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BY: DR: NAJEEB MEMON Assist: Prof: Faculty of Community Medicine & Public Health Sciences Liaquat University of Medical & ...
RABIES <ul><li>Primarily a Zoonotic disease of warm blooded animal   </li></ul><ul><li>such as :- </li></ul><ul><li>Dogs, ...
 
 
<ul><li>It is an acute </li></ul><ul><li>Highly fatal viral dis: of CNS </li></ul><ul><li>Transmitted to man by: </li></ul...
 
Agent Factors:   Agent    (LYSSAVIRUS type I)  Rhabdoviridae type I
Bullet shaped
<ul><li>History of Rabies Virus </li></ul><ul><li>Man described the disease in  2300 B.C.   </li></ul><ul><li>The origin “...
History of the Rabies Virus <ul><li>Outbreak of rabies  in Europe </li></ul><ul><li>in 20 th  century  spawned the  </li><...
History of the Rabies Virus <ul><li>Since Roman times, man established the link between the  infectivity of a rabid dogs s...
History of the Rabies Virus <ul><li>Louis Pasteur  was the first person to diagnose that rabies targeted the CNS. </li></u...
Epidemiology <ul><li>87 countries contain Rabies, but more cases are reported in Asia. </li></ul><ul><li>In Indo-Pakistan ...
<ul><li>Estimated Annual Human Rabies Cases 2005 </li></ul><ul><li>North America 4 - 8 </li></ul><ul><li>Europe 10 - 20 </...
<ul><li>FREE RABIES ZONE:  </li></ul><ul><li>Australia,  </li></ul><ul><li>China,  </li></ul><ul><li>Iceland,  </li></ul><...
Types of Rabies virus <ul><li>STREET VIRUS </li></ul><ul><li>Definition : the virus recovered from naturally occurring cas...
<ul><li>Features </li></ul><ul><li>It produces Negri bodies </li></ul><ul><li>Incubation period is long i.e. 20 to 60 days...
RESERVOIR OF INFECTION <ul><li>1)  URBAN RABIES :  </li></ul><ul><li>From Dogs and cats. </li></ul>
2)  WILD LIFE RABIES :  From jackals and foxes.
3)  BAT RABIES :  Vampire bats which live on the blood of animals and men. These are one of the main causes of the death o...
Source of Infection <ul><li>Saliva of Rabid animal </li></ul>
Host Factors <ul><li>All warm blooded animals including man. </li></ul><ul><li>Rabies in man is a dead-end infection. </li...
Mode of Transmission <ul><li>ANIMAL BITES </li></ul><ul><li>LICKS </li></ul><ul><li>AEROSOL </li></ul><ul><li>PERSON TO PE...
<ul><li>INCUBATION PERIOD : </li></ul><ul><li>normally it is 3 - 8 wks  </li></ul><ul><li>may be short that is  4 days </l...
PATHOGENESIS <ul><li>Replicate in muscle and C.T. --- attach to nerve ending --- CNS --- than centrifugally in peripheral ...
CLINICAL PICTURE <ul><li>1.  Prodromal symptoms </li></ul><ul><li>Headache, malaise, sore throat, low fever, pain at the s...
<ul><li>Hydrophobia ( Fear of water) </li></ul><ul><li>sight or sound of water may produce spasm of degulation </li></ul><...
 
(summary )  Transmission of Rabies Cl:Picture  <ul><li>The rabies infection and the symptoms that accompany it is classifi...
DIAGNOSIS <ul><li>History </li></ul><ul><li>Sign and symptom </li></ul><ul><li>Examination </li></ul><ul><li>Detection of ...
Control Measures <ul><li>Notification </li></ul><ul><li>Isolation </li></ul><ul><li>Disinfection </li></ul><ul><li>Immuniz...
Prevention of human rabies post Exposure prophylaxis <ul><li>General consideration:-   Aim is to neutralize virus before e...
<ul><li>c, Suturing </li></ul><ul><li>d,  Anti Rabies Serum </li></ul><ul><li>e, Antibiotic and ATS </li></ul><ul><li>f, O...
<ul><li>3, Immunization </li></ul><ul><li>1,NERVOUS TISSUE VACCINE (NTV  2,  Human diploid cell vaccine (HDCV) </li></ul>
Vaccines for immunization <ul><li>Definition: </li></ul><ul><li>it is  fluid or dried preparation  of Rabies “Fixed” virus...
2Tissue culture 2 nd  G (Non-human) Potent, low cost WHO recommendatio Now purified DEV developed Improvement over adult a...
Type of Vaccine <ul><li>NERVOUS TISSUE VACCINE (NTV) </li></ul><ul><li>Derived from adult animal nervous   tissue  eg. She...
Type of Vaccine (conti) <ul><li>Duck Embryo Vaccine (DEV) </li></ul><ul><li>Type:  Killed viral vaccine </li></ul><ul><li>...
Type of Vaccine (conti) <ul><li>CELL CULTURE VACCINES </li></ul><ul><li>Human diploid cell vaccine (HDCV) </li></ul><ul><l...
PASSIVE IMMUNIZATION <ul><li>Horse Anti Rabies serum : 40 iu / kg at 0 day </li></ul><ul><li>Human rabies immunoglobin  (H...
Classification Of Exposures <ul><li>Class I (slight Risk)   07 injection </li></ul><ul><li>Licks on healthy unbroken skin....
IMMUNITY <ul><li>Duration of Immunity is upto 06 month  </li></ul><ul><li>If again bite by rapid animal than dose accordin...
General measures <ul><li>Regist:,licensing & taxation of dog. </li></ul><ul><li>Muzzling of dogs </li></ul><ul><li>Yearly ...
<ul><li>Pre-Exposure Prophylaxis </li></ul><ul><li>It is done in persons who have high risk of repeated exposures. </li></...
Rabies in Dogs   <ul><li>Incubation period: 3-8 wks. </li></ul><ul><li>Clinical features:   Rabies in dogs may manifest it...
<ul><li>Dumb Rabies. </li></ul><ul><li>The excitative or irritative stage is  lacking . </li></ul><ul><li>The disease is p...
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Rabies ppt

  1. 2. BY: DR: NAJEEB MEMON Assist: Prof: Faculty of Community Medicine & Public Health Sciences Liaquat University of Medical & Health Sciences (LUMHS) Jamshoro Sind Pakistan
  2. 3. RABIES <ul><li>Primarily a Zoonotic disease of warm blooded animal </li></ul><ul><li>such as :- </li></ul><ul><li>Dogs, </li></ul><ul><li>wild cats, </li></ul><ul><li>Jackals, </li></ul><ul><li>wolves etc. </li></ul><ul><li>It is caused by the Neurotropic RNA virus belongs to Rhabdoviridae type I ( LYSSAVIRUS type I ) is Bullet shaped virus </li></ul>
  3. 6. <ul><li>It is an acute </li></ul><ul><li>Highly fatal viral dis: of CNS </li></ul><ul><li>Transmitted to man by: </li></ul><ul><li>Bites </li></ul><ul><li>OR </li></ul><ul><li>Licks of rabid animals </li></ul>
  4. 8. Agent Factors: Agent (LYSSAVIRUS type I) Rhabdoviridae type I
  5. 9. Bullet shaped
  6. 10. <ul><li>History of Rabies Virus </li></ul><ul><li>Man described the disease in 2300 B.C. </li></ul><ul><li>The origin “ rabhas”, meaning “to do violence” comes from ancient Indian Sanskrit dating 3000 B.C. </li></ul>
  7. 11. History of the Rabies Virus <ul><li>Outbreak of rabies in Europe </li></ul><ul><li>in 20 th century spawned the </li></ul><ul><li>Vampire myth- linked to bats. </li></ul><ul><li>Rabies epidemic in 13 th </li></ul><ul><li>century France may have </li></ul><ul><li>spurred Werewolf myth as </li></ul><ul><li>well- linked to wolves. </li></ul><ul><li>Rabies is commonly spread </li></ul><ul><li>by bats and wolves and other </li></ul><ul><li>wildlife like foxes </li></ul>
  8. 12. History of the Rabies Virus <ul><li>Since Roman times, man established the link between the infectivity of a rabid dogs saliva and the spread of the disease. </li></ul><ul><li>Because there is no cure for rabies, those that had been bitten by a rabid dog would commonly commit suicide to avoid the painful death that would inevitably follow. </li></ul>
  9. 13. History of the Rabies Virus <ul><li>Louis Pasteur was the first person to diagnose that rabies targeted the CNS. </li></ul><ul><li>Also determined that nervous tissue of an infected human or animal also contained the virus. </li></ul><ul><li>In 1890 created the rabies vaccine and saved 9 year old Joseph Meister after he had been bit by a rabid dog. </li></ul>
  10. 14. Epidemiology <ul><li>87 countries contain Rabies, but more cases are reported in Asia. </li></ul><ul><li>In Indo-Pakistan rabies is a major public health problem mainly due to presence of a large no: of stray dogs. </li></ul><ul><li>More than 30,000 people died of Rabies every year in Asia. Every year 10 million people require treatment and protection from Rabies which is great Financial loss. </li></ul>
  11. 15. <ul><li>Estimated Annual Human Rabies Cases 2005 </li></ul><ul><li>North America 4 - 8 </li></ul><ul><li>Europe 10 - 20 </li></ul><ul><li>Latin America 200 - 400 </li></ul><ul><li>Africa 500 - 1,000 </li></ul><ul><li>Asia 30,000 - 40,000 </li></ul>
  12. 16. <ul><li>FREE RABIES ZONE: </li></ul><ul><li>Australia, </li></ul><ul><li>China, </li></ul><ul><li>Iceland, </li></ul><ul><li>Ireland, </li></ul><ul><li>Japan, </li></ul><ul><li>New Zealand etc </li></ul>
  13. 17. Types of Rabies virus <ul><li>STREET VIRUS </li></ul><ul><li>Definition : the virus recovered from naturally occurring cases of rabies is called “street virus” </li></ul><ul><li>Sources : it is naturally occurring virus. It is found in saliva of infected animal. </li></ul><ul><li>(continue) </li></ul><ul><li>FIXED VIRUS </li></ul><ul><li>Definition : the virus which has a short, fixed and reproducible incubation period is called “fixed virus </li></ul><ul><li>S ources : it is prepared by repeated culture in brain of rabbit such that its I.P. is reduced & fixed </li></ul>
  14. 18. <ul><li>Features </li></ul><ul><li>It produces Negri bodies </li></ul><ul><li>Incubation period is long i.e. 20 to 60 days </li></ul><ul><li>It is pathogenic for all mammals </li></ul><ul><li>Cannot be used for preparation of vaccine </li></ul><ul><li>Features </li></ul><ul><li>It does not form Negri bodies </li></ul><ul><li>Incubation period is constant between 4-6 days </li></ul><ul><li>It can pathogenic for humans under certain conditions </li></ul><ul><li>Is used for preparation of antirabies vaccine </li></ul>
  15. 19. RESERVOIR OF INFECTION <ul><li>1) URBAN RABIES : </li></ul><ul><li>From Dogs and cats. </li></ul>
  16. 20. 2) WILD LIFE RABIES : From jackals and foxes.
  17. 21. 3) BAT RABIES : Vampire bats which live on the blood of animals and men. These are one of the main causes of the death of bovine, around 0.5 to 1 million per year.
  18. 22. Source of Infection <ul><li>Saliva of Rabid animal </li></ul>
  19. 23. Host Factors <ul><li>All warm blooded animals including man. </li></ul><ul><li>Rabies in man is a dead-end infection. </li></ul>
  20. 24. Mode of Transmission <ul><li>ANIMAL BITES </li></ul><ul><li>LICKS </li></ul><ul><li>AEROSOL </li></ul><ul><li>PERSON TO PERSON </li></ul>
  21. 25. <ul><li>INCUBATION PERIOD : </li></ul><ul><li>normally it is 3 - 8 wks </li></ul><ul><li>may be short that is 4 days </li></ul><ul><li>or may be prolonged for years. </li></ul>
  22. 26. PATHOGENESIS <ul><li>Replicate in muscle and C.T. --- attach to nerve ending --- CNS --- than centrifugally in peripheral nerve to many tissue including Skeletal muscle, heart, adrenal gland and skin --- salivary gland </li></ul>
  23. 27. CLINICAL PICTURE <ul><li>1. Prodromal symptoms </li></ul><ul><li>Headache, malaise, sore throat, low fever, pain at the site of bite </li></ul><ul><li>Excitation Symptoms </li></ul><ul><li>sensory sys: involvement </li></ul><ul><li>Aero phobia, excitation of N.S. </li></ul><ul><li>Motor sys: inv: </li></ul><ul><li>increase reflexes, muscle spasm, </li></ul><ul><li>Symp:inv: dilatation of Pupils. increase perspiration, salivation, and Lacrimation, </li></ul><ul><li>Mental changes: fear of death, anger, irritability and depression </li></ul>
  24. 28. <ul><li>Hydrophobia ( Fear of water) </li></ul><ul><li>sight or sound of water may produce spasm of degulation </li></ul><ul><li>the duration of illness is 2-3 days may be prolonged to 5-6 days </li></ul><ul><li>Stage of paralysis & coma </li></ul><ul><li>DEATH / Recovery </li></ul>
  25. 30. (summary ) Transmission of Rabies Cl:Picture <ul><li>The rabies infection and the symptoms that accompany it is classified by five stages: </li></ul><ul><li>1. Incubation (1-3 months) </li></ul><ul><li>2. Prodromal, where first symptoms occur </li></ul><ul><li>3. Acute neurological phase </li></ul><ul><li>4. Coma </li></ul><ul><li>5. Death or recovery </li></ul>
  26. 31. DIAGNOSIS <ul><li>History </li></ul><ul><li>Sign and symptom </li></ul><ul><li>Examination </li></ul><ul><li>Detection of Antigen by taking Skin Biopsy using Immunofluorescence </li></ul><ul><li>by virus isolation from Saliva & other secretions. </li></ul>
  27. 32. Control Measures <ul><li>Notification </li></ul><ul><li>Isolation </li></ul><ul><li>Disinfection </li></ul><ul><li>Immunization </li></ul>
  28. 33. Prevention of human rabies post Exposure prophylaxis <ul><li>General consideration:- Aim is to neutralize virus before entering CNS </li></ul><ul><li>LOCAL WOUND TREATMENT </li></ul><ul><li>a, Cleansing of wound(soap & water) </li></ul><ul><li>b, Chemical treatment: </li></ul><ul><li>Either Alcohol 400-700 ml /liter </li></ul><ul><li>Tincture Iodine </li></ul><ul><li>No more treatment with Ammonium compound </li></ul><ul><li>No Carbolic acid and Nitric acid as it leave very bad scar </li></ul>
  29. 34. <ul><li>c, Suturing </li></ul><ul><li>d, Anti Rabies Serum </li></ul><ul><li>e, Antibiotic and ATS </li></ul><ul><li>f, Observe the animal for 10 days </li></ul>
  30. 35. <ul><li>3, Immunization </li></ul><ul><li>1,NERVOUS TISSUE VACCINE (NTV 2, Human diploid cell vaccine (HDCV) </li></ul>
  31. 36. Vaccines for immunization <ul><li>Definition: </li></ul><ul><li>it is fluid or dried preparation of Rabies “Fixed” virus grown in the Neural tissue of </li></ul><ul><li>Rabbits, </li></ul><ul><li>Sheep, </li></ul><ul><li>Goats, </li></ul><ul><li>Mice or Rats </li></ul><ul><li>OR in embryonated duck eggs </li></ul><ul><li>OR in cell culture </li></ul>
  32. 37. 2Tissue culture 2 nd G (Non-human) Potent, low cost WHO recommendatio Now purified DEV developed Improvement over adult animal nervous tissue V Not available in India & Pakistan Suckling mouse brain V Devoid of Neuroparalytic effect Used in Latin America Improvement over adult animal nervous tissue V 1, (HDC) safe, potent Pre & post expos:Immunization Used in UK,USA in past Exposed subjects Uses Fewer Allergic risks Severe & fatal reactions Side effects Fewer doses of small volume Large nos: are required Doses More potent more safer Eliminate Neuroparalytic factors Low or variable potency From fixed virus grown in brain of sheep or other animals preparation Cell culture vaccine Duck embryo vaccine Nervous Tissue vaccine
  33. 38. Type of Vaccine <ul><li>NERVOUS TISSUE VACCINE (NTV) </li></ul><ul><li>Derived from adult animal nervous tissue eg. Sheep </li></ul><ul><li>Derived from suckling mouse brain </li></ul><ul><li>Type: Killed viral vaccine </li></ul><ul><li>Dose: 2.5 ml S/C (Ant. Abdominal wall) </li></ul><ul><li>Schedule: 14 doses </li></ul>
  34. 39. Type of Vaccine (conti) <ul><li>Duck Embryo Vaccine (DEV) </li></ul><ul><li>Type: Killed viral vaccine </li></ul><ul><li>Dose: 1 ml S/C ( Ant. Abdominal wall) </li></ul><ul><li>Schedule: 14 doses OD </li></ul><ul><li>not available in Pakistan </li></ul>
  35. 40. Type of Vaccine (conti) <ul><li>CELL CULTURE VACCINES </li></ul><ul><li>Human diploid cell vaccine (HDCV) </li></ul><ul><li>Second generation tissue culture vaccine (non- Human) </li></ul><ul><li>Type: Killed viral vaccine </li></ul><ul><li>Dose: 1 ml IM </li></ul><ul><li>Schedule: on 0, 3, 7, 14, 28 day, booster on day 90 </li></ul>
  36. 41. PASSIVE IMMUNIZATION <ul><li>Horse Anti Rabies serum : 40 iu / kg at 0 day </li></ul><ul><li>Human rabies immunoglobin (HRIG): 20 iu / kg around the wound and rest in IM on 0 day </li></ul><ul><li>Booster doses are essential whenever anti rabies serum is given with the vaccine </li></ul>
  37. 42. Classification Of Exposures <ul><li>Class I (slight Risk) 07 injection </li></ul><ul><li>Licks on healthy unbroken skin. </li></ul><ul><li>Scratches without oozing of blood. </li></ul><ul><li>Class II (Moderate Risk) according to the Schedule plus one booster dose after 3 week </li></ul><ul><li>Licks on fresh cuts. </li></ul><ul><li>Scratches with oozing of blood. </li></ul><ul><li>All bites except those on head, neck, face, palms and fingers. </li></ul><ul><li>Minor wounds less than 5 in number. </li></ul><ul><li>Class III (Severe Risk) according to the Schedule plus Two booster dose one after one week and another 2 week </li></ul><ul><li>all bites or scratches with oozing of blood on neck, head, face, palms and fingers. </li></ul><ul><li>Lacerated wounds on any part of the body. </li></ul><ul><li>Multiple wounds 5 or more in number . </li></ul><ul><li>Bites from wild animals. </li></ul>
  38. 43. IMMUNITY <ul><li>Duration of Immunity is upto 06 month </li></ul><ul><li>If again bite by rapid animal than dose according to blood titre </li></ul><ul><li>if more than 0.5 i.u. / ml than only two dose 0, 3 day </li></ul><ul><li>if less than 0.5 i.u. / ml than 0, 3, 7 day </li></ul>
  39. 44. General measures <ul><li>Regist:,licensing & taxation of dog. </li></ul><ul><li>Muzzling of dogs </li></ul><ul><li>Yearly mass vaccination of dog </li></ul><ul><li>Destruction of stray dogs </li></ul><ul><li>Facilities for diagnosis of rabies in dogs </li></ul><ul><li>Destruction of wildlife where the animals are known to be the reservoir of infection . </li></ul><ul><li>Publicity </li></ul>
  40. 45. <ul><li>Pre-Exposure Prophylaxis </li></ul><ul><li>It is done in persons who have high risk of repeated exposures. </li></ul><ul><li>Animal Handlers </li></ul><ul><li>Wildlife officers </li></ul><ul><li>Veterinarians </li></ul><ul><li>Lab: staff working with rabies virus </li></ul><ul><li>Protected by:- Cell-culture vaccine 1ml I/M </li></ul><ul><li>OR 0.1ml I/D ( 0,7& 28day) </li></ul><ul><li>Post-exposure R/ of persons </li></ul><ul><li>(who have been vaccinated previously) </li></ul><ul><li>HDC vaccine (1ml I/M 0,3 & 7 day 0 </li></ul>
  41. 46. Rabies in Dogs <ul><li>Incubation period: 3-8 wks. </li></ul><ul><li>Clinical features: Rabies in dogs may manifest itself in two forms. </li></ul><ul><li>Furious Rabies . </li></ul><ul><li>This the typical mad-dog syndrome characterized by. </li></ul><ul><li>change in behavior . </li></ul><ul><li>Tendency to run away from home , wander aimlessly and biting humans and animals. </li></ul><ul><li>Change in voice due to paralisis of laryngeal muscles. </li></ul><ul><li>Excessive salivation & foaming at the angle of the mouth. </li></ul><ul><li>Paralysis of the whole body leading to coma & death. </li></ul>
  42. 47. <ul><li>Dumb Rabies. </li></ul><ul><li>The excitative or irritative stage is lacking . </li></ul><ul><li>The disease is predominantly paralytic . </li></ul><ul><li>Dog withdraws itself from being seen or disturbed. </li></ul><ul><li>It elapses into a stage of sleepiness and dies in about 3 days. </li></ul>
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