RISK FACTORS
For exposure to rabies:
β’ Professions or activities that may expose a person to
wild or domestic animals, e.g., animal handlers, some
lab workers, veterinarians, spelunkers (cave explorers)
β’ International travel to countries where
RISK FACTORS
For exposure to rabies:
β’ Professions or activities that may expose a person to wild or domestic animals, e.g., animal handlers, some
lab workers, veterinarians, spelunkers (cave explorers)
β’ International travel to countries where canine rabies is endemic (most common risk factor)
β’ In the United States, most cases appear due to exposure to bats
GENERAL MEASURES
. Since there is no treatment for clinical rabies, this section is directed at prevention of disease following
exposure to potentially rabid animals
. Persons who observe abnormal behavior in any wildlife species should contact animal control or animal rescue agencies and should avoid approaching or handling these animals
. Physicians should evaluate each possible exposure to rabies and consult with local or state public health
officials about the need for rabies prophylaxis
. In the United States, raccoons, skunks, bats, foxes, coyotes are the animals most likely to be infected, but
any carnivore can carry the disease
. Postexposure prophylaxis should be considered for any person who reports direct contact with bats, unless it is known that an exposure did not occur.
. Outside the United States, dogs are a main reservoir especially in developing countries
. Before specific antirabies treatment is initiated, consider:
Types of exposure (bite or non-bite), epidemiology of rabies in involved species, circumstances of biting
incident and vaccination status of exposing animal
ACTIVITY As tolerated
DIET No restrictions
PATIENT EDUCATION
. Avoid wild and unknown domestic animals
. Seek treatment promptly if bitten
. Thorough wound cleansing with soap is first line of treatment
. Pre-exposure vaccination if at risk of inapparent or unrecognized exposure to rabies inside or outside the
United States
DRUG(S) OF CHOICE
. Postexposure prophylaxis regimen (do all 3)
. Local wound treatment: Immediate and thorough
washing of all bite wounds and scratches with soap
and water
. Passive vaccination: human rabies immune globulin
(BayRab, Imogam Rabies HT) 20 IU/kg body weight
(formula is applicable for all age groups). For patients
who have not been vaccinated, human rabies
immune globulin is administered only once, concomitantly
with vaccine. When there is a visible wound,
as much of the dose as is feasible is infi ltrated
directly into the wound.
. Active vaccination: rabies vaccine, human diploid
cell (Imovax Rabies) or Rabies vaccine adsorbed
(Bioport) or purifi ed chick embryo cell vaccine (Rabavert)
IM in the deltoid. For children, the anterolateral
aspect of the thigh is acceptable. Gluteal area should
never be used for vaccine injections. Give the fi rst
dose, 1 mL, as soon as possible after exposure; one
additional dose should be given on days 3, 7, 14, and
28.
. For previously vaccinated patients, two IM doses (1 mL
each) of vaccine should be administered, one immediately
and one 3 days later. RIG not necessary in these
patients.
. Preexposure vaccination: For persons in high risk
groups, such as veterinarians, animal handlers, certain
laboratory workers, and persons spending time in
foreign countries where rabies is enzootic
. Primary preexposure: IM vaccination regimen
consists of three 1.0 mL injections of HDCV or RVA
given in deltoid area, one each on days 0, 7, and 28.
HDCV may also be given in intradermal (ID) doses,
administered with a special syringe developed for
that purpose (Imovax Rabies I.D. Vaccine); the 0.1
mL ID dose is administered in the deltoid area, follow
the same schedule as for IM doses. Recently, the
manufacturer discontinued production of Imovax
rabies I.D.
. Preexposure boosters: For persons at frequent risk
of exposure to rabies, serum should be tested every
2 years. A preexposure booster (1.0 mL IM) should
be administered if this is less than acceptable level.
If titer cannot be obtained, a booster can be administered
instead
PATIENT MONITORING After primary
vaccination, serologic testing only necessary if patient
has disease or takes medications that may suppress
immune system
PREVENTION/AVOIDANCE See Treatment
POSSIBLE COMPLICATIONS None
EXPECTED COURSE/PROGNOSIS No
postexposure failures reported in the United States
since the 1970s