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Etiology Rabies is a zoonotic viral infectious disease caused by rhabdovirus. This infection istransmitted to human by the animals already suffering from it. The animals which are mainlyreported as causes of rabies are dogs, raccoons, skunks, bats, and foxes. Rabies virus infects the central nervous tissues and salivary glands of a wide range ofmammals. It is usually conveyed by saliva through bites or licks on abrasions or on intactmucous membranes. It is a vaccine-preventable viral disease which occurs in more than 150 countries andterritories. Humans are most frequently infected from dogs. The incubation period varies in humans from a minimum of 9 days to many months but it isusually 4 to 8 weeks. Severe bites especially if on the head or neck are associated with shorter incubation period.Risk FactorsFactors that increase the chances of getting rabies are following: Biting mammal is a known rabies reservoir or vector species. Biting by unimmunized dog. Bite by an animal that looks sick or displays abnormal behavior. A wound or mucous membrane was contaminated by the animal's saliva. Failure to use soap and water after bite.SymptomsIn humans, rabies typically manifests in five stages: Incubation period Prodrome Acute neurologic phase Coma Death (or in rare instances, recovery). PhasesDurationSymptomsExposure---Often unrecognizedIncubation period3-4 weeks to 3-4 months---Prodrome1-2 days to 1 weekFever, headache, nausea,vomitingAnorexia, anxiety,depression, agitation,lethargyAcute neurologic phase1-2 days to <1 weekConfusion, delirium,hallucinationsHyper-salivation,hyperactivity,hyperventilationHydrophobia, Seizures,pharyngeal spasmsComa, and deathSeveral days to 1 weekHypoventilation, apnea,respiratory arrestPituitary dysfunction,Hypo/ hyperthermia,autonomic instabilityHypotension, cardiacarrhythmia, cardiac arrest Diagnostic Tests All these techniques are recommended by WHO.Standard treatmentThere is no certain cure for rabies except supportive care. Untreated or inappropriately treatedrabies is almost always fatal because treatment is supportive only to limit the patient’s pain. An fective new rabies treatment regime that gives the protection from the disease is developed bythe scientists. The treatment regimes are; Medications to relieve the symptoms, Post-exposureprophylaxis, and Pre-exposure prophylaxis.Medications:Combination therapy for a patient with rabies includes administration of Supportive care Nutrition, fluids, vitamin, minerals. Provides patient with support to allow immune system to mount response tovirus. Therapeutic coma Ribavirin (broad-spectrum antiviral agent, given intravenously and intraventricularlyvia Ommaya reservoir), IFN-α (natural immune-regulatory protein and an immunotherapeutic drug forviral and neoplastic diseases, given intravenously and intra-ventricularly viaOmmaya reservoir) Ketamine (anesthetic agent and a noncompetitive antagonist of the N-methyl-daspartate(NMDA) receptor, given as intravenous infusion). Benzodiazepine (antipsychotic drugs). Diazepam, supplemented bychlorpromazine if needed.Pre-exposure prophylaxis Pre-exposure prophylaxis is required by those who handle potentially infected animalsprofessionally, work with rabies virus in laboratories, or live at special risk in rabies-endemicareas. Protection is afforded by intradermal injections of human diploid cell vaccine (HDCV), 1mlon days 0, 7,and 21 or 28, or two intramuscular injections given 4 weeks apart, followed byyearly boosters.Post-exposure prophylaxis If a person is bitten by an animal, the wound and scratches should be washed thoroughly withsoap and water to decrease the chances of infection. Post-exposure prophylaxis has different doses for different patients. Patients not previously vaccinated Human diploid cell vaccine (HDCV), 1ml on days 0, 3, 7 and 14.Immunosuppressant individuals should also receive a fifth dose on day 28. Human rabies immune globulin (HRIG), on days 0-7. On day 0, one dose of20 IU/kg body weigh should be given; half is infiltrated around the bite andhalf is given intramuscularly at a different site from the vaccine. 2.Patients vaccinated within previous 2 years Human diploid cell vaccine (HDCV), 1ml on days 0 and 3. The rabies vaccine works by stimulating a person’s immune system to produce antibodiesthat neutralize the virus. Rabies can usually be prevented if treatment is started within a dayor two of biting. The safest anti-rabies antiserum is human rabies immune globulin. The HRIG is in shortsupply. If it is not available immediately, the vaccine series should be initiated and HRIGmay be added at any point through day 7. After day 7, it is not necessary to add HRIG to patient regimen because endogenousantibodies are being produced and exogenous antibodies may actually be counterproductive. Brand Names: Side Effects of Medications Rabies vaccineCommon adverse effects associated with the use of either rabies vaccine include localinjection-site reactions such as erythema, itching, swelling, and indurations, and systemicreactions such as headache, nausea, abdominal pain, muscle aches, dizziness, and fever. RibavirinElevated bilirubin levels, dose dependent transient anemia and contradicted in pregnancy. INF-αIt can lead to severe inflammation in body or autoimmune diseases. KetamineNausea, vomiting, headache, hypertension, liver dysfunction, dizziness are side effects ofketamine. BenzodiazepinesDrowsiness and confusion are the most common adverse effects of benzodiazepines. Ataxiaoccurs at high doses.Counseling Plan The patient should be nursed in a quiet, darkened room. Vaccination should be done according to the days mentioned for efficient therapeutic effects. There are few adverse reactions to human diploid cell rabies vaccine because the vaccinecontains fewer foreign proteins. Local pain, swelling, and fever have been reported in aboutone half of recipients. Analgesics and antipyretics medicines can be prescribed and counselpatient to take them when required. Patients who are taking corticosteroids or are immunosuppressed may not develop activeimmunity with the vaccine. Therefore, antibody titers may need to be monitored for theseindividuals to ensure that they have developed antibody levels that will protect them fromrabies. Counsel patient to take nutritional supplement to boost their immunity. Common ADRs must be addressed to patients to increase patient compliance.

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