Rabies Control Program

Nature of Disease:
Signs and Symptoms:
 Sense of apprehension
 Headache
 Fever
 Sensory change near site of animal bite
 Spasms of muscles or deglutition on attempts to swallow (fear of
water/hydrophobia)
 Paralysis
 Delirium and convulsions
 Without medical attention, the rabies victim would usually last only for
2 to 6 days. DEATH is often due to respiratory paralysis
Source:
Rhabdovirius of the genus lyssavirus. There are two kinds: urban or canine
rabies-transmitted by dogs while sylvatic rabies-a disease of wild animals and
bats which sometimes spread to dogs, cats and livestock.
Mode of Transmission:
♥ Usually by bites of a rabid animal whose saliva has the virus. The virus
may also be intoducedinto a scratch or in fresh breaks in the skin (very
rare). Transmission from man to man is possible. Airborne spread in a
cave with millions of bats have occurred, although rarely. Organ
transplant (corneal) taken from person dying of diagnosed central
nervous system disease have resulted in rabies in the recipients.

Primary Prevention:

 Immediately clean the animal bite wound - use soap and water, or just
water if no soap.
 Seek immediate medical attention - after a bite or exposure.
 Rabies vaccine shots - taken as a safeguard or as a preventive
treatment after a bite or exposure.
 Avoid wild animals
 Pet vaccination
 Livestock vaccination
 Seal house animal entry points
 Be a responsible pet owner:

• Keep rabies vaccinations up to date for all dogs, cats, and ferrets. This
is important not only to keep your pets from getting rabies, but also to
provide a barrier of protection for you, if your animal is bitten by a
rabid animal such as a bat. Seattle and King County regulations require
that all dogs, cats and ferrets be vaccinated for rabies by 4 months of
age and booster shots be kept current.
• Keep your pets under direct supervision so they do not come in contact
with wild animals. If your pet is bitten by a wild animal, seek veterinary
assistance for the animal immediately and call Public Health for further
advice.
 • Call your local animal control agency to remove any stray animals from
your neighborhood. They may be unvaccinated and could be infected
with rabies.
• Spay or neuter your pets to help reduce the number of unwanted pets
that may not be properly cared for or regularly vaccinated.

 Avoid contact with unfamiliar animals:

• Enjoy wild animals like bats, raccoons, skunks, foxes, and coyotes from
afar. Do not handle, feed, or unintentionally attract wild animals with
open garbage cans, uncovered compost bins, or pet food left outside.
• Never adopt wild animals or bring them into your home. Do not try to
nurse sick animals to health. Call animal control, an animal rescue
agency or wildlife rehabilitator like PAWS for assistance.
• Teach children never to handle unfamiliar animals, wild or domestic,
even if they appear friendly. "Love your own, leave other animals
alone" is a good principle for children to learn.
• Prevent bats from entering homes or occupied spaces in churches,
schools, and other similar areas where they might come in contact with
people and pets. If a person or pet has any exposure to a bat,
including finding a bat in the house, it is very important to call
Public Health for advice.
• When traveling abroad, avoid contact with wild animals and be
especially careful around dogs in developing countries. Rabies is
common in parts of Asia, Africa, and Latin America where many dogs
are infected with rabies. Tens of thousands of people die of rabies each
year in these countries. Before traveling abroad, consult with a health
care provider, travel clinic, or your health department about your risk
of exposure to rabies, if you should be immunized against rabies
before you go, and how you should handle an animal exposure, should
it arise.

Secondary Prevention:

• Before the onset of rabies symptoms, both passive and active

immunizations are effective for preventing progression to full-blown
rabies.
• Vaccines :
o Human diploid cell vaccine (HDCV, Pasteur Merièux)
o Rabies vaccine, adsorbed (RVA, Michigan State Department of
Health)
• Optimal results require the following:
o Immediate vigorous wound cleansing with a solution of 1 part
soap and 4 parts water
o Passive immunization
 No prior vaccination with HDCV or RVA - Human rabies
immunoglobulin (HRIG)
 Prior vaccination - No HRIG
o Active immunization
  No prior vaccination with HDCV or RVA - Primary series
HDCV or RVA
 Prior vaccination - Booster series HDCV or RVA
• A neutralizing antibody (NAb) titer greater than or equal to 0.5 IU/mL
(or complete neutralization at a serum dilution of 1:5) is considered an
acceptable antibody response for protection against rabies. Of 7
patients infected with HIV who had CD4 counts less than 200 cells/µL,
3 had a poor or even undetectable NAb response to vaccination.
Patients infected with HIV who had higher CD4 lymphocyte counts had
a good antibody response to postexposure rabies vaccination. If an
acceptable antibody response is not achieved, a second double-dose
series of rabies vaccine should be administered in an attempt to
successfully mount an adequate antibody response.
• Elderly patients (>50 y) produce antibody titer levels 52% lower than
younger patients. Whether this equates to reduced protective efficacy
remains unclear.
• Do not administer immunoglobulin and vaccine with the same syringe
or in the same site.
• Passive antibody provides protection for 1-2 weeks until the vaccine
elicits protective antibody.
• In exposures to high-risk species, initiate treatment immediately
pending laboratory examination of the animal, if it is caught.
• Therapy can be stopped if results from the animal's brain examination
are negative.
• The median duration of rabies illness in dogs, cats, and ferrets is less
than 10 days, and viral shedding in saliva occurs within a few days of
onset of illness and death. Because of the exceedingly low prevalence
of rabies in domestic animals in the United States, healthy
unvaccinated domestic dogs, cats, and ferrets may be observed for 10
days for signs of illness. If the animal remains healthy, administer no
treatment; otherwise, begin treatment on the exposed individual
pending necropsy results of the animal. Treatment can be discontinued
if examination of the animal's brain is negative for rabies. Vaccinated
animals in the United States have not transmitted rabies; outside the
United States, rare instances of transmission occur. Species other than
the above should be managed in conjunction with the local health
department, taking into account whether viral shedding periods are
known for the species, the animal's history and risk for rabies
exposure, and local epidemiology.
• Consult the local health department because the risk of rabies differs
geographically based on local endemicity and immunization practices.
Some countries and limited areas in US territories are considered
rabies-free, and no prophylaxis is administered.
• Note that an assessment of whether a bite was provoked is subjective
and does not significantly affect the chances that the animal is rabid.
Therefore, this is probably not helpful in determining the need for
prophylactic treatment.
• Intensive cardiopulmonary supportive care is the only treatment
available for patients with symptomatic rabies.
 • Regardless of treatment, symptomatic rabies is invariably fatal,
resulting from autonomic dysfunction that leads to cardiac arrhythmia
and hypotension. Only 6 recorded cases of survivors exist, 5 of whom
received some level of preexposure or postexposure prophylaxis in the
asymptomatic phase and subsequently developed rabies. The use of
ribavirin and induced coma has yet to be reproduced or validated in
the one survivor who did not receive preexposure or postexposure
prophylaxis; however, some role for combination therapies including
ribavirin, interferon, ketamine, and immunomodulatory therapies has
been proposed and may be considered in future cases under
investigational protocols. The rarity of human rabies hinders timely
testing for effective therapies. Immunomodulatory therapies such as
rabies immunoglobulin, rabies vaccine, and interferon have not altered
outcomes in trials.
• Pregnancy is not a contraindication to postexposure prophylaxis
against rabies, which is warranted to protect the life of the fetus and
mother. No adverse pregnancy outcomes have been documented with
postexposure prophylaxis. No mother-to-fetus transmission has been
described; thus, neither rabies exposure nor diagnosis of rabies in the
mother is an indication for pregnancy termination.
• Steroids, which are usually indicated in the treatment of local vaccine
reactions or cerebral edema, are contraindicated because of increased
mortality noted in animal studies and because they reduce the
response to the vaccine.

Consultations

• Local health department personnel

• Infectious diseases specialist
• Neurologist