Saaxila Dhukkuba Saree maraattee, Wal-qunnamtii Bat, fi Ittisa Saaxila Booda (PEP) .¶

Dhukkubni saree maraattee dhukkuba vaayirasii encephalomyelitis cimaa fi guddachaa dhufe kan vaayirasii neurotropic gosa Lyssavirus jedhamuun dhufudha. Vaayirasichi sirna narvii giddugaleessaa erga seenee booda mallattoon niwurooloojikaalaa kilinikaa erga jalqabee booda dhukkubni kun dhibbeentaa 100n lubbuu namaa galaafata jechuun ni danda'ama. Haa ta’u malee, dhukkubni saree maraattees dhibbeentaa 100n kan ittifamuu danda’u yoo battalumatti madaa fiizikaalaa fi keemikaalaan faalama irraa qulqulleessuun yeroon isaa Post-Exposure Prophylaxis (PEP) waliin yoo walitti makamedha. Gogaa cabe irratti erga ciniinnaa, barruu ykn haxxiffannaa tuttuqqiin booda sa’aatii hunda booda foddaa murteessaa kan bakka bu’u yoo ta’u, kunis envelope vaayirasii fuula irratti argamu balleessuu fi osoo gara dhuma narvii naannootti hin seenin dura xixiqqoo vaayirasii niwutraalize ta’a.

Qajeelfamni kun pirootokoolii dirree fi daandii kilinikaa tartiiba tartiibaan qajeelfama Dhaabbata Fayyaa Addunyaa (WHO), Giddugala To’annoo fi Ittisa Dhukkubaa Yunaayitid Isteetis (CDC), Ejensii Nageenya Fayyaa UK (UKHSA), fi Federeeshinii Waldaalee Fannoo Diimaa fi Ji’a Diimaa Idil-addunyaa (IFRC) irraa argame waliin walsimu ni kenna. Biyya alaatti saree karaa irraa maqeen kan ciniinamte, foon bosona nyaatu kan si ciniiname yoo ta’e, kutaa kee keessaa battee argachuuf dammaqxee yoo ta’e, tarkaanfiiwwan kana hordofuun battalumatti lubbuu namaa baraara.

Amma kana godhi¶

Yoo ati ykn namni naannoo kee jiru gogaa cabe ykn mucous membranes irratti hoosistuu bosona, battee, ykn bineensa manaa hin talaalamne ykn karaa irraa maqe kamiinuu ciniiname, kan barreeffame ykn arraabame:

1. Gara nageenyaa socho'uu fi bineensicha harka qullaa osoo hin tuqin adda baasuu: Balbala, dallaa ykn konkolaataa jabaa hatattamaan duubatti tarkaanfadhu. Bineensonni dhukkuba kanaan qabaman sodaa uumamaa isaanii waan dhabaniif, irra deddeebi’anii waan haleelaniif, hoosistuu maraattee qabaachuu danda’u qabachuu, kornee ykn rukutuuf gonkumaa hin yaalin. Yoo batteen kutaa namni kamiyyuu rafe keessa jiraate, qondaalli to'annoo bineensotaa tishuu sammuu isaa dhukkuba saree maraattee qorachuu akka danda'aniif balbala keessaa fi foddaa hunda cufuun battee kutaa sana keessaa kiyyootti galchuu danda'a.
2. Dura dhiiguu lubbuu namaa balaa irra buusu to'adhaa: Yoo ciniinnaa gadi fagoon dhiiga dhangalaasu ykn walitti fufiinsaan dhangala'aa jiraate, huccuu qulqulluu ykn gaazii sterile madaa irratti jabeessanii dhiibaa. Lakkoofsa balaa tasaa naannoo keessanii bilbilaa (Ameerikaa fi Kanaadaatti 911, guutuu Gamtaa Awurooppaa keessatti 112, Yunaayitid Kingidam keessatti 999) ykn keenya mariisisaa lakkoofsa balaa tasaa daayirektarii battalumatti yoo dhiigni cimaa ta’e, yoo ciniiname mataa ykn qoonqoo hirmaachise, ykn namni sun mallattoo yoo agarsiise rifachuudha.
3. Madaa sana saamunaa fi bishaan yaa’aatiin walitti fufiinsaan daqiiqaa 15 guutuu dhiqachuu: Gogaa ciniiname, barruu, ykn haxxiffannaaf saaxilame kallattiin bishaan boollaa yaa’u jala kaa’i. Saamunaa mana dhugaatii idilee, saamunaa harkaa dhangala’aa, ykn saamunaan mi’a nyaataatiin daqiiqaa 15 guutuu sa’aatii irratti yeroo murtaa’eef sirriitti foolii godhi. Saamunaa envelope cooma alaa dadhaboo vaayirasii dhukkuba saree maraattee kan balleessu yoo ta'u, hospitaala osoo hin ga'iin dura carraa lubbuun jiraachuu vaayirasichaa dhibbeentaa 50 ol hir'isa.
4. Falmaata farra vaayirasii ajjeesuutiin jallisii: Daqiiqaa 15f bishaan saamunaa fi bishaan dhiqachuu erga xumurtee booda, bishaan qulqulluudhaan dhangala’aa saamunaa hunda dhiqachuun povidone-iodine (dhibbeentaa 1 hanga dhibbeentaa 10 bishaan keessaa), dhibbeentaa 70 isopropyl ykn ethyl alcohol, ykn chlorhexidine gluconate dibadhu. Yoo haxxiffannaan ija, hidhii ykn afaanitti dhangala’e, bishaan qulqulluu ykn soogidda idileetiin daqiiqaa 15f saamunaa malee, dafqa sana dhiqadhu.
5. Madaa sana gaazii sterile ta’een laaftuudhaan haguuggii: Yeroo geejjibaa xurii irraa akka eeguuf paadiin gaazii qulqulluu fi goggogaa bakka sana irratti laafaan kaa’i. Madaa ciniinnaa teeppii qilxuu, kolaa gogaa, ykn baandaajii cimaatiin cufame gonkumaa hin cufinaa, sababiin isaas madaa cufuun xiyyaarota tishuu oksijiinii xiqqaa qaban keessaa xixiqqoo vaayirasii fi baakteeriyaa afaanii gadi fagoo kiyyootti galcha.
6. Guyyaadhuma sanatti kutaa balaa tasaa hospitaalaa deemuun Post-Exposure Prophylaxis (PEP): Rabies Immune Globulin (HRIG) kallattiin madaa keessaa fi naannoo isaa seenee fi Day 0 intramuscular rabies vaccine dose keessan argachuuf hatattamaan kunuunsa yaalaa hatattamaa barbaadaa. Wal-qunnamtii kana aangawoota fayyaa hawaasaa naannoo ykn to’annoo bineensotaatti gabaasuu akka bineensichi qorannoo laabraatooriitiif nagaan qabamuu danda’u ykn tursiisa hordoffii dirqama guyyoota 10 jala galfamuu danda’a.

Muka murtii hatattamaa saaxilamummaa dhukkuba saree maraattee fi bat triage¶

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    ContactType -->|Touching animal or lick on unbroken intact skin| Cat1["WHO Category I: Saaxila Hin Qabu<br/>Gogaa bishaanii fi saamunaadhaan sirriitti dhiqachuu<br/>Talaalliin dhukkuba saree maraattee ykn immune globulin hin barbaachisu"]

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    Vector -->|Stray, Feral, Unvaccinated, or Escaped Dog/Cat/Ferret| StrayDom["Beeylada Manaa Hin Mirkanoofne: Hospitaala Hatattamaa PEP<br/>Talaallii HRIG + Guyyaa 0ffaa Hatattamaan kennuu<br/>Ibsa bineensotaa fayyaa hawaasaa naannootti gabaasuu"]

    Vector -->|Healthy, Captured Domestic Dog, Cat, or Ferret| ObsDom["Bineensa Manaa Kan Mirkanaa’uu Danda’u: Kunuunsa Yaalaa + Turtii Guyyaa 10<br/>Madaa baakteeriyaa fi teetanasiin wal’aanuu; yoo bineensi fayyaa ta’e PEP qabachuu<br/>Yoo bineensi manaa guyyaa 10 keessatti dhukkuba agarsiise ykn du’e hatattamaan PEP guutuu jalqabuu"]

    Vector -->|Squirrel, Mouse, Rat, Hamster, Guinea Pig, Rabbit| LowRisk["Balaa Xiqqaa Lagomorph/Rodent<br/>Rabies PEP yeroo muraasa kan barbaachisu yoo bineensi osoo hin kakaasne/neurologic hojjete malee<br/>Madaa teetanasii fi infekshinii baakteeriyaa madaaluu"]

Makaaniksii vaayirasii: maaliif saamunaa daqiiqaa 15f dhiqachuun lubbuu namaa baraara¶

Bineensi dhukkuba kanaan qabame tokko yeroo ciniinuu ykn xuuxu, haxxiffannaa xixiqqoo Lyssavirus fe'ame gara cooma gogaa jalaa, gogaa fi tishuu maashaa lafee keessatti kuufama. Sa’aatii muraasa jalqabaa keessatti madaa keessatti maaltu akka ta’u hubachuun, gargaarsi jalqabaa sinqiitti akkuma qoricha hospitaala keessatti kennamu maaliif barbaachisaa akka ta’e ibsa.

Akkaataa saamunaa vaayirasii dhukkuba saree maraattee tuttuqaa irratti balleessu¶

Vaayirasiin dhukkuba saree maraattee boca rasaasaa kan qabu, vaayirasii RNA hidda tokko kan qabuu fi envelope lipoprotein (fat) kan keessummeessituu irraa argamu micciiramaa ta'een marfameedha. Alaa meembraanii coomaa kanaa irratti kan uwwifaman ispiikeewwan gilaayikoopirootiinii (pirootinoonni G) dha. Vaayirasichi seelii maashaa namaa fi molakiyuulota walitti hidhamiinsa seelii niwuroonii bakka walqunnamtii niwuroo maashaalee irratti argaman irratti fudhatoota nikootiinii aseetiilkooliin adda baasuu fi walitti hidhamuuf ispiikeewwan gubbaa kana irratti hirkata.

1. Mechanical flushing removes bulk saliva: Bishaan tubaa daqiiqaa 15f gara qaawwa madaa sanaatti qajeelchee yaa'uun vaayirasichi fudhatoota tishuutti osoo hin maxxanin dura qaamaan vaayirasii bilisaa, dhiiga dhangala'ee fi caccabaa alagaa dhiqa.
2. Amphiphilic lipid dissolution: Saamunaa manaa idilee fi saamunaan mi’a nyaataa molakiyuulota amphiphilic surfactant mataa bishaan jaallatuu fi funyaan cooma jaallatu of keessaa qaba. Yeroo daqiiqaa 15f madaa ciniiname sanatti foolii saamunaa badhaadhaa ta'e hojjettu, funyaan cooma jaallatu kallattiin envelope lipoprotein vaayirasii keessa of seenu.
3. Complete structural collapse: Bishaan micelles saamunaa yeroo dhiqatu, meembraaniin lipidii vaayirasii ni ciccirama. Envelope lipid alaa fi glycoprotein spikes isaa malee, wiirtuun vaayirasii qullaa seelii maashaatti hidhamuu ykn aksoonii narvii seenuu hin danda'u. Dhaabbataan akka hin daddarbine taasifama.
4. Keemikaalaan ayoodinii ykn alkooliin hojiirra oolchuu: Daqiiqaa 15f saamunaa bishaan povidone-iodine ykn alkoolii dhibbeentaa 70n dhiqachuu hordofuun pirootiinota fuula irraa hafan kamiyyuu tishuu namaa fayya qabeessa madaa fayyisuuf barbaachisu osoo hin gubin denature godha.

Tarree sakatta’iinsa faalama dirree tartiibaan¶

• Ifa cimaa jalatti fuula qaamaa hunda sakatta’i: Miidhaamtoonni hedduun mallattoo ciniinnaa isa guddaa irratti xiyyeeffachuun barruu cirrachaa xixiqqoo ykn cirracha haxxiffannaa faalame naannoo isaanii jiru ni darbu. Cabbiin gogaa tokko tokko hundi dhiqamuu fi boodarra immune globulin jedhamutti seenuu qaba.
• Ringii, sa’aatii, fi uffata dhiphaa balleessi: Uffata sleeve ykn pant kan haxxiffannaa bineensotaatiin jiidhe irraa muraa (uffata faalame guwaantiidhaan qabadhuu bishaan ho’aa keessatti saamunaan dhiqadhu). Dhiita’uun osoo hin jalqabin battalumatti ringii qubaa baasuu.
• Bishaan yaa’u baay’ee fayyadamuu: Madaa sana daqiiqaa 15 walitti fufiinsaan dhiibbaa giddu galeessaan faucet ykn shower nozzle jalatti qabadhu. Bakka lafa onaa fagoo kan pilaanii hin qabne keessatti, siriinjii jallisii mililiitira 20 hanga mililiitira 50 (ykn qaruuraa bishaanii pilaastikii qulqulluu kan boolla xiqqaa kophee isaa keessatti bocame) fayyadamuun bishaan dhugaatii dhiibbaa dhaabbataa qabu gadi fageenyaan gara tiraaktii bocameetti dhangalaasaa.
• Buruushiin xuuxuu jabaa malee suuta dhiqachuu: Quba qulqulluu ykn gaazii lallaafaadhaan madaa sanatti suudii saamunaa hojjedhu. Keessa madaa raw puncture brushes cimdii naayiloonii jabaa ta’een hin dhiqatinaa; aggressive scrubbing dhuma narvii naannoo saaxilame miidhuu fi vaayirasiin gara fiber narviitti akka seenu haala mijeessa.
• Ija, hidhii fi afaan bishaan ykn soogidda qofaan dhiqachuu: Bineensi tokko yoo boo’e, haxxiffate, ykn haxxiffannaa ija, qaawwa hidhii ykn afaan keessanitti raasee, bishaan qulqulluu ho’aa ykn soogidda idilee dhibbeentaa 0.9 kan sterile ta’e fayyadamuun daqiiqaa 15f mucous membranes sana walitti fufiinsaan dhiqadhaa. Gonkumaa saamunaa ykn alkoolii ija keessa hin galchinaa.

Kuusaawwan dhukkuba saree maraattee addunyaa fi tartiiba balaa bineensotaa¶

Hoosiftoonni dhiiga ho’aa qaban kamiyyuu dhukkuba saree maraattee qabamuu kan danda’an yoo ta’u, gosoota foon nyaataniifi battee adda ta’an qofatu uumamaan marsaa vaayirasii itti fufiinsa qabu eega. Epidemiology naannoo fi piroofaayilii sanyii beekuun siifi hakiimni kee balaa sirritti madaaluuf gargaara.

Pirootokooliin bat encounter hatattamaa: maaliif ciniinnaa ijaan hin mul'anne nama ajjeesa¶

Biyyoota saroonni manaa yeroo hunda talaalamanii (kan akka Ameerikaa, Kaanaadaa fi guutuu Awurooppaa) keessatti, du’a dhukkuba saree maraattee namaa naannootti argamu keessaa harka caalu maaykiroobaatonni ilbiisota nyaatan itti gaafatamummaa qabu. Dhukkubsattoota dhukkuba saree maraattee bat-variant rabies'n du'an keessaa walakkaa ol ta'an ciniinamuu isaanii yaadannoo hin qaban.

Maaliif ciniinnaa battee guutummaatti osoo hin mul'atin hafa¶

Saroota ykn raakoon kanneen ciccituu dhukkubsataa ta’an irraa adda ta’ee, qamalee xixiqqoo ilbiisota nyaatan (kan akka battee rifeensa meetii qabu Lasionycteris noctivagans ykn battee halluu sadii qabu Perimyotis subflavus) ulfaatina giraama 10 hanga 15 (auunsii 0.35 hanga 0.5) gadi kan qabaniifi qamalee qara qabu, kan konikii qabu ilkaan dheerinni isaanii milimeetira 1 hanga 2 (inchii 0.04 hanga 0.08) qofa ta’e.

• Maayikiroo-punctures dhukkubbii hin qabne: Bat yeroo gabaabaaf harka qullaa, qoonqoo ykn fuula nama rafe irratti bu'u, nama sagaleedhaan rafu osoo hin dammaqsin nip ittisaa kan epidermis keessa seenee gara dermis keessa seenu kennuu danda'a.
• Hanga ganamaatti mallattoon mul'atu hin jiru: Bocaan sun maaykirooskoopii waan ta'eef dhiigni kaappilaarii xiqqaa ykn hin jiru, akkasumas ciccitiin gogaa xiqqaan sa'aatii muraasa keessatti guutummaatti cufama. Borumtaa isaa ganama daawwitii keessatti of sakatta'uun gogaa qulqulluu arguun mirkaneessa zeeroo ciniinnaan akka hin uumamne kenna.

Seenaariyoota fayyaa hawaasaa dirqamaa qorannoo battee ykn PEP barbaadan¶

Dhaabbileen fayyaa hawaasaa (CDC US, Ejensii Fayyaa Hawaasaa Kanaadaa, fi UKHSA dabalatee) haalawwan armaan gadii saaxila dhukkuba saree maraattee jedhamee tilmaamamu jechuun ramadu, yookaan qorannoo sammuu hatattamaa battee qabame yookaan hatattamaan jalqabuu guutuu Category III PEP nama saaxilame hundaaf:

1. Direct physical contact: You felt a bat brush against your bare skin, land on your body, get tangled in your hair, or scratch you while awake, even if you see no puncture mark afterward.
2. Waking up with a bat in the room: You wake up from sleep (even a brief daytime nap) and discover a live or dead bat inside the room.
3. Bat in a room with an unattended child: You find a bat in a room with an infant, toddler, or young child who cannot reliably explain whether the bat touched them.
4. Bat in a room with an incapacitated adult: You find a bat in a room with someone who has a cognitive disability, dementia, sensory neuropathy, or was heavily intoxicated by alcohol, sedatives, or sleep medication.

How to safely capture and contain a bat inside your home¶

Yoo battee tokko kutaa ciisichaa ykn bakka jireenyaa bakka saaxilamummaan namaa itti uumamuu danda'u keessa argame, kan dursa kennitu (ijoollee fi bineensota manaa kutaa keessaa erga sochooftee booda) battee harka qullaa osoo hin tuqin fi mataa isaa osoo hin caccabsin qabachuudha, kanaaf laaboraatooriiwwan fayyaa hawaasaa qorannoo Direct Fluorescent Antibody (DFA) tissue sammuu isaa irratti raawwachuu danda'u. Yoo mana yaalaa sa’aatii 24 hanga 48 keessatti battee dhukkuba saree maraatteef negaatiivii ta’uu mirkaneesse, namni mana keessaa tokkollee talaallii PEP walduraa duubaan fudhachuu hin barbaachisu.

1. Kutaa adda baasuu: Namootaa fi bineensota manaa hunda suuta kutaa keessaa baasuu. Balbala kutaa ciisichaa cufi, qaawwa balbalaa jalaa irratti haalluu guuti, akkasumas foddaa hunda cufamee akka battee ala miliquu hin dandeenyeef qabadhu.
2. Irra deebitee seenuu kee dura gear up: guwaantii hojii gogaa furdaa (guwaantii yaalaa laateeksii ykn naayitiraayil gonkumaa haphii hin qabne, kan ilkaan battee salphaatti bocu), harka dheeraa, paantii dheeraa, fi kophee ykn hoodie uffadhu.
3. Hanga batteen lafa bu'u eegaa: Broom, racket teenis, ykn kophee bat balali'u irratti hin lulluufatinaa. Bat rukutuun mataa isaa isa xiqqaa caccabsee ijaarsa sammuu qorannoo dhukkuba saree maraattee laabraatoorii keessatti barbaachisu balleessa. Ifa kutaa sanaa qabsiisiitii hamma batteen sun dadhabee dallaa, golgaa ykn lafa irratti bu’utti daqiiqaa 5 hanga 15 callistee eegi.
4. Kiyyoo saanduqa-fi-kaartoonii raawwadhu:
5. Meeshaa kuusaa pilaastikii jabaa, qaruuraa bunaa ykn saanduqa kophee jabaa harka tokkoon harka guwaantii qabuun, harka kaaniin immoo kaartoonii jabaa diriiraa qabattee suuta jettee battee boqonnaa itti dhihaadhu.
6. Afaan banaa meeshaa sanaa battee irratti squarely dallaa ykn lafa irratti kaa’i.
7. Suuta jettee kaartoonii diriiraa dallaa fi banaa meeshaa gidduutti siqsiisi, hamma banaan sun guutummaatti haguugamutti miila battee kaartoonii irratti suuta dhidhiiti.
8. Yeroo meeshaa sana dallaa irraa harkiftu kaartoonii sana qarqara isaa irratti jabeessitee qabi, sana booda kaartoonii sana teeppiidhaan qabadhu (ykn golgaa meeshaa sanaa cicciri) karaa hundumaa naannoo isaa sirriitti cufi.
9. Boolla qilleensaa xixiqqoo muraasa (milimeetira 2 / inchii 0.08 ol xiqqaa akka batteen hin micciirree; batteen qaawwa hanga miliimeetira 6 / inchii 0.25 dhiphoo ta’e keessaa micciiruun ni danda’ama) yoo batti lubbuun jiraate fiixee qalamaa fayyadamuun rukudhu.
10. Nageenyaan kuusuu fi hatattamaan aangawoota bilbiluu: Meeshaa cufame bakka tasgabbaa’aa fi gaaddidduu qabu daa’immanii fi bineensota manaa irraa fagaatee kaa’i. Yoo battee duraan du'e, guwaantii gogaa ykn tong fayyadamuun boorsaa pilaastikii cufame keessa meeshaa jabaa keessa kaa'uu fi firijii keessa kaa'uu ice pack irratti (jabaa hin qabbaneessinaa), sababiin isaas qorraan tishuu sammuu maaykirooskoopiif waan miidhuuf. Waajjira to’annoo beeyladaa naannoo keessanii ykn kutaa fayyaa hawaasaa hatattamaan bilbilaa fudhachuu fi qorannoo ariifachiisaa.

Paatofiiziyoloojii fi sadarkaa kilinikaa dhukkuba saree maraattee nama irratti¶

Vaayirasiin dhukkuba saree maraattee qaama namaa keessa akkamitti akka guddatu hubachuun, wal’aansi saaxilamummaa boodaa yeroo foddaa inkuubeshiniitti maaliif akka hojjetuu fi kutaalee qaamaa adda ta’an irratti ciniinuun maaliif kunuunsa hatattamaa akka barbaadu ifa godha.

Vaayirasiin kun madaa irraa gara sammuutti akkamitti akka imalu¶

1. Marsaa 1ffaa: Maashaalee naannoo (Local muscular replication) (Sa'aatii hanga Torban): Erga ciniinnaa ykn cirracha seenee booda vaayirasiin dhukkuba saree maraattee dhiiga keessa hin seenu. Kanaa mannaa, paartiikiliin vaayirasii tishuu madaa naannoo sana keessa hafee, fudhatoota nikootiinii aseetiilkooliinii fiber maashaa lafee irratti argamanitti hidhamee, bakka talaallii sanatti callisanii baay’atu. Foddaan mana jireenyaa naannoo kun yeroo saamunaa dhiqachuu fi rabies Immune Globulin (HRIG) lilmoodhaan vaayirasicha addaan kutuu fi balleessuu danda'uudha.
2. Marsaa 2ffaa: Seensa walqunnamtii niwuroo maashaalee fi geejjibni aksoonii duubatti deebi’uu (Guyyaa hanga Ji’aatti): Fiiber maashaa irraa vaayirasichi walqunnamtii niwuroo maashaa qaxxaamuree gara xumura narvii naannoo mootoraa ykn miiraa seena. Vaayirasichi erga aksoonii narvii keessa seenee booda farra qaama naannootti naanna’u irraa gaachana ta’a. Sirna geejjibaa pirootiinii mootoraa daayineen keessoo niwuroonichaa irratti yaabbannoo kan rukutu yoo ta’u, gara gaangilii hundee dugda dugda lafee dugdaatti fi hundee sammuutti saffisa tilmaamaan guyyaatti miliimeetira 12 hanga 100 (inchii 0.5 hanga 4) duubatti deebi’a.
3. Marsaa 3ffaa: Sirna narvii giddu galeessaa guddisuu (Guyyoota): Vaayirasichi erga lafee dugdaa fi sammuu bira ga’ee booda, walqunnamtii sinaaptikii qaxxaamuree niwuroonii irraa gara niwuroonitti saffisaan babal’atee, jeequmsi niwurootiraansimiiteroota hamaa fida.
4. Marsaa 4ffaa: Centrifugal spread to salivary glands and organs: Sammuu dhukkuba kanaan qabame irraa vaayirasichi narvii autonomic fi cranial nerves gara alaatti imaluun gara alaatti imaluun gara ujummoolee haxxiffannaa (bakka inni haxxiffannaa keessatti dhangala'u), cornea, follicles hair follicles at the nape of the neck, heart, and adrenal glands.

Qabxiilee yeroo inkuubeshinii fi guddina kilinikaa¶

Giddugaleessaan yeroon inkuubeshinii ciniinnaa irraa kaasee hanga mallattoon mul’atutti guyyoota 20 hanga 90 (ji’a 1 hanga 3) yoo ta’u, dhimmoonni galmaa’an guyyoota 4 hanga waggaa 1 ol ta’us. Ciniinaan fuula, gogaa mataa, ykn qoonqoo (hidda sammuutti dhihoo) ykn quba quba kan innervated baay'ee qabu irratti yeroo inkuubeshinii gabaabaa (yeroo tokko tokko guyyoota 10 gadi) qaba.

Yoo hin yaalamne, dhukkubni saree maraattee kilinikaa guyyoota 5 hanga 14 keessatti onnee fi sirna hargansuu lubbuu namaa galaafatu dura sadarkaa sadiitti mul’ata:

• Sadarkaa prodromal (guyyoota 2 hanga 10): Ho’a qaamaa infuleenzaa fakkaatu, mataa dhukkubbii, malaise, fi yaaddoo, dhukkubsattoota dhibbeentaa 50 hanga 80 irratti neuropathic paresthesia at the healed bite place (gubachuu, ququnca’uu, tingling, ykn throbbing pain radiating from the durii madaa) wajjin kan deemudha.
• Sadarkaa niwurooloojikaalaa cimaa (guyyoota 2 hanga 7): Akka Furious Rabies (dhibbeentaa 80) jeequmsa, hallucinations, autonomic instability, hypersalivation, hydrophobia (yeroo bishaan liqimsuuf yaalnu dhukkubbii pharyngeal spasms), fi aerophobia (spasms qilleensa qilleensaatiin kaka’u), yookaan akka Paralytic ta’ee dhiyaata Dhukkuba saree maraattee (dhibbeentaa 20) kan qaama ciniiname irraa eegalee gara laamsha’uu sirna hargansuutti ol ba’uu (ascending flaccid paralysis) waliin.
• Koomaa fi du'a: Saffisaan gara komaa, dhiita'uu sammuu, fi onneen dhaabachuutti guddachuu.

Gosoota Saaxilamummaa WHO fi Ittisa Saaxila Boodaa Ammayyaa (PEP) .¶

Yeroo kutaa balaa tasaa geessan, ogeeyyiin fayyaa sirna ramaddii sadarkaa sadii Dhaabbata Fayyaa Addunyaa fayyadamuun sirna yaalaa sirrii barbaachisu murteessa.

*Hub: "Namni kanaan dura talaallii fudhate" talaallii saree maraattee aadaa seelii ammayyaa ykn hanqaaquu miciree fayyadamuun, ykn yoo xiqqaate 0.5 IU/mL titer farra qaama niwutraaliziingii galmaa'e fayyadamuun PrEP ykn PEP series duraan xumuruu isaa galmeessee jira.

Qaama 1ffaa: Rabies Immune Globulin (HRIG / ERIG) Guyyaa 0ffaa¶

Because your immune system takes 7 to 14 days after your first vaccine shot to produce its own protective antibodies, Rabies Immune Globulin (RIG) bridges that two-week gap by providing immediate passive antibodies at the wound site on Day 0.

1. Weight-based dosing: Human Rabies Immune Globulin (HRIG) is dosed at 20 International Units per kilogram (20 IU/kg) for adults and children (Equine RIG is dosed at 40 IU/kg). Never exceed the calculated dose, as excess RIG suppresses active vaccine response.
2. Anatomical wound infiltration: Under current WHO and CDC guidelines, as much of the calculated HRIG dose as anatomically feasible must be infiltrated directly into the depth and around the edges of every single bite wound or scratch. Local infiltration neutralizes virus particles inside the tissue before they enter nerve axons. Any remaining volume that cannot fit into a tight anatomical space (such as a fingertip, where clinicians avoid excess pressure to prevent compartment syndrome) is injected intramuscularly at a site anatomically distant from the vaccine site.
3. The 7-day HRIG cutoff and syringe separation: If HRIG is unavailable on Day 0, it can and must still be administered up to and including Day 7 after the first vaccine dose (after Day 7, active vaccine antibodies are present). Never mix HRIG and vaccine in the same syringe or inject them into the same muscle.

Component 2: Modern Cell-Culture Rabies Vaccine Schedule¶

Modern vaccines, including Human Diploid Cell Vaccine (HDCV) and Purified Chick Embryo Cell Vaccine (PCECV), are safe intramuscular injections.

• Injection site rule (Deltoid or Thigh only): Inject intramuscularly into the deltoid muscle of the upper arm in adults and older children, or the anterolateral thigh in young children under age 2. Never inject rabies vaccine into the gluteal (buttock) area, where fat tissue causes poor absorption and vaccine failure.
• Standard 4-Dose Regimen (Healthy Unvaccinated Patients): Given on Day 0, Day 3, Day 7, and Day 14 (where Day 0 is the day of the first dose).
• 5-Dose Regimen (Immunocompromised Patients): Patients with HIV, organ transplants, chemotherapy, or high-dose steroids receive a fifth dose on Day 28 (Days 0, 3, 7, 14, and 28) plus antibody titer verification.
• 2-Dose Regimen (Previously Vaccinated Patients): Receive only two intramuscular booster doses on Day 0 and Day 3, with zero HRIG.
• Pregnancy and infancy: Pregnancy, breastfeeding, and infancy are never contraindications to rabies PEP.

The 10-day domestic animal observation rule and travel precautions¶

In domestic dogs, cats, and ferrets only, virological studies prove that if the rabies virus has reached the animal's saliva, the animal will inevitably show unmistakable neurological illness or die within 3 to 7 days (always under 10 days).

• When 10-day observation applies: If a healthy, identifiable pet dog, cat, or ferret bites you in a low-risk area and is securely confined for a 10-day observation period, you can defer starting PEP while the pet is monitored daily (unless the bite is to the head or neck from a suspicious animal). If the pet remains completely healthy on Day 10, it could not have shed rabies virus when it bit you, and no PEP is needed. If the pet becomes ill, dies, or escapes during the 10 days, start full HRIG and vaccine immediately.
• Never observe wild animals: The 10-day observation rule never applies to wild mammals or wolf-dog hybrids, which must be euthanized immediately for DFA brain testing or trigger immediate human PEP.
• If bitten while traveling abroad: Wash the wound with soap and water for 15 minutes immediately, insist on a modern cell-culture vaccine (HDCV, PCECV, or PVRV) in the deltoid, and if the local clinic lacks HRIG, get your Day 0 vaccine immediately and travel within 7 days to a major center or home country to receive your HRIG infiltration. Photograph all vaccine vials and lot numbers, leave puncture wounds open to drain, obtain prophylactic amoxicillin-clavulanate for deep or cat/hand bites (see our animal bites guide), and update your tetanus booster if your last dose was more than 5 years ago.

Gaaffiiwwan yeroo baay’ee gaafataman¶

This guide is for informational purposes and does not replace professional medical evaluation or hands-on training. We recommend taking an accredited first aid and CPR course through the International Federation of Red Cross and Red Crescent Societies (IFRC), your national Red Cross society, St John Ambulance, or a certified local training provider.

Maddoonni sakatta'aniiru¶

• World Health Organization (WHO): WHO Expert Consultation on Rabies, Third Report (WHO Technical Report Series, No. 1012) and Rabies Vaccines: WHO Position Paper.
• Centers for Disease Control and Prevention (CDC, United States): Human Rabies Prevention, Recommendations of the Advisory Committee on Immunization Practices (ACIP) and Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies.
• UK Health Security Agency (UKHSA, United Kingdom): Guidelines on Managing Rabies Post-Exposure Prophylaxis (Green Book Chapter 27: Rabies).
• Infectious Diseases Society of America (IDSA, United States): Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections.

Qajeelfamoota walqabatan¶

• Animal bites: dog bites, cat bites, and wound infection care
• Deep puncture wounds, stepping on a nail, and tetanus prevention
• Ciccituu, cirracha, fi kunuunsa madaa xixiqqoo
• To’annoo dhiiguu cimaa fi turniquets
• Lakkoofsa yeroo muddamaa biyyaan