Rabies

Lyssavirus, 7 types.

Zoonosis.

Any mammal may pass infection to humans.

Why is this so important?

Education saves lives.

55,000 die annually

If treated:

100% survival

Untreated:

100% die.

Dogs, 99%

Sylvatic:

• “Animal carer dies from rabies 'after being scratched by dog in Africa two years ago”

• “Rabies victim 'failed to tell doctors about about dog bite or her trip to India”

• “When Milly nipped me, I thought nothing of it... then she died and I heard she had rabies”

• “Bat bite rabies victim dies”

• Virus-laden saliva.

• Retrograde axonal transport towards brain.

• Incubation:4 days-years.

• Clinical: 1-10 days.

• Fatal if it reaches CNS. Encephalopathy.

Pathogenesis

Symptoms.

Hallucinations

Flacid paralysis

http://www.youtube.com/watch?v=-moG6JDmJdc

Before you travel:

“Pre-exposure rabies vaccination is strongly recommended for all travellers to rabies-endemic regions.” WHO guidelines

Chick embryo or Human diploid

0,7 and 21 daysBooster at 3-5yrs

Prevention is key...

Exposed?Lipoprotein envelope

Post exposure prophylaxis.

Rabies immunoglobulin. Human or equine.

Vaccine.

Level of risk in country Unimmunised or not completely immunised* Fully immunised

None No immunisation No further immunisation

Low5 doses human diploid cell vaccine (HDCV) on days 0, 3, 7, 14 and 30

2 doses on days 0 and 3

High

5 doses rabies vaccine on days 0, 3, 7, 14 and 30PLUS human rabies-specific immunoglobulin (HRIG) on day 0 only

2 doses on days 0 and 3

Scenarios.• You wake up in your tent in Scotland to find that the tent was

not zipped up properly. There is a bat in the tent, you do not find any cuts or bites on you.

You have been vaccinated with a full vaccination course.

Scenario 2

• You are on elective in India. A patient presents with a deep scratch from a monkey. He is unsure as to whether he has been vaccinated.

Scenario 3

• You are on an expedition in China when a stray dog bites you. You have been vaccinated, but do not have any booster shots with you. You will have to curtail the expedition to get to a hospital.

Questions?