यह क्या है?

आरabies है an acute viral encephalomyelitis (inflammatory disease of the brain and/or spinal cord) caused by infection with the rabies virus, a type of lyssavirus. Other lyssaviruses include Australian bat lyssavirus (ABLV) and the European bat lyssavirus (EBLV).

Rabies is transmitted to humans via bites or scratches from animals infected with the virus. Infection with the rabies virus, and other lyssaviruses, resultएस in progressive inflammation of the brain and spinal cord. Without vaccination और effective post-exposure management, rabies है almost always fatal. 

क्या ढूँढने के लिए

The incubation period of rabies is generally between 3 and 12 weeks, but the onset of symptoms has occurred as early as days after exposure or as long as 19 years later.   

Early signs of infection involve non-specific symptoms, such as loss of appetite, cough, fever, headache, discomfort and fatigue, nausea and vomiting, and sore throat. There also may be discomfort, paraesthesia (prickling or itching sensation) and fasciculations (muscle twitching) at the site of the scratch or bite.  A person may show signs of anxiety, confusion and agitation. These initial symptoms last 1 to 4 days. Following this, symptoms progress to: 

  • delirium and bizarre behaviour 
  • disorientation
  • hallucinations 
  • hypersalivation, hyperthermia and hyperventilation (signs of autonomic instability) 
  • hydrophobia (fear of water) 
  • paralysis 
  • insomnia.

The disease progresses rapidly. Once clinical signs have developed, the person’s neurological status will deteriorate over a period of up to 12 days, resulting in death. There is no specific treatment for rabies.

यह कैसे संचारित होता है?

Rabies is a zoonotic disease (spread between animals and humans). Dog species (including wolves, coyotes, foxes and jackals) are the main source of infection for humans. Skunks, raccoons, monkeys and bats can also harbour infection.  

Human exposure occurs primarily through the scratch or deep bite of an infected animal. Transmission can also occur if saliva of an infected animal comes into direct contact with a person’s mucosal surface (nose, eyes or mouth).  

The virus travels from the site of the injury to the brain by moving along nerve pathways.

एपिडेमियोलॉजी

Rabies is found in animals on all continents of the globe except Antarctica. Australia is currently rabies free. However, ABLV has been known to occur in fruit bats and insectivorous bats.  It is difficult to determine the disease burden in animals, due to the impracticalities of testing wild and domestic animals. 

Each year, rabies infection causes approximately 59,000 human deaths worldwide, 95% of these occurring in Africa and Asia. The burden of disease in humans is higher in rural, low-income populations. Children are more likely to be infected due to their size and proximity to the ground, being less likely to appreciate an animal’s temperament, and their tendency to make sudden movements or loud noises which are intimidating to animals. 

निवारण

According to the World Health Organization, vaccinating dogs in rabies-prone regions is the most cost-effective strategy for preventing rabies in people.

People who will be travelling to, or living in, rabies-prone regions should take preventative measures. These include:

  • avoiding close contact with wild and domestic animals (this is especially important for children)
  • not feeding, patting or playing with animals
  • getting vaccinated.

Vaccination

Vaccines can be administered either before potential exposure (pre-exposure prophylaxis), or after exposure has occurred (as part of post-exposure prophylaxis). 

Pre-exposure vaccination requires fewer vaccine doses and eliminates the need for immunoglobulin if exposed (except for those who are severely immunocompromised). Immunoglobulin may be expensive and difficult to source in developing countries.  

There are 2 rabies vaccines available in Australia: 

  • Verorab 
  • Rabipur 

Both Verorab and Rabipur are inactivated vaccines and can be administered via the intramuscular (IM) route or the intradermal (ID) route 

It is preferable but not essential to use the same brand of vaccine for the entire course. If using the same brand is not possible, vaccination should not be delayed, and the alternate brand should be used. 

  • Pre-exposure prophylaxis

    Vaccination is recommended for: 

    • people who work with bats 
    • laboratory workers who work with live lyssaviruses 
    • people travelling to, working in or moving to rabies-prone regions, based on a risk assessment with a travel medicine adviser. 

    Table 1: Pre-exposure prophylaxis schedule

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    *intradermal route is not recommended for individuals with immunocompromise, can only be administered by providers with specialist training and should not be administered to patients taking antimalarials at the time of vaccination or within 1 month of vaccination.
    ^intradermal accelerated schedules should not be used in people > 50 years of age due to a lack of evidence for seroconversion.
    #If exposure risk continues > 1 year after vaccination, refer booster dose recommendations in the table below.  

  • एक्सपोज़र के बाद प्रोफिलैक्सिस

    There are important steps to take after a potential exposure to the rabies virus. These include:  

    • timely wound management 
    • medical review (including risk assessment) 
    • administration of rabies vaccine (regardless of pre-exposure vaccine history). 

    Human rabies immunoglobulin is also administered in some cases. Rabies immunoglobulin provides short-term protection against the immediate development of rabies. Vaccination provides longer-term protection against the development of disease.  

    Those who have previously been vaccinated against rabies still require postexposure treatment. 

    The Australian Immunisation Handbook includes 2 different post exposure prophylaxis management algorithms. For detailed guidance, refer to:  

    If post-exposure prophylaxis is commenced overseas (with clear documentation of an appropriate vaccine course), Australian clinicians can complete treatment in accordance with the post-exposure prophylaxis guidance in the Handbook. If there is unclear documentation or in other scenarios, consult the Immunisation Handbook or an Infectious Diseases specialist.

Boosters and serology 

Recommendations for vaccine boosters and serology (blood testing to check antibody levels) vary on a case-by-case basis. Individuals should seek personalised advice from their healthcare provider (e.g. immunisation provider, travel medicine adviser or other specialist consultant). 

It is especially important for individuals in the following groups to speak with their health provider for specific advice on boosters and serology: 

  • immunocompromised individuals 
  • laboratory workers who work with live lyssaviruses 
  • people with ongoing exposure to bats or potentially rabid mammals. 

Table 2: Immunisation Handbook एसerology recommendations

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* Or, receive a booster dose every 3 years without checking serology.

A single IM booster dose is recommended for people with significant ongoing exposure risk: 

  • when serology is < 0.5 IU/mL   
  • 12 months after dose 1 of primary course of vaccination (whether pre- or post-exposure) then every 3 years after first booster (may check serology first).

एहतियात

People with anaphylaxis to egg should receive Verorab instead of Rabipur. 

People with latex allergy should receive Rabipur instead of Verorab 

अन्य टीकों के साथ सह-प्रशासन

Verorab and Rabipur can be co-administered with other vaccines, using separate injection sites.  

Tetanus vaccination status should also be considered after a bite or scratch from an animal, see MVEC: Tetanus. 

वैक्सीन के दुष्प्रभाव

Common side effects following rabies vaccination include nausea, headache, injection site pain and myalgia (muscle aches). 

Due to the seriousness of disease, post exposure vaccination should never be delayed, even in those who have experienced an unpleasant side effect or who have a history of allergic reactions. A specialist immunisation service should be contacted for specific advice. 

संसाधन

लेखक: राचेल मैकगायर (SAEFVIC रिसर्च नर्स, मर्डोक चिल्ड्रन रिसर्च इंस्टीट्यूट)

द्वारा समीक्षित: Katie Butler (MVEC Education Nurse Coordinator) and राचेल मैकगुइर (एमवीईसी शिक्षा नर्स समन्वयक)

तारीख: February 2024

नई जानकारी और टीके उपलब्ध होते ही इस अनुभाग की सामग्रियों को अद्यतन किया जाता है। मेलबर्न वैक्सीन एजुकेशन सेंटर (MVEC) कर्मचारी सटीकता के लिए नियमित रूप से सामग्रियों की समीक्षा करते हैं।

आपको इस साइट की जानकारी को अपने व्यक्तिगत स्वास्थ्य या अपने परिवार के व्यक्तिगत स्वास्थ्य के लिए विशिष्ट, पेशेवर चिकित्सा सलाह नहीं मानना चाहिए। टीकाकरण, दवाओं और अन्य उपचारों के बारे में निर्णय सहित चिकित्सा संबंधी चिंताओं के लिए, आपको हमेशा एक स्वास्थ्य देखभाल पेशेवर से परामर्श लेना चाहिए।