Rabies

Front 1

What is Family and Genus for Rabies

Back 1

Rhabdoviaridae, Lyssavirus

Front 2

Which is only Lyssavirus in the new world

Back 2

Rabies

Front 3

Describe Rabies Genome

Back 3

negative sense RNA, non-segmented

Front 4

describe shape and qualities of RNA virus

Back 4

'bullet-shaped', with round and flattened ends, easily inactivated by heat, irradiation, exposure to lipid solvents and oxidizing agents.

Front 5

what is rabies virion structure

Back 5

enveloped with lipid bilayer,
glycoprotein
Ribonucleoprotein core, N, P, L helical shape.
codes own RNA polymerase
matrix protein

Front 6

what is rabies transmission mode

Back 6

bite
rarely aerool, licks, scratches, organ tranplants
must come into body from break in skin.

Front 7

when and where does rabies virus replicate after inoculation

Back 7

in muscle cells for hours to weeks.

Front 8

where does rabies virus go after replicating

Back 8

into CNS thru NM junctions. Replicates faster in neurons

Front 9

where does rabies go following nerve entry

Back 9

brain via axons, then quickly to organs, salivary glands thru somatic and autonomic nerves.

Front 10

is rabies virus usually found in blood

Back 10

very little in peripheral blood

Front 11

can human immune response fight rabies

Back 11

no, insufficient antigenic load?
replication in CNS where it is immunologically privileged.
virus immunosuppression

Front 12

do rabies virus cases develop antibody

Back 12

not measurable

Front 13

describe 4 phases of rabies dz in humans

Back 13

1 inoculation
2 prodromal
3 acute neurologic phase
4 coma phase

Front 14

Describe incubation phase of rabies

Back 14

1-2 months
depends on location, severity of bite, quantity of virus introduced, host age, host immune system

Front 15

Describe prodromal phase of rabies

Back 15

2-10 days
malaise, chillds fever, ha, photophobia, anorexia, nausea, vomiting, diarrhea, sore throat, cough, musculosk pain.
itching, burning, numbness around bite

Front 16

acute neurologic phase in rabies

Back 16

cns dysfunction - hypersalivate - foaming at mouth, paralysis, delirium

Front 17

describe 'furious'rabies

Back 17

hyperactivity and fast neurologic progression 2-7 days

Front 18

what is 'dumb'rabies

Back 18

paralysis, slower progression up to 30 days

Front 19

what is pathognomonic sign of rabies

Back 19

hydrophobia in 17-80% of cases
(can't swallow, drink)

Front 20

what is last phase of rabies

Back 20

coma! 3-7 days, results in death

Front 21

how was rabies treated before vaccine

Back 21

cauterizing or amputating

Front 22

vaccine was first made by whom and how

Back 22

Pasteur from wild type virus. desiccated spinal cords from rabies infected rabbits.
poor safety profile - caused rabies from poorly inactivated virus.
Induced allergic rxns.
nnot effective in cases of bites on head and neck.

Front 23

what is post exposure propohylaxis

Back 23

anti rabies serum introduced in 1889, not commonly used til 40s

Front 24

60s rabies virus from

Back 24

cultured in huma diploid cells. safer, more effective.

Front 25

1st vaccine for rabies?

Back 25

nerve tissue vaccine, weak antigenically, neurological rxns, cheap!

Front 26

what is preferred rabies vaccine

Back 26

cell culture vaccine or embryonic egg vaccine.
safe, effective, > expensive

Front 27

how many of PEP txs are done with preferred vaccine?

Back 27

only 20% and < 2% get rabies immunoglobulin
expensive and limited.

Front 28

is there another source of rabies immunoglobulin

Back 28

equine immunoglobulin

Front 29

pre exposure vaccine for rabies

Back 29

0, 7, 21 or 28 days
Booster if low titer, hi exposure

Front 30

PEP how many

Back 30

4 MILLION/YEAR!

Front 31

tx if never vaccinated against rabies

Back 31

clean wound w soap and water or alcohol
PASSIVE infiltrate immunization of rabies immune globulin @ SITE and IM distant from vaccine site
2. ACTIVE VACCINE on day 0, 3, 7, 14, 28

Front 32

tx, if previously vaccinated

Back 32

wound cleanse
no immunoglob
vaccine on days 0 & 3

Front 33

What is Wisconsin protocol

Back 33

coma induced in 2004 in 15 year old girl after one month bat bite.
isolation for 31 days, discharged after 76 days

Front 34

how many cases of rabies are described on clinical grounds alone

Back 34

85%
HX of exposure to endemic country important to know about

Front 35

lab DX of rabies

Back 35

IFA on skin punch biopsy(post mortem)
VIRAL RNA-RT-PCR on skin biopsy, saliva, tears, csf, needle necropsy(post mortem)
VIRUS ISOLATION - tissue culture of saliva, tears,CSF

Front 36

annual toll of rabies virus

Back 36

55,000 die/year in Asia and Africa
3 billion live in endemic areas.
10 million receive post-exposure prophylaxis/year after exposure

Front 37

who are usual hosts for rabies

Back 37

any warm blooded mammals
-encephaliitic dz
-almost always fatal if dz
-never isolated in cold blooded vertebrates

Front 38

what is unusual maintenance strategy for rabies

Back 38

causes acute, lethal dz.
depends on transmission during development of dz

Front 39

how is rabies maintained in nature

Back 39

BROAD HOST range
MODIFICATION of host behavior

Front 40

Nonmaintenance host does what to transmit rabies?

Back 40

nothing - they are dead end, like human.

Front 41

maintenance host of rabies do what to maintain virus

Back 41

sensitive to their own rabies virus variant, and will induce appropriate behavioral changes to maximize transission

Front 42

Describe epidemiology of human rabies

Back 42

EFFECTIVE DOMESTIC CANINE VACCINATION - dec in humans, wild dog source
WHERE NO CANINE VACCINATION - inc human rabies, source: dog bites

Front 43

is rabies a high cauee of mortality?

Back 43

hi in developing countries. >95% of human cases/deaths in developing countries.

Front 44

Reasons for high rates of rabies in developing countries

Back 44

no vaccines for reservoir
inaccessible to pre and post exposure prophylaxis

Front 45

bites from what animal are primary source of rabies in developing countries?

Back 45

domestic dogs

Front 46

who is most at risk for rabies

Back 46

children: 30-60% under 15
dog bites more common in kids
dogs more likely to bite kids face and neck.
kids don't receive tx

Front 47

what other populations are at risk for rabies

Back 47

rural - poverty and lack of tx
low seg - inc exposure,
high cost tx for PEP
govt use cheaper vaccines, less effective.

Front 48

what are rabies control strategies

Back 48

zoonotic dz. focus must be on animal reservoir

Front 49

What are domestic animal rabies control mechanisms

Back 49

-vaccination
-stray animal mgmt
-animal importation and quarantine regulations

Front 50

What are wild animals strategies for rabies control

Back 50

oral vaccines within bait(live attenuated vaccinnia-recombinant)
Western Europe, eastern Canaa, US
Effective agnst terrestrial reservoirs (fox, coyote,raccoon)
No effective vaccine for bats

Front 51

what level of vaccination needs to be maintained to eliminate rabies in humans

Back 51

70% for dogs

Front 52

what is vaccination level in asia and africa for rabies and is it enough to eliminate?

Back 52

40-50% - not enough to break transmission cycle.

Front 53

Central point vaccination strategy

Back 53

very effective, high coverage (80%), $2/dog

Front 54

Combined strategy for vaccination

Back 54

central point, house to house, community HW
>70% coverage, $4-6/dog