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Roxanne Evans, DVM Concordia University Nebraska MPH 500 Dr. Rebecca Toland September 28, 2014 1.

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Presentation on theme: "Roxanne Evans, DVM Concordia University Nebraska MPH 500 Dr. Rebecca Toland September 28, 2014 1."— Presentation transcript:

1 Roxanne Evans, DVM Concordia University Nebraska MPH 500 Dr. Rebecca Toland September 28,

2 Aristotle described rabies in the 4 th 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) 2

3 3 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)

4 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). 4

5 5 (Rabies, 2014)

6 6 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)

7 7 Furious Form (Rabies, 2014) Hypersensitivity Agitation Hydrophobia Aerophobia Cardio-Respiratory Arrest Death Ataxia Progressive Paralysis Coma Death Paralytic Form (Rabies, 2014) Once clinical symptoms set in rabies is >99% fatal (Jackson, et al., 2003).

8 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). 8

9 9 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)

10 10 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

11 Protocol 1 Given 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 This picture illustrates the locations approved to give the PEP. (Rabies - MCSPH, 2014) (Rabies, 2014)

12 12 1. Education about rabies exposure and risk of rabies. 2. Pre-exposure vaccinations to high risk individuals 3. Vaccination of dogs and cats to promote herd immunity (Schneider, 2014). 4. Reduction of stray dogs and cats. 5. Reducing interactions with wild animals. 6. Availability for exposed individuals to receive PEP. This is me vaccinating a dog for rabies in a South African border town in (Rabies, 2014)

13 13 For 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 For Pets (Cats & Dogs) : (Rabies, 2014) (Administration of Rabies Vaccination State Laws, 2014) (Defensor 3, )

14 14 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) 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)

15 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) 15 Rabies is 100% preventable! (Rabies around the World, 2011)

16 I receive my rabies pre- exposure vaccination series in 1991 still have high titers as of 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. 16 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)

17 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. ( ). Retrieved from Zoetis: Haupt, W. (1999, March 26). Rabies - risk of exposure and current trends in prevention of human cases. Vaccine, 17(13-14), doi: /s x(98) Human Rabies. (2012, May 3). Retrieved September 12, 2014, from Centers for Disease Control and Prevention: 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), Retrieved September 19, 2014, from Lackenbach, F. I. (1912, March). Rabies and the Pasteur Treatment. California State Journal of Medicine, 10(3), Retrieved September 19, 2014, from 17

18 McGrath, M. (2014, May 26). Experts' anger over 'invisible' rabies death toll. Retrieved September 12, 2014, from BBC News: 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: Rabies - MCSPH. (2014). Retrieved from Maricopa County Department of Public Health: Rabies. (2014). Retrieved September 2, 2014, from World Health Organization: Rabies around the World. (2011, April 22). Retrieved September 2, 2014, from Centers for Disease Control and Prevention: Rabies, Rabies, and more Rabies. (2010). Retrieved from Worms and Germs Blog: Rabies' Victims. (2014). Retrieved from Global Alliance for Rabies Control: Rabies Virus. (2010). Retrieved from Pathogen Profile Dictionary: Schneider, M.-J. (2014). Introduction to Public Health (4th ed.). Burlington, Massachusetts: Jones & Bartlett Learning. 18


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