Content dump ( plan)

1. OVERVIEW
a. abstract
i. Rabies is a highly infectious zoological disease ( 19th
century) caused by a neurotropic virus from the Lyssavirus
genus of the Rhabdoviridae family ( rabies overview)
ii. Has the highest death rate in human cases ( Dacheux
review)
iii. Despite the presence of a vaccine for 125 years( the
prevention and management it still remains extremely
dangerous
b. Pathogenesis
It is transmitted by infected bites of the rabid animals. Less
common , via contamination of virun in open skin or aerosols
inhalation or organ transplant. ( rabies epidemiology) ( everything
you wanted to know)
c. 2 types of rabies
o Encephalitic Rabies (80% of cases): Hyperexcitability,
hydrophobia, and autonomic dysfunction.
o Paralytic Rabies (20%): Flaccid paralysis, often starting in
the bitten limb.
• Outcome: Both forms are almost universally fatal once
symptoms appear. ( rabies epidemiology) ( rabies overview)
d. Transmission
i. Over 90% to 99%of human rabies cases are due to dog bites
( rabies epidemiology; the prevention and management)
e. Incubation period
i. vary from days to up to years
usually around 1-3 months ( rabies overview; rabies epidemiology)( C. Rupprecht et al.
"Rabies re-examined.." The Lancet. Infectious diseases, 2 6 (2002): 327-43. https://doi.org/10.1016/S1473-3099(02)00287-6)

2. The popularity of rabies; contributing factor to the world spread of

rabies
a. 95% of rabies cases in humans are in ASIA and AFRICA ( the
prevention and management) ( the spread and evolution) ( rabies
21st century)
 b. Rabies-free countries include Australia, Japan, the UK, and others.
Indian islands like Andaman and Lakshadweep are rabies-free.
(Rabie overview) ( the prevention and management) ( the spread
and evolution
c. India has the highest number of deaths from rabies ( the prevention
and management) accounts for 25,000–30,000 deaths ( rabies 21st
century)
d. Contributing factor
i. Inaccessibility: Rabies control is limited in some wildlife
reservoirs and regions with poor healthcare access.( rabie
epidemiology)
ii. Disparities: Modern cell culture vaccines and rabies
immune globulin are safer but less affordable, leading to
continued use of older, riskier nerve-tissue vaccines in some
areas. ( rabies epidemiology) (the prevention and
management of rabies.)
iii. Developing countries face severe shortages of rabies immune globulin
(RIG) and affordable vaccines for post-exposure prophylaxis (PEP).
( rabies 21st century)
3. The impact to the world of rabies
a. 40% of the victims are children ( everything you wanted) who
usually approach animals with no caution and are at higher risk.
boys are at a higher risk ( rabies epidemiology)
b. Half of the human population is in danger of rabies canine ( have a
map of the risk territory) ( the prevention and management)
c. Over 50,000 thousand people die annually because of rabies 9
rabies overview; the prevention and management, everything you
wanted to know; rabies 21st century; the spread and evolution ;
d. Global burden: 6 billion dollars, including cases in human animals
and prevention method like PEP( the prevention and management)
e. In India only 1/6 of the patients get proper PEP( the prevention and
management of rabies
f.
4. How to deal with rabies ( Prophylaxis and Treatment)
a. Since the classical antiquity era, Pliny Caelius Aurelianus had
noted the palliative treatment of rabies.( 4000 years of rabies )
b. Introduced more 4000 years ( 4000 years) ( 19th century
c. That’s true because once the neurological symptoms have
developed, which means it has reached the CNS where it is
propagated massive and virally ( rabies overview) , the disease is
universally fatal for both types ( rabies epidemiology, the immune
response, the spread and evolution of rabies, rabies in the 21st, the
prevention and management, every articles)
d. Therefore prevention is the primary approach to tackling rabies
( rabies epidemiology)
e. Appropriate post-exposure immunisation reduces the risk of rabies
propagation from 50% to less than 5% ( rabies overview)
f. How did people in the past deal with rabies?
i. Ancient time
1. Rabies is associated with madness (19th century ) .,
understood as the poison in saliva like snake bites
( 4000 years)
2. Treatments were often developed based on
superstition or religious beliefs and usually be
ineffective ( 19th century), (4000 years )
3. Incantations, amulets, wound cauterisation and some
miracle cures were implemented. ( 19th century),
(4000 years )
ii. After the 16th century
1. Understand more about the transmission and its effect
to the nervous system
2. Use strict regulation of keeping dogs, quarantine and
elimination of dog-mediated rabies
iii. Pasteurs breakthrough
1. Pasteur’s first rabies vaccine using attenuated virus
strain marked a turning point in the human treatment
of rabies ( 4000 years) ( 19th century)
 2. The vaccine was extracted from the cord of a rabid
rabbit ( neural-tissue vaccine ) ( report on Pasteur's
work)
3. This discovery reduced mortality rates from rabies and
paved the way for future vaccine development.
( Report on pasteurs work)
4. Joseph Meisters was the first person who survived
rabies using Pasteur vaccine (4000 years ; 19th
century;
5. By 1886, April Pastures had successfully treated
approximately 300( 19th century) to over 600 ( report
Pasteurs) patients from all over EU America, Russia
with only one case of death recorded ( report on
Pasteures)
6. Pasteur’s attenuated vaccine still has been being used.
g. Modern prevention and treatment
i. Vaccine and rabies immune globulin evolved, enhancing
effectiveness and safety.
ii. 2 types of vaccines
1. Cell culture-based or embryonated eggs or vaccines
are safer and more effective ( rabies 21st century;
Dacheux review) but also more expensive ( rabies 21st
century)
2. Neural-tissue vaccine or attenuated vaccine,
developed by Pasteur and his crew ( report on Pasteur)
is still being used in many developing nations due to
its affordability ( rabies epidemiology)
3. Or inactivated and attenuated vaccines
iii. Prophylaxis
1. PEP ( post-exposure prophylaxis) ( after exposure)
a. Includes wound care, vaccination and rabies
immune globulin ( rabies overview; the
prevention and management of rabies)
b. The WHO recommends the PEP to consist of
one passive immunisation( RIG) ( rabies
overview) and 4 doses of vaccination ( World
Health Organization et al. "Rabies vaccines: WHO position paper,
April 2018 - Recommendations.." Vaccine, 36 37 (2018): 5500-
 5503 . https://doi.org/10.1016/j.vaccine.2018.06.061.)to
5( the
prevention and management , rabies overview,
doses of inactivated vaccine over a
month( immune response to rabies)
intradermally or intramuscularly.
c. Intradermal (ID): through skin ( cheaper)
d. Intramuscular (IM): injected into muscle (more
effective)
e. Dosage schedule : day 0,3,7,14 ( WHO; the
prevention and ) or 0,3,7,21,28 ( rabies
overview) ( the immune response)
2. PrEP ( Pre-exposure prophylaxis) before exposure
a. Recommended for those with occupational risk
like animal handlers, zookeeper, travelers to
endemic area ( the prevention and management)
( rabies overview)
b. Given on day 0,3,21/28 ( rabies epidemiology) (
the prevention and management) ( rabie 21st
century)
3. Treatment
a. With the development of neurological
symptoms, which means the virus has reached
the CNS, treatment is only palliative, and
fatality is nearly 100%( rabies overview; the
prevention and ), the highest fatality rate in
human-case disease ( Dacheux review)
i. Heavy sedation, and physical support for
nutrition and water ( rabies overview)
b. Milwaukee protocol( induced coma and
antivirals
i. Limited success, with only six survivors
recorded( rabies overview
ii. Story of a 15-years old girl who became
the first survivor of rabies without
vaccination ( rabies overview)
iii. Requirement: young age, normal immune
system , those who have already had the
 rabies vaccine ( the prevention and
management
5. The plan
a. Who : National/ regional medical system
b. What: Allow access to rabies vaccination to everyone; strictly
obligate pets to get vaccination.
c. Cost: 1 Billion dollars ( Vietnam)
i. $10-15 for vaccine
ii. $20-30 for immune globulin
iii. 15x5x100,000,000 +25x 100,000,000 + estimated
expenditure for constructing new clinical infrastructure =
approx. $10 billion
d. Implementation
e. Rabies vaccine has to be prepared at any medical system in the
country particularly the suburban area and places that has few
people
f. This requires new constructions of some medical facilities
g. Therefore, when the citizen seems to be exposed to rabies have
immediate access to vaccine
a. Solvency: rabies symptom one has appeared only palliative
treatment is available. However, the incubation period is usually
quite long for this parasite to reach the nervous system.
Specifically, vaccination is still effective during incubation period
of rabies. Appropriate post-exposure immunisation reduces the risk
of rabies propagation from 50% to less than 5%( rabies overview)
h. How this would help
i. Reduce the number of death
ii. Reduce the economic burden
iii. Decline the fear of rabies amongst people

References
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