Rabies

is a zoonotic disease The disease infects domestic and wild animals, and is spread to people through close contact with infected saliva via bites or scratches.

symptoms
The incubation period is typically 13 months, may vary from <1 week to >1 year. The initial symptoms : fever and often pain or an unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site. the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops.

CYCLE OF INFECTION & REPLICATION VIRUS

1: ATTACMENT (receptors and virion interation). 2: Penetration (virus entry). 3:Uncoating (envelope removal). 4. Transcription (synthesis of mRNAs). 5. Translation (Synthesis of structural proteins). 6. Processing (G-protein gycosylation). 7. Replication (production of genomic RNA from intermediate strand. 8. Assembly. 9: Budding (complete virions).

Diagnosis
No tests - diagnose rabies infection in humans before the onset of clinical disease, unless the rabies-specific signs of hydrophobia or aerophobia are present, the clinical diagnosis may be difficult. Human rabies can be confirmed intra-vitam and post mortem viral antigens or nucleic acids in infected tissues (brain, skin, urine or saliva).

Transmission
Deep bite or scratch by an infected animal. 1. Dogs are the main host and transmitter of rabies. 2. Bats are the source of most human rabies deaths in America and Canada. 3.Foxes, raccoons, skunks, jackals, mongooses and BUT OTHER wild carnivore host species are very rare. Transmission can also occur usually saliva comes into direct contact with human mucosa or fresh skin wounds. - Human-to-human transmission . Rarely, rabies by inhalation of virus-containing aerosol or via transplantation of an infected organ. Ingestion of raw meat or other tissues from animals infected with rabies is not a source of human infection.

Post-exposure prophylaxis (PEP) 1.local treatment of the wound, initiated as soon as possible 2.potent and effective rabies vaccine that meets WHO recommendations; 3. rabies immunoglobulin, if indicated.

Categories of contact with suspect rabies

Category I touching or feeding animals, licks on intact skin Category II nibbling of uncovered skin, minor scratches or abrasions without bleeding Category III single or multiple bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks, contacts with bats.

Post-exposure prophylaxis

None

Immediate vaccination and local treatment of the wound

Immediate vaccination and administration of rabies immunoglobulin; local treatment of the wound

Who is most at risk?

Dog rabies potentially threatens 1.rural areas where human vaccines and immunoglobulin are not readily . 2.Poor people are at a higher risk, 3.children aged under 15. the majority are male. 4.Travellers with extensive outdoor exposure in rural, 5.areas medical care may be limited should be considered at risk . 6.Children living in or visiting rabies-affected areas are at particular risk.

Prevention
Eliminating rabies in dogs Rabies is a vaccine-preventable disease. The most cost-effective strategy for preventing rabies in people (dogs vaccination). Preventive immunization in people Safe, effective vaccines used for pre-exposure immunization. This is recommended for : 1.travellers spending a lot of time outdoors, e 2.high-risk occupations laboratory with live rabies virus and other lyssaviruses, direct contact with bats, carnivores, and other mammals in rabies-affected areas. 3.children at higher risk (tend to play with animals), 4.living in or visiting high risk areas.

Rabies Treatment
no cure and death is almost certain, 1.Supportive care treatment 2.Post-exposure treatment

one dose of rabies immune globulin and five doses of the rabies vaccine over a 28-day period. rabies immune globulin and the first dose of the vaccine Normally, additional doses of rabies vaccine follow on days 3, 7, 14, and 28 after the first vaccination
Older rabies vaccines required painful, daily injections in the abdomen (stomach) for up to three weeks, and could produce severe side effects. Current vaccines are relatively painless in arm, (like a flu or tetanus vaccine) as soon as possible after exposure.

Preventive immunization

GEOGRAPHY RABIES