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Zoonotic Diseases. Zoonosis: An infection or infectious disease transmissible under natural conditions from vertebrate animals to man. e.g., Rabies Anthrax Undulant fever/ brucellosis/ malta fever plague/ black death Tetanus ( locked jaw) Bovine tuberculosis etc. Rabies.

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zoonotic diseases

Zoonotic Diseases

Zoonosis: An infection or infectious disease transmissible under natural conditions from vertebrate animals to man.

e.g.,

Rabies

Anthrax

Undulant fever/ brucellosis/ malta fever

plague/ black death

Tetanus ( locked jaw)

Bovine tuberculosis etc.

rabies
Rabies
  • Primarily zoonotic disease of warm blooded animals particularly carnivores e.g.,

Dogs, foxes, cats, tigers, jackals, wolves.

  • Characterized by :
  • Classical hydrophobia
  • Long and highly variable incubation period
  • A short period of illness due to encephalitis ending in death.
  • Only communicable disease which is always fatal despite intensive care.
slide3

Source of infection: saliva of rabid animals

  • Reservoir of infection: in 3 epidemiological forms
  • Sylvatic (wild life) rabies – wild life cycle perpetuated by jackals, foxes, tigers etc; unidentified reservoir of infection.
  • Urban areas:

From wild life to domestic dogs and maintained by them i.e., from dogs to dogs which leads to 99% of human cases.

3.Bat rabies:

  • Vampire bat – importance
  • Provides constant source of infection for wild animals thus enabling virus to be present in nature.
  • Agent: Lyssa-virus type I

family Rhabdoviridae

slide4

Mode of transmission:

  • Animal bites
  • Licks over abraded/ un-abraded skin
  • Aerosols (respiratory)
  • Person to person rare but on record
  • Incubation period:
  • 6-60 days but highly variable otherwise at site, severity, no dose.
epidemiology
Epidemiology
  • Where: Approx. 40 countries including England, Japan, New Zealand are reported to be free of rabies because of strict importation of animals.
  • In Indo-Pak subcontinent, it is a major public health problem due to large number of stray dogs.
  • WHO(population at risk):
  • Dog-handlers
  • Lab-workers
  • Cave-explorers (bat rabies)
  • Veterainarians
  • Hunters
  • Wild-life officers etc.
  • When : endemic
slide6

P.O.C: In days 3-5 before the onset, rarely communicable from man to man.

  • Susceptibility/ Resitance: No natural immunity, prophylactic anti-rabies if started will prevent the disease.
  • Diagnosis:
  • History of exposure
  • Clinical signs/ symptoms
  • Microscopic examination
  • Characteristic eosinophilic inclusions(Negri –bodies)can be found inside nerve cells particularly in hippocampus and this is pathognomic sign in rabies.
method of control
Method of Control
  • Dog detention for 10 days, if dies – Rabid.
  • Pets – preventive vaccination
  • Destruction of stray dogs
  • Pets – leash application
  • Public – health education
  • If animal clinically rabid, even though the P.M brain examination fails to reveal negri-bodies vice versa or animal disappears after biting

un-identified, un-provoked attack, bitten by wild animals – control of infected - person, contract environment.

prevention
Prevention
  • Post exposure prophylaxis:
  • Local treatment of wound
  • Immunization + ARS ( N.T.V

D.E.V

H.D.C.V)

  • Pre-exposure prophylaxis:

Population at risk should be vaccinated

  • Post exposure treatment of persons previously vaccinated.
beware of friendly animal rabies and its treatment
Beware of friendly animal(rabies and its treatment)
  • Mode of infection:
  • Animal bite
  • Contamination of wound by virus laden saliva
  • Media of transmission:
  • Saliva
  • Urine
  • Tears
  • Serum
  • Other body fluids
slide10

Routes of transmission:

  • Licks on damaged skin
  • Bites or scratches
  • Inhalation
  • Crossint through intact mucous membranes
  • Contamination of wounds
  • Incubation period: Highly variable ranging from few days to several years (commonly 30-90 days) depends upon the site & intensity of bite. Long incubation period makes rabies a suitable disease for post exposure prophylactic immunization.
slide11

Concept of therapy:

  • Neutralization or removal of virus before its lodging on the nerve
  • Enhancement of body immune system for long lasting antibody response.
  • No lab tests (antibodies titre) are required before initiation of anti-rabies treatment.
prevention treatment
Prevention & Treatment
  • Pre-exposure prophylaxis (PEP):

3 standard IM doses of cell-cultured vaccine on day 0, 7, 21, 28. Persons who are in close contact or at high risk e.g., rabies research & diagnostic lab-workers, rabies biological product workers, spelunkers, veterinarians, animal control & wild life workers, animal hunters.

  • Post exposure management:
  • Local wound treatment
  • Vigorous cleansing of wound with soap water, detergent, ether, alcohol or aqueous sol. of Iodine.
  • Avoid wound suturing until and unless unevitable
  • Anti-tetanus injection
  • Analgesics & antibiotics symptomatically
slide13

Active immunization: Semple type( sheep brain suspension) – 2.5ml SC for cosecutive 14 days on anterior abdominal wall, followed by 2 boosters with 10 days interval & 3rd booster dose on 90th day

  • Intramuscular regimes: Essen schedule (5 doses)

On day 0, 3, 7, 14 & 28 or 30 plus RIG (only once as soon as possible)

  • Reduced or Alternate regime: (4 doses) 2-1-1 on day 0, 7 & 21
  • 2 doses on day 0 plus RIG
  • 3rd on day 7
  • 4th (last) on day 21
  • Previously immunized persons: Having adequate rabies antibody titre , if exposed again, require 2 doses of ant-rabies vaccine on days 0 & 7.
recommended standard protective rabies anitbody titre
Recommended Standard Protective Rabies anitbody titre
  • Recommended WHO rabies antibody titer is 0.5IU/ml,

25-30 days after 5th or last injection

  • Rabies antibody titer has no significance before initiation of treatment.
  • If the titer is below the required level, booster dosage should be administered.
  • The protection afforded lasts for 6 months from the completion of anti-rabies treatment.
  • For long term protection, 1st booster after one year & subsequent booster after 5 years.
method of administration
Method of Administration
  • Intramuscular injection into deltoid region or antero-lateral part of the thigh in small children.
  • Infiltrate half of the dosage of RIG in & around the wounds locally & remaining should be administered distant from the site of vaccine administration.
  • Never inject vaccine or sera into gluteal region because of dalayed absorption.
  • Use different syringes each time.
dosage
Dosage
  • Human Rabies Immune-globulin (HRIG) 20IU / kg body weight.
  • Equine Rabies Immune-globulin (ERIG) 40IU / kg body weight.
  • Dilute 2-3 folds with sterile saline solution if the calculated dosage of RIG is insufficient to infiltrate all wounds.
  • Skin testing should be performed with ERIG and if found to be positive, treatment should proceed but precautionary measures should be at hand & observe the patient for at least one hour after injection. A negative skin test must never reassure the physician that no anaphylactic reaction will occur.
slide18

Exposure to hare and rodent seldom, if ever, requires specific anti-rabies treatment.

  • If an apparently healthy dog or cat in or from a low risk area is placed under observation, it may be justified delaying the specific treatment.
  • This observation period applies only to dogs and cats.
anthrax
Anthrax
  • This is an acute bacterial infection of animal transmissible to man.
  • ANTHRAX / ANTHRACOSIS
  • Organism: Bacillus-Anthracis
  • Source: tissue, skin & hides, hair & wool of animals dying of anthrax.
  • Reservoir: farm animals / infected cattle, sheep, goats & horses.
  • Occurrence: wide spread in agricultural areas
mode of transmission
Mode of Transmission

According to Clinical form

1-Cutaneous anthrax or malignant pustule – contact of spores over skin of population at risk.

Sequence of events:

  • Small red indurate area
  • Later becomes edematous and soft
  • Lastly become hard, edematous & necrotic
  • Also characterized by lymphadenopathy, cellulitis & septicemia.
slide21

2- Inhalational anthrax or Wool sorter’s disease (W.S.D) or pulmonary anthrax

Occurs due to inhalation of infected material

3- Intestinal or ingestion material:

Ingestion of infected meat / other material.

Incubation period 1-7 days

slide22

Epidemiology

  • When : endemic
  • Where : agricultural / industrial area
  • Who : agriculturist, hide-workers, butchers, shepherds, wool factory workers, tanners in tannery factory, veterinarians, farm workers / farmers etc.
  • Diagnosis:
  • Shears from skin lesions (cutaneous anthrax)
  • Sputum examination – W.S.D
  • Blood by culture
preventive control measures
Preventive/Control Measures

1-Animals: Sick must be isolated and treated. Carcases 6feet buried or burnt.

  • Precaution: Never opened or bled

Vaccination with alum precipitated antigen of animals.

2-Factors:

  • Control of effluents
  • Trade-waste
  • Dust control / ventilation
slide24
3- At Community level:
  • Health education
  • Medical care of skin

4- Material :

Disinfection:

  • Hair – steaming
  • Wool – formaldehyde
  • Hides – bin chloride of formic acid /HCl
  • In epidemic – quarantine for 10 days.