Rabies

Treatment Overview

After possible exposure to the rabies virus, proper wound care and vaccinations are the most effective methods to stop the spread of infection.

Wound care

If you are bitten or scratched by an animal, clean the wound immediately with plenty of soap and water to reduce the chance of infection. Call a doctor to find out whether further wound care is needed.

Postexposure prophylaxis (PEP)

If you think you have been exposed to rabies, you may be given a series of shots (injections) known as postexposure prophylaxis (PEP). The shots help the body's immune system destroy the disease in its early stages. Getting PEP before symptoms appear usually prevents infection, and you are likely to recover. After symptoms of rabies are present, PEP is thought to not be effective.

PEP is given depending upon your risk of exposure to rabies. Your local health department or a doctor can help determine your risk and whether you need PEP. Factors involved in determining this risk include:

• Type of exposure. Exposure to the rabies virus may be through either a bite or a nonbite. Nonbite exposures (which occur when an open cut in the skin or mucous membrane is exposed to the rabies virus) rarely lead to rabies but will need treatment.
• Type of animal involved. Some animals are more likely to carry rabies than others. Bats, skunks, raccoons, foxes, and coyotes are common carriers of the rabies virus in the United States. People in Asia, Latin America, Africa and many other countries are most likely to get rabies from dog bites.^{2, 3}

In the United States, PEP has two parts:

• Injection of antibodies. An injection of human rabies immune globulin (HRIG) antibodies helps inactivate the rabies virus near the wound and in the body until your body can make its own antibodies.
• Vaccination series. A series of shots with a vaccine helps your immune system increase its own response against the rabies virus. Vaccines for rabies include the human diploid cell vaccine (HDCV), rabies vaccine, adsorbed (RVA), and purified chick embryo cell culture (PCEC).

The vaccines and HRIG are usually given at the same time.

Some vaccines that are not approved for use in the United States or Canada are used in developing countries. These sometimes are given in a series of fewer shots or are injected in the area under the skin rather than into muscle. Some vaccines used in other countries and some older vaccines are made from nerve tissue. These vaccines may cause more adverse reactions than newer vaccines.

If you are exposed to rabies outside the United States or Canada, you may be offered one of these vaccines. The World Health Organization (WHO) approves of these vaccines.⁴ If you have any choice, request HDCV, RVA, or PCEC. If these are not available, it is better to accept one of the other vaccines with more risk of an adverse reaction than to get no vaccine at all. As soon as you are able to return home, ask your doctor about whether you should receive any more vaccines.

Preventive vaccination

Certain jobs or hobbies or frequent travel to developing countries may present a greater risk of exposure to rabies. Preventive vaccination, or preexposure prophylaxis, is often recommended if you are at high risk of exposure.

Rabies vaccinations may be recommended if you will be traveling in rural areas of countries where rabies is a risk. In many developing countries throughout Asia, Africa, and Central and South America, rabies is much more common, with the majority of human infections caused by dog bites. Because children are at a greater risk of animal bites than adults and because bites to children tend to be more severe, vaccinations may be recommended if you will be traveling with children.⁵ Contact your doctor or local public health department for more information.

After symptoms develop

After symptoms of rabies appear, intensive medical care can maintain the heart, lungs, and other vital organs for a while, but death will usually occur. In extremely rare cases, the immune system may overcome the infection with the help of vaccinations and antiviral medicines. If you have had any contact with an animal that may have rabies, seek medical treatment immediately.

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Author:	Caroline Rea, RN, BS, MS	Last Updated: September 9, 2008
Medical Review:	William M. Green, MD - Emergency Medicine W. David Colby IV, MSc, MD, FRCPC - Infectious Disease
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