Transcript Rabies, 2014

Roxanne Evans, DVM
Concordia University Nebraska
MPH 500
Dr. Rebecca Toland
September 28, 2014
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Aristotle described rabies in the 4th century.
"Dogs suffer from madness that puts them in a state of
fury, and all animals which they bite when in this
condition, become also attacked by madness”
(Lackenbach, 1912)
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 Rabies is a virus and appears
like a bullet under an electron
microscope (Quinn, Markey, Cater,
Donnelly, & Leonard, 2002).
 Rabies can infect all
mammals (Black, 2002)
 This is a fitting shape for the
virus, since it needs to be
pushed into tissue to be
infectious to the host, much
like the penetration of a
bullet from a gun.
(Rabies Virus, 2010)
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 Approximately 2.5 billion people across 100 different
countries are at risk for contracting rabies with the
majority, 99%, of rabies infections occurring in tropical
developing countries. (Haupt, 1999)
 60,000 people worldwide die from Rabies (Rabies around the
World, 2011).
 Approximately 4 people in the US die from Rabies annually
(Human Rabies, 2012).
 Children account for 40% of rabies victims (McGrath, 2014).
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(Rabies, 2014)
Rabies is spread from
one infected animal
through a bite or
scratch that is latent
with rabies virus.
Around the World
 Dogs are most common
cause of rabies disease in
people
(Rabies, Rabies, and more
Rabies, 2010)
In the USA
 Bats are most common
cause of rabies disease in
people
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Furious Form (Rabies, 2014)
Paralytic Form (Rabies, 2014)
 Hypersensitivity
 Ataxia
 Agitation
 Progressive Paralysis
 Hydrophobia
 Coma
 Aerophobia
 Death
 Cardio-Respiratory Arrest
 Death
Once clinical symptoms set in rabies is
>99% fatal
(Jackson, et al., 2003).
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 Diagnosis of rabies infections in people is extremely
difficult if there has been no record of animal bite
(Institute for International Cooperation in Animal Biologies, 2008)
Currently there is no diagnostic test to detected rabies
before clinical symptoms occur (Rabies, 2014).
 Once displaying clinical symptoms, rabies can be
identified in the brain and spinal tissue using a direct
fluorescent antibody test (FAT) (Quinn, Markey, Cater, Donnelly, &
Leonard, 2002).
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Treatment of rabies MUST be done prior to
clinical symptoms starting (Rabies, 2014)
Once exposed to rabies, either by suspected rabid animal
or animal that can not be tested, post exposure
prophylaxis (PEP) needs to be initiated
IMMEDIATELY!
(Rabies, 2014)
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Categories of contact with
suspect rabid animal
Post-exposure prophylaxis measures
Category I – touching or
feeding animals, licks on intact
skin
None
Category II – nibbling of
uncovered skin, minor
scratches or abrasions without
bleeding
Immediate vaccination and local
treatment of the wound
Category III – single or
multiple transdermal bites or
scratches, licks on broken skin;
contamination of mucous
membrane with saliva from
licks, contacts with bats.
Immediate vaccination and
administration of rabies
immunoglobulin;
local treatment of the wound
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 Protocol 1
 Given one dose of intramuscular vaccine on days 0, 3, 7, 14, and 30.
This picture
illustrates the
locations approved
to give the PEP.
(Rabies - MCSPH, 2014)
 Protocol 2
 Given one dose of intramuscular vaccine in BOTH arms on day 0,
then one dose on days 7 and 21.
(Rabies, 2014)
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1.
2.
3.
4.
5.
6.
Education about rabies
exposure and risk of rabies.
Pre-exposure vaccinations
to high risk individuals
Vaccination of dogs and
cats to promote herd
immunity (Schneider, 2014).
Reduction of stray dogs and
cats.
Reducing interactions with
wild animals.
Availability for exposed
individuals to receive PEP.
(Rabies, 2014)
This is me vaccinating a dog
for rabies in a South African
border town in 2008.
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For People:
For Pets (Cats & Dogs):
 Herd immunity created
 Vaccinate!!!
by pets (Schneider, 2014)
 Educating people about
wild animals that can
spread Rabies
 Highly available supply
and administration of
PEP
 Mandated laws in each
state for Rabies Vaccine
 Quarantine exposed
 Test deceased
animals
(Administration of
Rabies Vaccination
State Laws, 2014)
(Rabies, 2014)
(Defensor 3, 2013-2014)
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 High Risk People
 Veterinarians and Staff
 Cavers
 Laboratory Workers
 Travelers to poor or
underdeveloped
countries
(Rabies, 2014)
To the right: Me with an outdoor feline
patient who present with neurological
symptoms of an unknown cause.
Rabies was on the list of possibilities.
The cat made a full recovery and it was
determined later to have had head
trauma from a child in the house. (2013)
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 Global Alliance for Rabies Control
 Raises money to:
 Vaccinate dogs in poor or underdeveloped countries
 Educates children and adults about risk and spread of disease
 Educates children and adults about proper hygiene when
exposed to potentially rabid animals
 Provides PEP to those who can’t afford it.
(Rabies' Victims, 2014)
Rabies is 100% preventable!
(Rabies around the World, 2011)
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 I receive my rabies pre-
exposure vaccination
series in 1991 still have
high titers as of 2009.
 I got my rabies vaccine
because I was working as
a volunteer in a veterinary
hospital.
 I always wanted to be a vet
 I was 10 years old.
 Any who is high risk, for
any reason, it is worth the
money to get the vaccine.
Top Left: Me in
St. Kitts about to
neuter a donkey.
(2008)
Top Right: Me
and a feline
patient read for
rabies vaccine.
(2013)
Bottom: Me in
South Africa
helping to
anesthetize and
radio collar a
bull elephant.
(2008)
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Administration of Rabies Vaccination State Laws. (2014, August). Retrieved from American Veterinary Medical
Association: https://www.avma.org/Advocacy/StateAndLocal/Pages/rabies-vaccination.aspx
Black, J. G. (2002). Microbiology; Principles and Explorations (5th ed.). New York, New York: John Wiley &
Sons.
Defensor 3. (2013-2014). Retrieved from Zoetis:
http://www.zoetis.co.za/runtime/popcontentrun.aspx?pageidref=2308
Haupt, W. (1999, March 26). Rabies - risk of exposure and current trends in prevention of human cases. Vaccine,
17(13-14), 1742-9. doi:10.1016/s0264-410x(98)00447-2
Human Rabies. (2012, May 3). Retrieved September 12, 2014, from Centers for Disease Control and Prevention:
http://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html
Institute for International Cooperation in Animal Biologies. (2008). Emerging and Exotic Diseases of Animals
(3rd ed.). (A. R. Sprickler, & J. A. Roth, Eds.) Ames, Iowa: Institute for International Cooperation in Animal
Biologies.
Jackson, A. C., Warrell, M. J., Rupprecht, C. E., Ertl, H. C., Dietzschold, B., O'Reilly, M., . . . Wilde, H. (2003,
January 1). Management of Rabies in Humans. Clinical Infectious Disease, 36(1), 60-63. Retrieved
September 19, 2014, from http://cid.oxfordjournals.org/content/36/1.toc
Lackenbach, F. I. (1912, March). Rabies and the Pasteur Treatment. California State Journal of Medicine, 10(3),
123-124. Retrieved September 19, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1893649/
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McGrath, M. (2014, May 26). Experts' anger over 'invisible' rabies death toll. Retrieved September 12, 2014, from BBC News:
http://www.bbc.com/news/science-environment-27538721
Quinn, P., Markey, B., Cater, M., D. W., & Leonard, F. (2002). Veterinary Microbiology and Microbial Disease. Ames, Iowa:
Blackwell.
Rabies - Epidemiology and burden of disease. (2014). Retrieved September 12, 2014, from World Health Organization:
http://www.who.int/rabies/epidemiology/en/
Rabies - MCSPH. (2014). Retrieved from Maricopa County Department of Public Health:
http://www.maricopa.gov/publichealth/Programs/rabies/prevention.aspx
Rabies. (2014). Retrieved September 2, 2014, from World Health Organization:
http://www.who.int/mediacentre/factsheets/fs099/en/
Rabies around the World. (2011, April 22). Retrieved September 2, 2014, from Centers for Disease Control and Prevention:
http://www.cdc.gov/rabies/location/world/index.html?s_cid=cs_521
Rabies, Rabies, and more Rabies. (2010). Retrieved from Worms and Germs Blog:
http://www.wormsandgermsblog.com/2010/06/articles/animals/cats/rabies-rabies-and-more-rabies/
Rabies' Victims. (2014). Retrieved from Global Alliance for Rabies Control: http://rabiesalliance.org/rabies/rabies-and-children/
Rabies Virus. (2010). Retrieved from Pathogen Profile Dictionary: http://www.ppdictionary.com/viruses/rabies.htm
Schneider, M.-J. (2014). Introduction to Public Health (4th ed.). Burlington, Massachusetts: Jones & Bartlett Learning.
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