Rabies MCQ

D, there have been rare cases including post corneal transplant from a patient that was unknown to have died from rabies passing on the disease.
Pre-exposure prophylaxis only primes the immune system it will not prevent the disease completely hence the need for post-exposure prophylaxis
The death rate is highest in children with 40% under the age of 15 years.
Only Rabipur and Verolab have been approved by the WHO for this route

D, all the above. Dogs are responsible for 99% of cases and rabies affects mainly the poor rural communities in Asia and Africa, although it can occur in any country in the world. In fact, if you were in America then the predominant cause of rabies would be from he bat.

B, half the dose is usually infiltrated into the wound and the other half is given intramuscularly at another site. 

There is also horse immunoglobulin and this is more widely available but has a higher risk or serum sickness. Typical recommendations when giving post-exposure prophylaxis state that immunoglobulin can be given within 7 days of starting the vaccine. However, if you had a new possible case present even up to a year later then you would give the vaccine and the immunoglobulin if recommended. The immunoglobulin should always be given IM.

A. There are lower antibody titres but long term outcomes are not affected. WHO recommends day 0 and 3 for post exposure prophylaxis either ID or IM in the fully-immunised, an alternative regimen would be the “4-site” intradermal. This consists of 4 injections of 0.1ml equally distributed over left and right deltoids, thigh or supra scapular areas during a single visit.

B. It is an inactivated vaccine, usually from the Wistar rabies strain. The only polysaccharide vaccines are pneumococcal, meingicocal and salmonella Typhi. The vaccine is safe in children, pregnancy and breast feeding.

C, It does not cause ulceration, nor do the other vaccines.

B, Lengthening the intervals between vaccine is okay, shortening them is not. Answer B is the safest and most pragmatic. 

A. The illness usually begins within 2 weeks  to 2 months of the initial exposure but, exceptionally, may not appear for a year (rarely, 19 years after the initial incident).

Rabies usually starts fairly abruptly with fever, anxiety, insomnia and behavioural changes, notably agitation. Paraesthaesia, pain and intense itching at the site of the bite are also features. Two-thirds of the cases go on to exhibit hydrophobia and delirium (furious rabies). One-third goes on to ‘paralytic’ rabies with an ascending sensori-motor neuropathy, cranial nerve palsies and marked personality/behavioural changes.

The ANS is not spared. Profuse salivation (‘froth at the mouth’) and excessive sweating mark both the furious and paralytic forms.

Rabies virus travels in nerve axons to the brain and spinal cord. This means that the quickest deaths will occur in bites to the head or neck with large inoculums of virus. Such a scenario is more likely in children than in adults. Early institution of treatment including injection of rabies immune globulin into the site of the bite is essential.

Intensive care and the administration of a cocktail of antiviral drugs have been reported to have saved some patients with bat-rabies. However any form of clinical rabies is a virtual death sentence. Recovery is extraordinarily rare.

B. Rabies is a viral zoonosis that is transmissible to humans. The virus can be readily transmitted by direct inoculation or by sometimes by aerosol inhalation. Speleologists (cave explorers) are especially liable to pick up the virus from infected bats in this way. Bat rabies is regularly reported from the US and Australia. Rabies virus is a rhabdovirus, belonging to the genus lyssavirus. Paralytic rabies is far more likely to appear in cats than in dogs.

B. Mass vaccination programs have proven the most cost effective. By vaccinating 70% of dogs actually breaks the transmission cycle.