EXPOSURE TREATMENT IN THOSE WHO HAVE RECEIVED PRE-EXPOSURE VACCINATIO

overcome by giving doses of vaccine on days 30 and 90. Summary of post-exposure, pmphylaxis - Minor exposure - including licks of the skin, scratches or abrasions, minor bites on covered areas of arms, trunks and legs: Unprovoked attack by cat or dog available for observation. Vaccine Stop treatment if animal remains remains healthy for 10 days. Stop treatment if animal's brain fluorescent antibody test proves negative. Administer serum if positive diagnosis, and complete course of vaccine Attack by wild animal or domestic dog or cat unavailable for observation Serum and vaccine. Major exposure - including licks of mucosa or major bites (multiple on face, head, fingers or neck). Unprovoked attack by cat or dog or attack by wild animal or domestic dog or cat unavailable for observation Serum and vaccine Stop treatment if domestic dog or cat remains healthy for 10 days Stop treatment if animal's brain fluorescent antibody test proves negative. Pre-exposure prophylaxis - Indications - Those exposed to mammals before or during quarantine in kennels, zoos or laboratories, those working with rabies virus, veterinary surgeons, explorers, naturalists and speleologists travelling to rabies-endemic areas. Vaccine - 1 ml IM or 0 1 ml intradermal on days 0, 7 and 28. Booster doses of 1 ml IM or 0.1 ml intradermal should be given every 2 years if continued protection is needed, but laboratory personnel working with rabies virus should receieve booster dose every G months. POST EXPOSURE TREATMENT IN THOSE WHO HAVE RECEIVED PRE-EXPOSURE VACCINATION - If a full pre-exposure course of HDCSV (or other established tissue culture vaccine) has been given, or if neutralising antibody, 0.5 N or more, has been demonstrated, passive immunization with RIG is not needed If the bite is severe or antibody tit re unknown, three doses of HDCSV 1ml IM are advised on days 0, 3 and 7. If bite is not severe, only two doses on days 0 and 3.Causes of death despite post-exposure vaccination: 1. Inadequate wound cleaning. 2. Delay in starting vaccine 3 Injections of vaccine into buttock. 4. Lack of passive immunization .5. Failure to infiltrate RIG around the wound. 6. Use of immunosuppressive drugs e.g. corticosteroids. 7. Impaired immune response e g cirrhosis. 11. DENGUE FEVER Etiology - Causutive agent - Group B arbovirus of which there are at least four antigenically overlapping strains Transmission - From man-to-man by Aedes aegypti mosquitoe Transmission may be kept up by reinfection of the local inhabitants who have lost the immunity acquired as result of previous attack, or by infection of visiting non-immunes. Dengue infections present clinically as three overlapping syndromes: 1. Undifferentiated fever - in young children. Mild febrile illness lasting 1-3 days, often with upper respiratory signs. 2. Dengue fever syndrome. Incubation period - 3 to 8 days Clinical features - STAGE OF INVASION - Sudden onset with malaise, severe headache, pain in eyeballs, intense pains in joints and muscles, and bodyache aggravated by movements (breakbone fever) Fever, maximum on first day. Flushed face, congestion of eyes and of mucous membranes, photophobia and sometimes nausea and vomiting. Primary rash consisting of transitory erythema on neck, face, and shoulders may occur at onset. STAGE OF REMISSION - On about the 3rd day, temperature drops to normal and remains so for 12 hours to 3 days. STAGE OF TERMINAL FEVER AND ERUPTION (i)