Roxanne Evans, DVM - PowerPoint Presentation

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Roxanne Evans, DVMConcordia University NebraskaMPH 500Dr. Rebecca TolandSeptember 28, 2014

Rabies:A Human Disease

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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 – The Ancient DiseaseSlide3

3What is Rabies?

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)Slide4

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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Who’s at risk for Rabies?Slide5

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Distribution of risk levels for humans contracting rabies, worldwide, 2011.

(Rabies, 2014)Slide6

6How is Rabies Spread?

Around the World

Dogs

are most common cause of rabies disease in people

Bats

are most common

cause of rabies disease in people

In the USA

Rabies is spread from one infected animal through a bite or scratch that is latent with rabies virus.

(Rabies, Rabies, and more Rabies, 2010)Slide7

7Furious Form (Rabies, 2014)

Hypersensitivity

Agitation

Hydrophobia

AerophobiaCardio-Respiratory ArrestDeath

Ataxia

Progressive Paralysis

Coma

Death

Symptoms of Rabies

Paralytic Form

(Rabies, 2014)

Once clinical symptoms set in rabies is >99% fatal

(Jackson, et al., 2003).Slide8

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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Diagnosis Rabies DiseaseSlide9

9Treatment of Rabies

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)Slide10

10Categories of contact and recommended post-exposure prophylaxis (PEP)

(Rabies, 2014)

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 woundSlide11

Protocol 1Given one dose of intramuscular vaccine on days 0, 3

, 7, 14, and

30

.

Protocol 2

Given one dose of intramuscular vaccine in

BOTH

arms on day

0

, then one dose on days

7

and

21

.

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Post-Exposure Prophylaxis (PEP)

This picture illustrates the locations approved to give the PEP.

(Rabies - MCSPH, 2014)

(Rabies, 2014)Slide12

12Preventing Rabies Worldwide

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.

This is me vaccinating a dog for rabies in a South African border town in 2008.

(Rabies, 2014)Slide13

13For People:

Herd immunity created by pets (Schneider, 2014)Educating people about wild animals that can spread Rabies

Highly available supply and administration of PEP

Vaccinate!!!

Mandated laws in each state for Rabies Vaccine

Quarantine exposed

Test deceased

animals

Preventing Rabies in the USA

For Pets

(Cats & Dogs)

:

(Rabies, 2014)

(Administration of Rabies Vaccination State Laws, 2014)

(

Defensor

3, 2013-2014)Slide14

14Who should be vaccinated?

High Risk PeopleVeterinarians and StaffCaversLaboratory WorkersTravelers 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)Slide15

Global Alliance for Rabies ControlRaises money to:Vaccinate dogs in poor or underdeveloped countriesEducates children and adults about risk and spread of diseaseEducates children and adults about proper hygiene when exposed to potentially rabid animals

Provides PEP to those who can’t afford it. (Rabies' Victims, 2014)

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What can be done to Help?

Rabies

is 100%

preventable!

(

Rabies around the World, 2011

) Slide16

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 vetI was 10 years old.

Any who is high risk, for any reason, it is worth the money to get the vaccine.

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Personal Note

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)Slide17

Administration of Rabies Vaccination State Laws. (2014, August). Retrieved from American Veterinary Medical Association: https://www.avma.org/Advocacy/StateAndLocal/Pages/rabies-vaccination.aspxBlack, 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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ReferencesSlide18

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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References

(Continued)