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Most likely exposure of rabies to humans in US
Most likely exposure of rabies to humans in developing countries
Rabies PEP consists of
- Course of rabies Ig and 4 doses of vaccine
- Given over a 2 wk period
- Costs $1000
Human Rabies Ig
- Manufactured by plasmaphoresis from immunized human volunteers
- Rarely stocked in developing country
- Provides rapid, passive immunity that has half life of ~ 3 wks
- Rabies vaccines elicit an active immune response beginning 7-10 days after vaccination
- RIG should always be given in a different syringe from the vaccine and at a different IM site
PEP for Non-immunized individuals
- Wound cleansing: With soap and water. If available, use virucidal agent such as povidine-iodine soln to irrigate wounds.
- RIG: Full dose should be infiltrated around any wound (s) and any remaining volume should be administered IM at anatomical site distant from vaccine administration. (RIG should NOT be administered in the same syringe as vaccine because RIG might partially suppress active production of Ab, no more than the recommended dose should be given.
- Vaccine: HDCV or PCECV 1.0 mL, IM (deltoid area) one each on days 0, 3, 7, and 14
PEP for Previously Immunized Individuals
- Wound cleansing (like for non-immunized)
- NO RIG SHOULD BE GIVEN
- Vaccine: HDCV or PCECV 11.0 mL, IM (deltoid area), one each on days 0 and 3.
Sin Nombre is what type of virus? What does it cause?
- Causes Hantavirus Pulmonary Syndrome
*Originally named Muerto Canyon Virus, then Four Corners Virus
How is Sin Nombre (Hantavirus) transmitted?
Aerosolization of rodent excreta
*Man are incidental hosts
Sin Nombre (Hantavirus) clinical presentation
- Acute interstitial nephritis
- Massive acute capillary leak syndrome
- Febrile Stage: 4-7 days
- Headache, abdominal and lower back pain, dizziness blurred vision
- Conjunctival injection and petechiae occur
- Erythematous flush that blanches on pressure on torso and face
Severe Clinical Shock: Hypotensive
Sin Nombre Tx
Ribavirin and supportive therapy (dialysis, plasma, whole blood, heparin NOT recommended for DIC)
Risk factors for exposure to Lymphocytic Choriomeningitis Virus
Aersols from rodent excreta, directe contact w/ rodents, rodent bites
Rodent infestation associated with substandard housing, cleaning rodent infected buildings, owing pet rodents that may be infected, and transplacental infection of the fetus in a pregnant woman
Approach to suspected case of Viral Hemorrhagic Fever
- Travel History
- Rural area
- Exposure within 3 weeks of onset (if they've been back for 6 months then you don't need to worry about this)
- Symptoms and Physical Signs
- Nonspecific: fever, headache, sore throat, myalgia, abdominal pain, diarrhea
- Supportive VHF diagnosis: pharyngitis, conjunctivitis, rash, hemorrhage and shock