RABIES
Provincial Government
HUMAN RABIES
Human rabies is most common in people
aged under 15, although all age groups are
susceptible
Once clinical symptoms have occurred, the
disease is almost always fatal.
Reported incidence of human rabies cases
is often incomplete and the estimated
50,000 deaths per year may be
underestimated
TRANSMISSION
In almost all cases
Due to a bite, scratch or even lick on mucous membrane
from 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 man
Indirectly: transplantation of infected tissues
Directly: from a bite or through saliva of an infected
person
Animal Bite Management
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
CATEGORY II
Nibbling of uncovered skin
Minor scratches/ abrasions without
bleeding (includes wounds that are
induced to bleed)
Licks on broken skin
Management:
Local wound treatment
Start vaccine immediately (Active)
Antibiotics, Anti-tetanus
Category II
•includes wounds
that are induced to bleed
Local Wound Care
Wounds should be immediately and
vigorously washed and flushed with
soap and water preferably for 10
minutes
Local Wound Care
Apply antiseptic
(alcohol, tincture of iodine
etc)
Give antibiotics for:
All frankly infected wounds
All category III cat bites
All other category III bites that are either deep,
penetrating, multiple or extensive or located on
the hand/face/genital area
Drugs of choice: Amoxicillin/clavulanic OR
Cloxacillin OR Cefuroxime axetil
Local Wound Care
Anti-tetanus immunization should be
given since animal bites are
considered tetanus prone wounds
Type of Non- Immune Immune
injury immune/ Booster > 5 Booster < 5
Incomplet yrs yrs
e
Clean DPT/DT / DPT/DT None
minor TT /TT
wounds
Tetanus DPT/DT/TT DPT/DT/TT None
prone + TIG/ATS
wounds
Neglected DPT/DT/T DPT/DT/TT DPT/DT/TT
Local Wound Care: Don’ts
TANDOK COIN
BAWANG
BATO
SUCKING THE
BITE WOUND
Local Wound Care: Don’ts
If possible, suturing of wounds should be
avoided (as it may inoculate virus deeper
into the wound)
Wounds may be coaptated using sterile adhesives
strips
However, if suturing is necessary, anti-
rabies immunoglobulin should be infiltrated
around and into the wound before suturing
If suturing is unavoidable, it should be delayed
for at least 2 hrs after administration of RIG to
allow diffusion of the RIG to occur through the
tissues
CATEGORY III
Single or multiple transdermal bites or
scratches
Contamination of mucous membrane with
saliva (ie. Licks)
Exposure to a rabid human through bites,
contamination of mucous membrane with
saliva/fluids through splattering, 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 head and
neck area
Category III
CATEGORY III
Management:
Local wound treatment
Start Vaccine and RIG immediately
( Active and Passive Immunization)
Antibiotics and Anti Tetanus treatment
OBJECTIVES OF POST EXPOSURE
TREATMENT
To reduce the quantity of rabies virus
at the bite site
To ensure a high titer of neutralizing
antibodies early and maintain it as
long as possible
POST-EXPOSURE TREATMENT
First Aid Treatment: Wash with soap
and running water for at least 10
minutes.
Medical Treatment:
Active Immunization
Passive Immunization
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)
ACTIVE IMMUNIZATION
Intramuscular schedule
Given on Day 0, 7, 21
2-1-1 Regimen
Given IM
Day 0 – 2 doses
Day 7 - 1 dose
Day 21 – 1 dose
Regimen used in health facilities where only a
few animal bite patients are seen everyday
ACTIVE 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 and
personnel are trained on ID
administration of vaccine
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
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
Dogs are friendly
rabies is deadly
THANK YOU AND
GOD BLESS