major source of infection, the most
logical and cost-effective approach is elimination of
stray and ownerless dogs.
 Registration and licensing of all domestic dogs.
 Restraint of dogs in public places.
 Quarantine for about 6 months of imported dogs.
 Health education of people regarding the care of dogs
and prevention of rabies.
 Prevent bats from entering living spaces or other
structures near your home.

34.  Avoid contact with wild animals.
 Oral vaccines :- An attempted live rabies vaccine harmless but
immunizing to foxes, is a great advancement in the rabies prophylaxis of
wild life.