THIS IS A SHORT PRACTICAL GUIDE ESPECIALLY FOR GEN PRACTITIONERS THAT ARE DEALING WITH CASES OF DOG BITE IN DAY TO DAY PRACTICE.

1. PRACTICAL RABIES
NEHAL VAIDYA
MBBS, DCH.
POOJAN HOSPITAL BHUJ

2. RAPID
FIRE

3. 1
• The rabies virus is passed on by contact with
what part of an infected animal?
• A. Skin
• B. Saliva
• C. Blood
• D. Claws
• E. B and C

4. ANSWER
• The correct answer is B. Saliva .
• The rabies virus is transmitted to others through
the saliva of the infected animal. All mammals
can carry the virus. Humans can contract the
virus through a bite from the infected animal, or
from a scratch, scrape, open wound, or mucous
membrane that comes in contact with the saliva.
It is not possible to contract the virus by petting a
rabid animal or through contact with the blood,
urine, or feces of a rabid animal, the CDC says.

5. 2
• How soon do symptoms typically appear after
a person is infected with the rabies virus?
• A. 48 hours
• B. 1 week
• C. 1 month
• D. 1 year

6. A
• The correct answer is C. 1 month .
• Symptoms usually appear 30 to 90 days after
exposure. Depending on the severity of the
bite and the place on the body that was
bitten, symptoms may appear more quickly. In
rare cases, however, a person may not
develop symptoms until a year or more after
exposure.

7. 3
• SUTURING WOUND PROTECTS
• -TRUE
• - FALSE

8. A
• FALSE
• The wound should be cleaned with plenty of
soap and water and should be kept open
• Suturing or bandaging can help virus
replication

9. 4
Recently instead of five doses a one dose
vaccination schedule is available.
- True
- False

10. A
• False
• The vaccination schedule for post exposure is
0,3,7,14,28.

11. 5
• In non serious cases, you can give anti rabies
serum and wait for 7 days before starting
vaccination
• True
• false

12. A
• False
• Both should be started

13. HOW RABIES REACHES BRAIN

14. Event symptoms Clinical phase Duration Pathogenesis
Exposure
Bite or scratch from, or mucosal contact
with, a rabid animal
Fever, malaise, chills, fatigue, insomnia,
anorexia, headache, anxiety, irritability
Incubation
20–90
days
1. Virus inoculation
2. Virus replicates in the muscle
3. Virus binds to nicotinic
acetylcholine receptors
Paralytic rabies
Flaccid muscle
weakness
Furious rabies
Pain, paraesthesia or
pruritus at the
wound site
Non-specific
prodromal
phase
2–10
days
Ascending spread
of flaccid muscle
weakness, muscle
fasciculations,
bilateral weakness
of facial muscles,
sphincter
Involvement
Arousal, hyper
excitability periods
of confusion,
hallucinations,
agitation and
hydrophobia
First
neurological
signs
> 10 days
4. Virus travels within the axons
in peripheral nerves
Onset of coma
Acute
neurological
phase
2–7 days
5. Infection of the brain neurons
causing neuronal dysfunction
6. Centrifugal spread along nerves
to salivary glands, skin, corneas
and other organs
Death
Coma
0–14
days*

15. RAPID LEARNING
Category
Type of contact with a suspect or
confirmed rabid domestic or wild animal, or
animal unavailable for testing
Recommended post-exposure
prophylaxis
I
Touching or feeding animals, licks on
intact skin (i.e. no exposure)
No prophylaxis
II
Nibbling of uncovered skin, minor scratches or
abrasions without bleeding
• Anti-rabies vaccine immediately
• Stop treatment if animal remains
healthy throughout an observation
period of 10 days
III
Single or multiple transdermal bites or
scratches, licks on broken skin, contamination
of mucous membrane with saliva from licks,
exposures to bats
• Anti-rabies immunoglobulin
immediately
• Anti-rabies vaccine immediately.
• Stop treatment if animal remains
healthy throughout an observation
period of
10 days*

16. RAPID LEARNING
• Observation Period, should depend on availability of
animal for observation and laboratory testing.
• In developing countries like India, the vaccination
status of the implicated animal alone should not be
considered when deciding whether to give or
withhold PEP eg: Stray or Pet dog exposure
• Treatment may be modified if animal involved (dog
or cat) remains healthy throughout the observation
period of 10 days by converting post-exposure
prophylaxis to pre-exposure vaccination by skipping
the vaccine dose on day 14 and administering it on
day 21 or 28 while using Essen Schedule

17. DON’Ts AND DOs
Magical , religious practices
do not help (e.g. witchcraft, turmeric
powder etc.)
Wash the wound
thoroughly with plenty of
water and soap
Apply an antiseptic
(povidone iodine) or
alcoholDo not cover or Suture
the wound
DON’T
AT HOME or
CLINIC
AT CLINIC
Cat II
& III
Cat III

18. RAPID LEARNING
WHO recommended Essen (5-dose) intramuscular regimen
Injected into deltoid (adults) or anterolateral area of thigh (children <2 years)

19. PEP: Passive Immunization for Category III exposure
RIG administration is must for category III exposure
• RIG infiltrated in & around wound/s
• Two types of RIG
– Human RIG
– dose 20 IU/kg of body weight
– Equine RIG
– dose 40 IU/kg of body weight
• RIG provides passive immunity
– Immediate access to rabies virus-
neutralizing antibodies (RVNA)
– Provides protection until active
immunity begins
– 7-10 days post-vaccination
Source: 1. WHO Rabies Report 2010; 2. NCDC Rabies report 2007, Govt. of India

20. 20
Re-exposure prophylaxis
Only 2 doses to be given to pre-vaccinated (PrEP or PEP) victims
x1 x1
Day 0 3
One dose (IM) is
administered
on Days 0 & 3
No RIG is required
• In instances where the biting dog or cat is healthy, vaccinated and available for an
observation period of 10 days, one may ensure a proper wound management and defer
booster vaccination if the PrEP or previous PEP was completed in the last 3 months.
Source: 1. WHO 2004. Rabies Technical Report Series 931; 2. WHO Rabies Report 2010; 3. NCDC Rabies report 2007, Govt. of India; 4. Rabipur PI
Injected into deltoid (adults) or anterolateral area of thigh (children <2 years)

21. PRE EXPOSURE PROPHYLAXIS
• COURSE
• 0, 7, 28.
• BOOSTERS EVERY 3 YRS

22. CATEGORY?

23. CATEGORY?

24. HOW TO FACE AN ATTACKING DOG?

25. ATTACK IF YOU ARE ATTACKED

26. THANK YOU