Community Health Nursing

1. RABIES

2. INTRODUCTION
● Rabies is a fatal disease that attacks the nervous system
● All warm-blooded animals, including humans,are at risk of
infection with rabies virus
● Exposures most often occur as a result of contact with
domestic animals like dogs,cats,horses or cattle
● Globally more than 30,000 people die from rabies every
year

3. DEFINITION
Rabies is an infectious viral disease that
causes acute inflammation of brain in humans
and other warm blooded animals
It almost always fatal after onset of clinical
symptoms
Rabies is caused by Lyssavirus

4. CAUSATIVE AGENT
● Lyssavirus type 1 that belongs to rhabdoviridae family
causes rabies
● The virus excreted in the saliva of the infected animal
● The source of infection is saliva of dogs and cats where
virus may appear 3 to 4 days before the onset of clinical
symptoms and remains until death .

5. HOST FACTORS
● Warm-blooded animals including man are at risk
● Usually the victims belong to age of 1 to 24 years
● Laboratory staff who work with the rabies virus
● Dog handlers
● Veterinarians
● Hunters

6. ENVIRONMENT
● Living with unimmunized pets in the house
causes risk
● Many street dogs around
● Rabid dogs and cats those have the virus in
saliva

7. TRANSMISSION
● The disease is usually transmitted through saliva from a
bite but may also be spread if the infected saliva enters
the body through a cut or comes in contact with the
eyes,nose or mouth
● Human to human in case of corneal transplant from an
infected individual

8. CLINICAL SIGNS
● The disease starts with prodromal symptoms such as headache
,malaise, sore throat and mild fever. Following that a tingling pain
at the site of the bite is specific to rabies
● Stimulation or triggering of all parts of nervous system occurs
● Patient has phobias,becomes intolerant to noise,bright light or
drought of air
● Increased reflexes occur
● Muscle spasms
● Dilation of pupils
● Increased perspiration,salivation and lacrimation

9. As the disease advance
● Irritability
● Confusion
● Anger
● Depression
● Double vision
● Swallowing is difficult because of the muscle spasms
● Convulsions
● Paralysis
● Coma

10. DIAGNOSIS
● History of bite by a rabid animal
● Clinical manifestations,behavioural symptoms-
hydrophobia
● Antigen using immune- fluorescence of skin biopsy
● Isolation of virus from saliva

11. DIAGNOSIS AND TREATMENT
● Early symptoms are pain,paresthesia and oru
Titus at the site of virus entry
● Patient who are critically Ill are hospitalised

12. FIRST AID TREATMENT FOR DOG BITE
Soon after the bite ,first aid need to be provided promptly
Cleansing
Immediate flushing and washing of the wound and scratches under a
running tap for at least 5 minutes
CHEMICALS
Wound should be treated with alcohol/ tincture iodine/provision iodine
to inactive the left over virus after washing

13. Suturing
Bite should not be sutured immediately. If suturing is
necessary it is done after 24-48 hours under the cover of anti
rabies serum locally
Observe the animal for 10 days - if it
develops symptoms of rabies- to be killed

14. FURTHER TREATMENT
ISOLATION
The patient should be isolated in a quiet room so that he can be kept
away from external stimuli such as noise and bright light or cold
drought those will precipitate spasm and convulsions
RELIEVE ANXIETY
To relieve anxiety and allay acute suffering inj.morphine sulphate 30-
45mg is administered as per orders

15. SPASTIC MUSCULAR CONTRACTIONS
Treated by using drugs with curare -like ( blocking of
neuromuscular transmission)action
HYDRATION
Hydrate patient adequately
Monitor urine out put to asses the kidney function

16. INTENSIVE CARE
Intensive care is provided for those patients develops respiratory and
cardiac problems
VCCINE
People at high risk of exposure to rabies
People at high risk of getting exposed to rabies should be vaccinated
with rabies vaccine.some of such high risk people are animal
handlers,workers at rabies laboratory, and biological production
workers,etc.

17. The people who most often have contact with rabies virus or rabid animals
In addition international travelers
The pre exposure schedule for rabies vaccination is 3 doses
Given at following times
First dose : as appropriate
Second dose: 7 days after first dose
Third dose: 21 days or 28 days after first dose
Periodic testing for immunity,and booster doses should be given to laboratory workers and others
who may be exposed to rabies virus repeatedly

18. VACCINATION AFTER AN EXPOSURE
● If a person has nee bitten by an animal,or have been exposed to
rabies,should clean the wound and seek medical advice immediately. The
doctor will advise whether the person to be vaccinated
● A person who is exposed and has never been vaccinated against rabies
should get 4 doses of rabies vaccine: first dose immediately, and subsequent
doses on the 3rd ,7th,and 14th days . Rabies immune globulin should be
given along with the first dose
● A person who has been vaccinated before should receive 2 doses of rabies
vaccine - one immediately and second on the 3rd day. For those types of
cases “ rabies immune globulin “is not needed

19. CONTROL MEASURES FOR ANIMALS
● Must get the registration and licensing done for all
domestic dogs
● Practice restraint of dogs in public places
● Immediate destruction of dogs and cats bitten by rabid
animals
● Quarantine all the imported dogs for 6 months
● Health educate people on the care of dogs and prevention
of rabies