The document provides information about rabies including its definition, causes, transmission, symptoms, diagnosis, treatment and prevention. It defines rabies as a viral disease affecting the nervous system that is fatal if not treated. The rabies virus is transmitted via saliva, usually through animal bites. Symptoms start with fever and pain at the bite site then progress to neurological symptoms. Diagnosis involves biopsy of skin or antibody tests. Post-exposure prophylaxis within 7 days of exposure can prevent onset of disease. Vaccination and avoiding contact with wild animals are key prevention methods.

1. DAVE JAY S. MANRIQUEZ RN. RABIES

2. RABIES

3. CONTENTS:

5. The Rabies Virus RV – a neurotropic filterable virus present in the saliva of rabid animals. It has a preferrence for nerve tissues. Virus – minute organism not visible with ordinary light microscopy. It is parasitic in that it is entirely dependent on nutrients inside cells for its metabolic and reproductive needs. Can only be seen by use of eclectron microscopy. Consists of DNA or RNA covered with a protein covering called capsid. Neurotropic – viruses that reproduce in nerve tissue Filterable virus – virus causing infectious disease, the essential elements of which are so tiny that they retain infectivity after passing through a filter of the Berkefeld type. Berkefeld filter – a filter of diatomaceous earth designed to allow virus-size particles to pass through Diatomaceous earth – substance composed of diatoms, a group of unicellular microscopic algae that possess a siiceous or calcium-containing cell wall. RHABDOVIRUS: any group of rod-shaped RNA viruses with 1 important member, rabies virus, pathogenic to man. The virus has a predilection for tissue of mucus-secreting glands and the Central Nervous System. All warm-blooded animals are susceptible to infection with these viruses. RHABDO: from Greek rhabdos , "rod" LYSSA: Greek – frenzy, rage, fury, canine madness A rhabdovirus of the genus lyssavirus. This is a photograph of the virus under electron microscope Parts of the rabies virus Rod-shaped rabies viruses colored for effect

6. Mononegavirales Rhabdoviridae lyssavirus novirhabdovirus cytorhabdovirus nucleorhabdovirus Australian Bat lyssavirus European Bat lyssavirus 1 Lagos Bat virus Rabies virus Duvenhage virus European Bat lyssavirus 2 Mokola Bat virus ephemerovirus vesiculovirus order family genus species

10. RABIES INCIDENCE: WORLDWIDE:35, 000- 50, 000 cases/ year (WHO) EPIDEMIOLOGY

12. EPIDEMIOLOGY PHILIPPINES: 350-450 cases/ year 5-7 per million population DOG BITE INCIDENCE: 140, 000- 560, 000/ year 200-800 per 100, 000 population/ year AGE MOST AFFECTED: 5-14 year age group (53% of cases) BITING ANIMALS: (SLH STUDY 1982- 2002) DOGS: 98% PET: 88% STRAY: 10% CATS: 2%

14. The trend for animal bite cases has increased from 1992 to 2001 but decreased in the year 2002-2004. The increasing number of patients who are consulting the health centers for animal bite cases is due to the increasing level of awareness on rabies. On the other hand, the human rabies cases have been decreasing from 1995 to 2004. This is due to early provision of post exposure vaccination to dog bite victims. In 2004, there were 95,568 animal bite victims reported with 88 percent of them bitten by dogs. Of this animal bite victims, 55,582 or 58 percent had post-exposure vaccination and the other 40,000 or so had no vaccine protection at all. During the same year, 228 (0.2 percent of the total animal bite cases) were confirmed cases based on the appearance of the unequivocal signs and symptoms of rabies which include death for most.

15. Distribution of Animal Bite Cases of Cebu Province (Jan-June 2006)

17. PATHOLOGY CHART 1: Rabies infection

18. PATHOLOGY CHART 2: Rabies Infection

19. STAGES OF RABIES INFECTION Rabies virus Entry into the body INCUBATI0N PERIOD (20 – 90 days) INVASION (0 – 10 days) PARALYTIC EXCITEMENT (2 – 7 days) COMA (5 – 14 days) DEATH

21. DIFFERENT STAGES OF RABIES INFECTION INVASION PHASE VIRUS IN SALIVA EXCITEMENT INHALED AEROSOLS INVASION PHASE VIRUS IN SALIVA DEATH DEATH B A T S PARALYSIS PARALYSIS DOGS CATS

38. VACCINATION (Intradermal Schedule) Day of Immunization PVRV/PCECV Site DAY 0 0.1 ml L & R deltoids/ anterolateral thighs of infants DAY 3 0.1 ml L & R deltoids/ anterolateral thighs of infants DAY 7 0.1 ml L & R deltoids / anterolateral thighs of infants DAY 28/30 0.1 ml L & R deltoids/ anterolateral thighs of infants

39. Intramuscular Schedule Day of Immunization PVRV PCECV Site Day 0 0.5 ml 1.0 ml One deltoid/ anterolateral thigh of infants Day 3 0.5 ml 1.0 ml Same Day 7 0.5 ml 1.0 ml Same Day 14 0.5 ml 1.0 ml Same Day 28 0.5 ml 1.0 ml same

41. PET Schedule for previously immunized patients: Interval from the last dose Give < 1 month No booster 1 month- 6 months 1 booster dose > 6 months- 3 years 2 booster doses (D0, D3) > Than 3 years Full course of active immun.

50. QUESTION: Is an increase in the incidence of rabies r/t El Niño? ANSWER: No. Rabies both in humans & animals doesn’t in any way follow a seasonal pattern. QUESTIONS MOST FREQUENTLY ASKED ABOUT RABIES

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66. A painting of the US’ campaign against rabies in wildlife. Wildlife advocates believe that a vaccinated racoon is the best tool for combating rabies in the wildlife. Racoons are one of the most common vectors of Rabies. It may eat an infected bat yet may also spread the virus itself to the bats as it rummages through the bat colony. Tick me!