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Flashcards in One Health approach to zoonoses Deck (33):
1

How often is rabies transmitted to humans?

99.9% dog bites
(>99% dogs, <1% other carnivores, bats)

2

On which continent are there the most deaths due to Rabies?

Asia, closely followed by Africa

3

What are the 2 rabies reservoirs?

Urban - domestic dogs - Africa, Asia, Latin America,

Sylvatic - wild animals (skunk, raccoons, bats) - Europe, N/S America, Asia

4

What does human outcome depend on? 3

Bite location
Severity
Serovar
Age
Immune status
Clinical onset may not be immediate

5

How common is rabies in children?

over 40% cases are in children (unknown why, perhaps less educated)

6

Outline rabies pathogenesis

Bite: slow multiplication of virus in muscle cells (incubation)
Rapid transport of virus genomes in nerve axons
Rapid virus spread within CNS
Massive virus replication in nerve cells
Transport in nerve axons to salivary glands and other peripheral organs

VIRUS EXCRETION AND EXPRESSION OF CLINICAL SIGNS

7

Clinical signs - dog rabies

FURIOUS FORM (30%): agitated, aggressive, difficulty swallowing, salivation, seizures - death, incoordination, paralysis, coma and death

DUMB FORM (70%): dropped jaw, bone in throat, incoordination, paralysis and death

8

Outline rabies in livestock

Incubation = 10-40 days
Morbidity = 3 days
Both variable
Death can occur per-acutely with no clinical signs
Manifests as furious form in 80% animals

CS: changes to behaviour, aggression, head butting, drooling, animals can be restless, depressed, head tremors, incoordination, paralysis

9

Define PEP

Post-exposure prophylaxis

10

How many rabies vaccination boosters should you hav?

Boost 1/2 years after primary vaccination. Subsequent boosters should be given at 3-5 year intervals.

11

Define RIG

Rabies immunoglobulin

12

What are the 2 types of RIG that can be used in humans

Human RIG (HRIG)
Equien RIG (ERIG)

As much of the RIG dose as anatomically feasible should be infiltrated in the area around the wound and the remaining volume is administered IM. RIG provides transiet protection during the period before vaccine-induced immunity is conferred (usually 1 week)

13

How can exposure to rabies be categorised?

CATEGORY 1 = touching or feeding animals licks on intact skin - NO Tx

CATEGORY 2 = nibbling of uncovered skin, minor scratches or abrasions without bleeding - Local treatment of wound and immediate vaccination

CATEGORY 3 - single or multiple transdermal bites or scratches, licks on broken skin, contamination of MM with saliva from licks, exposures to bats - local treatment of wound, immediate vaccination and administration of RIG.

14

Current limitations of RIG

short supply
high cost
difficulty in finding immune donors
batch-to-batch variation of polyclonal sera
risks related to use of blood products

15

What are possible alternatives to RIG?

serveral murine Abs

16

How are domestic animals vaccinated against rabies?

Inactivated virus + adjuvant (aluminium phosphate)
IM or SC with peak neutralising Ab titre reached by 4-6 weeks in dogs.

Single dose --> protective immunity:
Nobivac (Intervet): dog, cat, horse, cattle
Rabisin (Merial): dog, cat

Booster required: 1-3 years

17

Outline oral vaccination of dogs against rabies

Considered as a supplement to PN vaccination. Could be applied on a larger scale.

18

How can wildlife be vaccinated against rabies?

Oral vaccination - live attenuated vaccine within a bait (fishmeal).
SADB19, SAD p5/88 (attenuation mechanism unknown)
SAG2 (2 point mutations in the glycoprotein gene)
VRG (vaccinia recombinant expressing glycoprotein)

19

What are the 'rules of steck'? 3

Compartmentalisation of the contaminated area using natural and artificial barriers.

Repeat vaccination until rabies elimination is confirmed and to protect rabies-free areas.

Establish concerted plans of vaccination with neighboring countries - fly over border and drop baits on both sides.

20

Define ORV

Oral Rabies Vaccination

21

How did ORV affect fox rabies in W. Europe?

Within 25 years of introduction of ORV, fox rabies was eliminated in W. Europe.

22

Outline lyssavirus evolution

NEW WORLD: classical rabies virus, NO other lyssaviruses

OLD WORLD: lyssaviruses in bats, NO classical rabies virus

OVERALL: epidemiological confusion

23

Clinical presentation - EBLV-1 - bat rabies

Hydrophobia (?)
Fierce reaction to high frequencies
Prolonged very loud screaming
Uncontrolled wing beats
Strong biting and aggressive behaviour

24

When was rabies eradicated in the UK?

1902 with leash laws, muzzles and destruction of strays. Never became established in terrestial wildlife.
See occasional cases of imported human disease

25

How can rabies be diagnosed?

FAT and real time PCR - within 3 hours
Virus isolation - 2 days --> mice innoculation --> developed rabies in 9 days.
Immunohisopathology identification of rabies virus Ag in the medulla.

26

When was PETS introduced?

2000

27

Outline PETS from January 2012

Dogs, cats and ferrets
–No longer requirement for blood testing if vaccination certificate in order
–No requirement for quarantine where importation from unlisted ‘third countries’
–Instead, vaccination, blood tested 1 month later and a further 3 month wait in country of origin prior to entry
–Risk of illegal importation remains
•Spain+France 2013
–Loss of requirement for tick treatment-tapeworm treatment debated

28

How can wildlife rabies be controlled?

Provision of emergency vaccine stockpile
Ring vaccination (ORV)
Poisoning)

29

Is rabies a candidate for true eradication?

No due to the distribution and abundance of bats as reservoir hosts.

30

Define PHE

Public Health England

31

Define HPT

Health Protection Teams

32

Define CRCE

Centre for Radiation and Chemical Environmental Hazards

33

Define CCDC

Consultants in Communicable Disease Control

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