2. VERONICA EBO
monamoursansfin@yahoo.com
093 331 61116

3. CONTENTS
1. Definition  9.Treatment
2. History  10. Prevention
3. Distribution  11. Recomendation
4. Epidemiology
5. Life cycle
6. Symptomology
7. Diagnosis
8. Prognosis

4. RABIES!? SAY WUH!?
 is a viral disease that causes
acute encephalitis (inflammation
of the brain) in warm-blooded
animals
 Rabies is a zoonotic disease (a
disease that is transmitted to
humans from animals) that is
caused by a virus

6. Etymology
 The term is derived from
the Latin rabies, "madness". Thi
s, in turn, may be related to the
Sanskrit rabhas, "to do
violence“
 The Greeks derived the word
"lyssa", from "lud" or "violent";
this root is used in the name of
the genus of rabies lyssavirus

7. The rabies virus is type
species of Lyssavirus
genus, in the family
Rhabdoviridae, order
Mononegavirales

9. Rabies under a
microscope

10.  The disease infects domestic
and wild animals, and is spread
to people through close contact
with infected saliva via bites or
scratches.
 Dogs are the source of 99% of
human rabies deaths
 Once symptoms of the disease
develop, rabies is nearly always
fatal.

12. Where did this all begin?
 Rabies may be the
oldest infectious disease
known to man.
 2300 BC
Dog owners in the Babylonian
city of Eshnunna are fined heavily
for deaths caused by their dogs
biting people.

13. BABYLONSIANS
AND THEIR DOGS
ON A HUNTING
TRIP

14.  The first written record of rabies
is in the Mesopotamian Codex of
Eshnunna (ca. 1930 BC), which
dictates that the owner of a dog
showing symptoms of rabies
should take preventive measure
against bites

15.  Inancient medical times, the
attachment of the tongue (the
frenum linguae, a mucous
membrane) was cut and
removed from where they
thought the rabies came from.
This changed once they found
the actual cause of rabies.

16.  Rabies was considered a scourge for
its prevalence in the 19th century
 In France and Belgium, where Saint
Hubert was venerated, the "St
Hubert's Key" was heated and
applied to cauterize the wound; by an
application of magical thinking, dogs
were branded with the key in hopes of
protecting them from rabies

17. At Cahors France a 16-Year Old Boy
Grabs and Controls a Rabid Dog
Which is Terrifying Passers-By

18. Hubert’s Key

19.  All human cases of rabies
were fatal until a vaccine was
developed in 1885 by Louis
Pasteur and Emile Roux.
Their original vaccine was
harvested from infected
rabbits, from which the virus
in the nerve tissue was
weakened by allowing it to dry
for five to ten days

21. LOUIS PASTEUR

23. Distribution
 occurs in more than 150 countries and
territories
 Worldwide, more than 55 000 people die
of rabies every year.
 Every year, more than 15 million people
worldwide receive a post-exposure
preventive regimen to avert the disease –
this is estimated to prevent 327 000
rabies deaths annually.

24.  Rabies is present on all
continents with the exception
of Antartica, but more than
95% of human deaths occur
in Asia and Africa

27. Rabies in the Philippines
 High numbers of rabies cases are
from Western Visayas, Central
Luzon, Bicol, Central
Visayas, Ilocos and Cagayan
Valley regions
 200- 300 deaths per year (281 in
2007)

28.  Majority of rabies victim are
children under 15 years of age
 More males (55.7%) than
females (44.3%)
 Dogs remain the principal cause
of animal bites and rabies cases
in 2006- and 2007 90%, Cats
(7%)

29. CHDs with Most Number of
Human Rabies
Rank 2007 2006
(281 cases) (219 cases)
1 CHD5(41) CHD2(27)
2 CHD3(40) CHD3(23)
3 CHD4A(38) CHD5(22)
4 CHD2(23) CHD6&12(20)
5 CHD7(22) CHD7&8(19)

30. Provinces with Most Number
of Human Rabies
RANK 2007 (269 cases) 2006 (219 cases)
1 Camarines Sur(21) Cagayan(13)
2 Cagayan (16) Isabela(12)
3 Nueva Ecija(12) Iloilo(10)
4 Bulacan, Bohol(10) Nueva Ecija, Bohol
5 Laguna(9) Tarlac (8)
Albay(7)

31. Epidemiology
 Rabies is widely distributed across
the globe, with only a few countries
(mainly islands and peninsulas)
being free of the disease.
 Jackals, bat-eared foxes and
mongoose are involved in rabies
transmission in Africa, particularly
in the south-eastern part of the
continent.

32. Rabid Bat eared Fox

34. BITE MARKS

35.  By contrast, canine rabies
predominates in most of the
developing countries of central
and south America, Africa and
Asia, where the greater burden
of human rabies falls. More than
90% of cases of human rabies
are transmitted by dogs; most
deaths occur in Asia and Africa.

36. RABID DOG

37. RABID DOG

39. Epidemiology in the
Philippines
 Although rabies is not among the
leading causes of disease and death
in the country it has become a public
health problem of significance for two
reasons
 most acutely fatal infections which
causes the death of between 200-500
Filipinos annually

40.  4thWorldwide
 53.7 percent of animal bites
patients are children
 Based on the report from
NCDPC (2004)
 This is due to early provision of
post exposure vaccination to dog
bite victims. Dogs remain the
principal animal source of rabies

41. Life Cycle
 Rabies viruses move from the site of
entry, such as through a wound, and
are transported along nerve fibres
towards the spinal cord and ultimately
the brain, where the virus undergoes
replication.
 Abnormal behaviour results from the
effects of viral infection in nerve
tissues.

42.  From the brain, rabies virus is
further spread to other organs
via the nervous system.
 The salivary glands, located in
the tissues of the mouth and
cheeks, receive high
concentrations of virus, making
saliva an effective medium
for virus transfer when the
infected animal bites another
animal.

44. Symptomology
 The incubation period for rabies
is typically 1–3 months, but may
vary from <1 week to >1 year.
 The initial symptoms of rabies
are fever and often pain or an
unusual or unexplained tingling,
pricking or burning sensation
(paraesthesia) at the wound site.

45.  As the virus spreads through the
central nervous
system, progressive, fatal
inflammation of the brain and spinal
cord develops.
 Two forms of the disease can follow.
 People with furious rabies exhibit
signs of hyperactivity, excited
behaviour, hydrophobia and
sometimes aerophobia. After a few
days, death occurs by cardio-

49.  Paralytic rabies accounts for about 30%
of the total number of human cases. This
form of rabies runs a less dramatic and
usually longer course than the furious
form.
 The muscles gradually become
paralyzed, starting at the site of the bite or
scratch.
 A coma slowly develops, and eventually
death occurs. The paralytic form of rabies is
often misdiagnosed, contributing to the
underreporting of the disease.

52. Diagnosis
 Several tests are necessary to
diagnose rabies ante-mortem
(before death) in humans; no single
test is sufficient
 Tests are performed on samples of
saliva, serum, spinal fluid, and skin
biopsies of hair follicles at the nape
of the neck.

53.  Saliva can be tested by virus
isolation or reverse transcription
followed by polymerase chain
reaction (RT-PCR)
 Serum and spinal fluid are tested
for antibodies to rabies virus
 Skin biopsy specimens are
examined for rabies antigen in the
cutaneous nerves at the base of
hair follicles.

54.  Postmortem, the standard
diagnostic technique is to
detect rabies virus antigen in
brain tissue by fluorescent
antibody test.

56. Prognosis
 Treatment after exposure (receiving
the vaccines), known as post-
exposure prophylaxis (PEP), is highly
successful in preventing the disease
if administered promptly, in general
within ten days of infection.
 Begun with little or no delay, PEP is
100% effective against rabies

57.  Inunvaccinated humans, rabies is
usually fatal
after neurological symptoms have
developed, but prompt post-
exposure vaccination may
prevent the virus from
progressing.

59. Treatment
 Effective treatment soon (within a few
days, but as soon as possible) after
exposure to rabies can prevent the
onset of symptoms and death.
 Post-exposure prevention consists of
local treatment of the
wound, administration of rabies
immunoglobulin (if indicated), and
immediate vaccination.

60. post-exposure
prophylaxis
consists of 1 dose of rabies
immunoglobulin (20IU/kg)
and 5 doses of rabies
vaccine over 28 days (days
0, 3, 7, 14 and 28)

65. Table: Recommended post-exposure prophylaxis for rabies
infection
Category of exposure to
Post-exposure measures
suspect rabid animal
Category I – touching or feeding
animals, licks on intact skin (i.e. None
no exposure)
Category II – nibbling of
Immediate vaccination and local
uncovered skin, minor scratches
treatment of the wound
or abrasions without bleeding
Category III – single or multiple
transdermal bites or scratches, Immediate vaccination and
licks on broken skin; administration of rabies
contamination of mucous immunoglobulin; local treatment
membrane with saliva from licks, of the wound
exposures to bats.

66. PREVENTION
 Eliminating rabies in dogs
 Rabies is a vaccine-preventable
disease. The most cost-effective
strategy for preventing rabies in
people is by eliminating rabies in
dogs through vaccination.

67.  Vaccination of animals (mostly
dogs) has reduced the number of
human (and animal) rabies cases
in several countries, particularly
in Latin America.
However, recent increases in
human rabies deaths in parts of
Africa, Asia and Latin America
suggest that rabies is re-
emerging as a serious public
health issues

68. Preventive immunization in
people
 Pre-exposure immunization in people
is recommended for travellers to high-
risk areas in rabies-affected
countries, and for people in certain
high-risk occupations such as
laboratory workers dealing with live
rabies virus and other lyssaviruses,
and veterinarians and animal
handlers in rabies-affected areas

69. World Rabies day
September 28
 raise awareness about the
impact of human and
animal rabies, how easy it
is to prevent it, and how to
eliminate the main global
sources

70.  Sincethe inaugural campaign in
2007, World Rabies Day events
have been held in 135 countries;
educating 150 million people
and vaccinating 4.6 million
dogs.

74. In the Philippines
 National Rabies Prevention and
Control Program
 Goal: To eliminate human rabies in
the Philippines and Declare a
Rabies – free Philippines by year
2020

78. Recommendations
 Do a program in order to inform
the people where rabies are
endemic
 Inform them on the disease and
how to avoid it
○ Includes vaccination of
animals

79.  Make it mandatory to have people
vaccinate their pets and also dog &
cats who are stray
 If they do not vaccinate, a fee will
be imposed
 Post posters showing the signs
and symptoms of a rabid animal
and person
 Once animal is rabid, euthanize it

81. EL SOURCES
 http://www.ncbi.nlm.nih.gov/books/NBK8
618/
 http://www.who.int/mediacentre/factshee
ts/fs099/en/
 http://www.cdc.gov/rabies/location/world/
index.html
 http://www.slideshare.net/davejaymanriq
uez/r-a-b-i-e-s-presentation