Objective

With neat labelled diagram

morphology of rabies virus
Describe
features of rabies
clinical
" Mention special reference to Nesri
laboratory diagnosisof rabies with
Discuss
bodies

Discuss prophylaxis against rabies

" vaccines against rabies
neural
"Describe neural and non
 . Describe morphology of rabies virus with nest
labelled diagram

OMorphology
nm in length)
"Bullet-shaped (75 nm in width &180
peplomer
"Enveloped- lipid envelope (10 nm long)hemagglutinating
spikes (glycoprotein-G) areembedded.
Envelope is lined internally by a layer of matrix protein
 clinical features of rabies
Mention
ranges from 1 week to 19 years
prolonged and variable,
" Incubation period - virus to travel fronm tho
relatedto the distance for the
. Incubation period inversely in
inoculation to CNS. Hence it is usually shorter
site of
Children than inadults
Bites on head, neck &upper limbs than legs
Short people
Severe lacerations
Presence of genetic predisposition
>Low host immunity
>Virus- High dose of inoculum and from the site of inoculation to CNS and
‘virulence of the strain
 Clinical spectrum

Prodromal phase non-specific symptoms such as fever

characterized by throat, abnormal
Itlasts for 2-10days, vomiting, photophobia, sore
site.
malaise,anorexia, nausea, pruricus) around the wound
sensation (paresthesia,
pain, or
Acute Neurologic Phase
(80%) or paralytic type (20%).
may be either encephalitic type
This and is characterized by:
oEncephalitic rabies: It lasts for2-7 days,
Hyperexcitability
VLucid interval
VAutonomic (sympathetic) dysfunction
Hydrophobia (fear of water) or aerophobia (fear of air)
 ne

"*Paralvtic or dumb rabies

VThis occurs in 20% of cases, especially in people who are partially
vaccinated or infected with bat rabies virus.
VIt is characterized by flaccid paralysis, often begins in the bitten limh
and progressing 10 quadriparesis with facial paralysis.
*Coma and Death
VFollowing acute neurological phase, patient develops coma that
eventually leads to death within 14 days.
 ". Discuss laboratory diagnosis of rabies with specia
reference to Negribodies
of the neck and fro
"Antigen detection from hair follicles at nape
cornealsmear-bydirect Immunoflourescnce test

" Viral Isolation by:

>Mouse inoculation

>Cell lines inoculation-Mouse neuroblastoma and BHK cell lines

"Antibody detection from serum and CSF-by Mouse neutralization
test (MNT), Rapid fluorescent focus inhibition test ((RFFIT),
Fluorescent antibody virus neutralization test (FAVN), and Indirect
fluorescence assay ( IFA)
 against rabies
Discuss prophylaxis

measures:
prevented by providing prophylactic
" Rabies is
>Post-exposure prophylaxis
(PEP) and

>Pre-exposure prophylaxis (PrEP).

" PEP consists of three components
>Local wound care,
Rabies vaccine,
>Rabies immunoglobulin (RIG).
 categorization and recommended anti-rabies
Risk
prophylaxis (WHO, 2018)
Recommended prophylaxís
Type of exposure
Category of risk (who**)

No treatment needed if history is

Categoryl (No risk) Touching, or feeding of animal reliable
Licks on intact skin

without Wound management

Minor scratches or abrasions
Category l (No risk) skin Rabies vaccine
bleeding or nibbling of uncovered
Observe the dog for 10 days

Wound management
Category lI(Major Single or multiple transdermal
Rabies immunoglobulin
risk) bites with oozing of blood
Rabies vaccine
Licks on broken skin (fresh
Wounds) or mucOus membrane Observe the dog for 10 days
Direct contact with bats or wild
animals
 Local Wound Care

Physicalcleansing
Chemical inactivation: Antiseptics -povidone iodine or alcohol can be
used to inactivate the residual viruses

"Suturing: Suturing causes local tissue damage - help in spreading of the

virus. Therefore, suturing should be avoided.
" Do not touch the wound(s) with bare hand.
" Do not apply irritants like soil, oil,
lime, herbs, chalk, betel leaves, etc.
 (0
Rabies Vaccine

Type of vaccines: Cell line derived non-neural vaccines are

recommended. Three vaccines are available
>1. Purified chick embryo cell (PCEC) vaccine: Prepared from
chicken
fibroblast cell line
>2. Purified Vero cell (PVC) vaccine: Prepared from Vero cell line
>3. Human diploid cell (HDC) vaccine: Derived from WI-38
(human
embryonic lung fibroblast cell line).
" Routes: Intradermal (ID)or intramuscular (IM)
" Site: Deltoid area of the arm for adults and the anterolateral area of the
thigh for children (aged <2 years); never administered in gluteal
region.

"Dose: One ID dose is 0.1 mL of vaccine and one IM doseis

considered as an entire vial of vaccine, irrespective of the vial sizce
 dose
regimens are cost effective;
Schedule of PEP regimen: ID
preferred over IM regimens
time-sparing -
sparing and
vaccine is given on days 0, 3 and 7
PEP regimen (2-2-2): 2-site ID
" ID
doses are given. Two schedules are
four
IM PEP regimens: Total
available
and fourth dose between days 14 to
>1-site IM vaccine - days 0, 3, 7
28 or
day 0and 1-site IM on days 7 and 21
>2-site IM vaccine given on
Rabies Immunoglobulin (RIG)

neutralizing the virus

immunization, by
"RIGprovides passive
possible and not beyond day 7 after the
Timing:Only once, assoon as
first dose of vaccine.

Human RIG (hRIG) and equine RIG (eRIG).

"Preparations:
maximum dose is 20 IU(hRIG) or 40 IU (eRIG) per kg body
"Dose: The
weight
 (4
Pre-exposure Prophylaxis (PrEP)
conditions.
in two
"PrEP is recommended
higher occupational risk
>For individuals at

>For sub-populations in remote endemic areas

given to individuals of all ages,

"PrEP regimencan be
available
" Schedule: Two schedules are
>2-site ID vaccine given on days 0 and 7
>1-site IM vaccine given on days 0 and 7.
booster
" Booster: Provide lifetime protection, no need to take PrEP
periodically
Describe neural and nonneural vaccines
against rabies
trom die nervous tissues of
ONeural Vaccines- These are derived Neural vaccines were in
animals infected with the fixed rabies virus.
a long time, but they are encephalitogenic., Doorly
use in India for quite serious Iisk of neurological
immunogenic and are associated
with
use since 2004 and have heen
complications. They are no longer in
vaccines.
replaced by non-neural
Examples include:
" Semple vaccine
" Beta propiolactone (BPL)vaccine
" Infant mouse brain vaccines
 Non-neural Vaccines
derived, recombinant glycoprotein and
ONon neural vaccines include egg the later two are currently used in India
cellline derived vaccines: of whích
cavity of embryonated eggs is the best site
Egg-derived vccines: Allantoic
fort he preparation of rabies vaccine.
Purified duck embryo vaccine (PDEV)
vaccines- now it is obsolete
VLiveattenuated chick embrvo
ORecombinant vaccine:
carrying the rabies surface glycoprotein gene has been
rVaccinia virus
developed. animals, bur still in
been successful for immunizing
VIlisgiven orally, has
experimental stage for human use.
 cellculture-derived vaccines
recommended vaccine for
culture-derived vaccines are the most
" Cell
prevention of rabies.
neurological
immunogenic and devoid of
V They are highly
complications.
are available in India
Vthree vaccines
embryo cell (PCEC) vaccine:
1. Purified chick
cell (PVC) vaccine:
Purified Vero
2. (HDC)vaccine
Human diploid
cell
3.
 -l andPprolens
(RNA polymerase)
G(oyoprotein).

Liod bilayer

M(matrix protein)

--strand RNA
genome
" Viral RNAdetectionby
RT-PCR
"Negri body detection in histopathological staining of brain biopsies
(nippocampus)for postmortem diagnosis of rabies.

Negri bodies in brain biopsy by H and E stain