1 Human Rabies

8/8/2019 1 Human Rabies

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RABIES

Provincial Government


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HUMAN RABIES Human rabies is most common in people

aged under 15, although all age groups aresusceptible

Once clinical symptoms have occurred, thedisease is almost always fatal.

Reported incidence of human rabies casesis often incomplete and the estimated50,000 deaths per year may beunderestimated

RF1


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Slide 2

RF1 Ruiz Family, 2/28/2007


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TRANSMISSION

In almost all cases

Due to a bite, scratch or even lick on mucous membranefrom from animals (DOGS) whose saliva contains the

virus

In very exceptional cases

By inhaling virulent aerosol (laboratory experiment,exploration of enclosed caves inhabited by bats)

By transmission from man to manIndirectly: transplantation of infected tissuesDirectly: from a bite or through saliva of an infectedperson


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CATEGORY I

Licks on intact skin

Touching or feeding of animals

Management: Wash exposed skin with soap and water

(10-15 mins. Running water)

No vaccine or immunoglobulin required

May give Pre Exposure Prophylaxis

Animal Bite Management


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CATEGORY II

Nibbling of uncovered skin

Minor scratches/ abrasions without

bleeding (includes wounds that areinduced to bleed)

Licks on broken skin

Management:

Local wound treatment Start vaccine immediately (Active)

Antibiotics, Anti-tetanus


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Category IICategory II

includes woundsincludes wounds

that are induced to bleedthat are induced to bleed


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Local Wound CareLocal Wound Care

Wounds should be immediately and

vigorously washed and flushed with

soap and water preferably for 10minutes


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Local Wound CareLocal Wound Care

Anti-tetanus immunization should begiven since animal bites areconsidered tetanus prone wounds

Type ofinjury Non-immune/

Incomplete

ImmuneBooster > 5yrs

ImmuneBooster < 5yrs

Clean

minorwounds

DPT/DT

/TT

DPT/DT

/TT

None

TetanusTetanuspronepronewoundswounds

DPT/DT/TTDPT/DT/TT+ TIG/ATS+ TIG/ATS

DPT/DT/TTDPT/DT/TT NoneNone

Neglectedwounds

DPT/DT/TT +

DPT/DT/TT+

DPT/DT/TT+


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Local Wound Care: DontsLocal Wound Care: Donts

COINCOIN

SUCKING THESUCKING THE

BITE WOUNDBITE WOUND

TANDOKTANDOK

BAWANGBATOBATO


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L

ocal Wound Care: DontsL

ocal Wound Care: Donts If possible, suturing of wounds should

be avoided (as it may inoculate virus

deeper into the wound) Wounds may be coaptated using sterileWounds may be coaptated using sterile

adhesives stripsadhesives strips

However, if suturing is necessary, anti-rabies immunoglobulin should be

infiltrated around and into the woundbefore suturing Ifsuturing is unavoidable,Ifsuturing is unavoidable, it should beit should be

delayedfor at least 2 hrs afterdelayedfor at least 2 hrs afteradministration ofRIG to allow diffusion ofadministration ofRIG to allow diffusion of

the RIG to occur through the tissuesthe RIG to occur through the tissues


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CATEGORY III

Single or multiple transdermal bites orscratches

Contamination of mucous membrane

with saliva (ie. Licks) Exposure to a rabid human through

bites, contamination of mucousmembrane with saliva/fluids throughsplattering, mouth-to-mouth

resuscitation, licks of eyes, lips, vulva Handling of infected carcass or ingestion

of raw infected meat

All Category II exposures on the headand neck area


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Category IIICategory III


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CATEGORY III

Management:

Local wound treatment

Start Vaccine and RIG immediately( Active and Passive Immunization)

Antibiotics and Anti Tetanus treatment


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POST-EXPOSURE

TREA

TMEN

T

First Aid Treatment: Wash with soap

and running water for at least 10minutes.

Medical Treatment:

Active Immunization

Passive Immunization


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VACCINES

Active Immunization Egg Embryo Vaccines

Purified Duck Embryo Vaccine (PDEV)

Purified Chick Embryo Vaccine (PCEV)

Cell Culture Vaccines

Purified Vero Cell Vaccine (PVRV)

Human Diploid Cell Vaccine (HDCV)


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ACT

IVE IMMUNIZATION

Intramuscular schedule Given on Day 0, 7, 21 2-1-1 Regimen

Given IM Day 0 2 doses

Day 7 - 1 doseDay 21 1 dose

Regimen used in health facilitieswhere only a few animal bite patientsare seen everyday


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ACT

IVE IMMUNIZATION

Intradermal Schedule

Given on Days 0,3,7,30,90

2-2-2-1-1 Given Intradermally using Insulin syringe

Vaccines should be used within 8 hours

Used in Animal Bite Centers where many

patients are seen everyday andpersonnel are trained on IDadministration of vaccine


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PASSIVE IMMUNIZATION

(Rabies Immunoglobulin) Human Rabies Immunoglobulin

(HRIG)

0.133 / KBW = amount given in ml

No need for testing

Equine Rabies immunoglobulin (ERIG)

0.2 / KBW = amount in ml

Skin testing needed


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PRE EXPOSURE PROPHYLAXIS Recommended for persons who have

high risk of exposure

1-1-1 on Days 0, 7, 21 IM (1 vial) or ID (0.1 / 0.2 ml)

Booster every 1-2 years


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Dogs are friendly

rabies is deadly THANK YOU AND

GOD BLESS

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1 Human Rabies