1 human rabies
TRANSCRIPT
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RABIES
Provincial Government
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HUMAN RABIES Human rabies is most common in people
aged under 15, although all age groups aresusceptible
Once clinical symptoms have occurred, thedisease is almost always fatal.
Reported incidence of human rabies casesis often incomplete and the estimated50,000 deaths per year may beunderestimated
RF1
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Slide 2
RF1 Ruiz Family, 2/28/2007
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TRANSMISSION
In almost all cases
Due to a bite, scratch or even lick on mucous membranefrom from animals (DOGS) whose saliva contains the
virus
In very exceptional cases
By inhaling virulent aerosol (laboratory experiment,exploration of enclosed caves inhabited by bats)
By transmission from man to manIndirectly: transplantation of infected tissuesDirectly: from a bite or through saliva of an infectedperson
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CATEGORY I
Licks on intact skin
Touching or feeding of animals
Management: Wash exposed skin with soap and water
(10-15 mins. Running water)
No vaccine or immunoglobulin required
May give Pre Exposure Prophylaxis
Animal Bite Management
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CATEGORY II
Nibbling of uncovered skin
Minor scratches/ abrasions without
bleeding (includes wounds that areinduced to bleed)
Licks on broken skin
Management:
Local wound treatment Start vaccine immediately (Active)
Antibiotics, Anti-tetanus
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Category IICategory II
includes woundsincludes wounds
that are induced to bleedthat are induced to bleed
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Local Wound CareLocal Wound Care
Wounds should be immediately and
vigorously washed and flushed with
soap and water preferably for 10minutes
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Local Wound CareLocal Wound Care
Anti-tetanus immunization should begiven since animal bites areconsidered tetanus prone wounds
Type ofinjury Non-immune/
Incomplete
ImmuneBooster > 5yrs
ImmuneBooster < 5yrs
Clean
minorwounds
DPT/DT
/TT
DPT/DT
/TT
None
TetanusTetanuspronepronewoundswounds
DPT/DT/TTDPT/DT/TT+ TIG/ATS+ TIG/ATS
DPT/DT/TTDPT/DT/TT NoneNone
Neglectedwounds
DPT/DT/TT +
DPT/DT/TT+
DPT/DT/TT+
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Local Wound Care: DontsLocal Wound Care: Donts
COINCOIN
SUCKING THESUCKING THE
BITE WOUNDBITE WOUND
TANDOKTANDOK
BAWANGBATOBATO
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L
ocal Wound Care: DontsL
ocal Wound Care: Donts If possible, suturing of wounds should
be avoided (as it may inoculate virus
deeper into the wound) Wounds may be coaptated using sterileWounds may be coaptated using sterile
adhesives stripsadhesives strips
However, if suturing is necessary, anti-rabies immunoglobulin should be
infiltrated around and into the woundbefore suturing Ifsuturing is unavoidable,Ifsuturing is unavoidable, it should beit should be
delayedfor at least 2 hrs afterdelayedfor at least 2 hrs afteradministration ofRIG to allow diffusion ofadministration ofRIG to allow diffusion of
the RIG to occur through the tissuesthe RIG to occur through the tissues
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CATEGORY III
Single or multiple transdermal bites orscratches
Contamination of mucous membrane
with saliva (ie. Licks) Exposure to a rabid human through
bites, contamination of mucousmembrane with saliva/fluids throughsplattering, mouth-to-mouth
resuscitation, licks of eyes, lips, vulva Handling of infected carcass or ingestion
of raw infected meat
All Category II exposures on the headand neck area
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Category IIICategory III
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CATEGORY III
Management:
Local wound treatment
Start Vaccine and RIG immediately( Active and Passive Immunization)
Antibiotics and Anti Tetanus treatment
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POST-EXPOSURE
TREA
TMEN
T
First Aid Treatment: Wash with soap
and running water for at least 10minutes.
Medical Treatment:
Active Immunization
Passive Immunization
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VACCINES
Active Immunization Egg Embryo Vaccines
Purified Duck Embryo Vaccine (PDEV)
Purified Chick Embryo Vaccine (PCEV)
Cell Culture Vaccines
Purified Vero Cell Vaccine (PVRV)
Human Diploid Cell Vaccine (HDCV)
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ACT
IVE IMMUNIZATION
Intramuscular schedule Given on Day 0, 7, 21 2-1-1 Regimen
Given IM Day 0 2 doses
Day 7 - 1 doseDay 21 1 dose
Regimen used in health facilitieswhere only a few animal bite patientsare seen everyday
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ACT
IVE IMMUNIZATION
Intradermal Schedule
Given on Days 0,3,7,30,90
2-2-2-1-1 Given Intradermally using Insulin syringe
Vaccines should be used within 8 hours
Used in Animal Bite Centers where many
patients are seen everyday andpersonnel are trained on IDadministration of vaccine
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PASSIVE IMMUNIZATION
(Rabies Immunoglobulin) Human Rabies Immunoglobulin
(HRIG)
0.133 / KBW = amount given in ml
No need for testing
Equine Rabies immunoglobulin (ERIG)
0.2 / KBW = amount in ml
Skin testing needed
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PRE EXPOSURE PROPHYLAXIS Recommended for persons who have
high risk of exposure
1-1-1 on Days 0, 7, 21 IM (1 vial) or ID (0.1 / 0.2 ml)
Booster every 1-2 years
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Dogs are friendly
rabies is deadly THANK YOU AND
GOD BLESS