Rabies

Treatment

Rabies is an overwhelmingly fatal disease, with only a few documented survivors. There is no effective curative treatment for rabies once clinical signs have appeared.

All cases of suspected rabies exposure should be treated immediately to prevent the onset of clinical symptoms and death. Post-exposure prophylaxis (PEP) consists of wound treatment, the administration of rabies vaccines based on WHO recommendations, and if indicated, the administration of rabies immunoglobulin (See table below).

Recommended post-exposure prophylaxis for rabies infection

Category of exposure to suspect rabid animal Post-exposure measures
Category I – touching or feeding animals, licks on intact skin (i.e. no exposure) None
Category II – nibbling of uncovered skin, minor scratches or abrasions without bleeding Immediate vaccination and local treatment of the wound
Category III – single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks, exposures to bats. Immediate vaccination and administration of rabies immunoglobulin; local treatment of the wound

WHO strongly recommends the discontinuation of production and use of nerve tissue vaccine and their replacement by modern cell culture vaccines. Intradermal vaccination is recommended as an alternative to intramuscular vaccination as it is safe, immunogenic and dose and cost sparing.

There are no contraindications to PEP; it can be safely given to infants, pregnant women and immunocompromised individuals. Life-saving PEP should not be withheld from these individuals.

Where possible, animals that conform to the definition of a suspected or probable rabies case should be euthanized humanely and sent for laboratory diagnosis. Animals that are deemed healthy by a trained professional, should be observed closely for 10 days. However, in rabies endemic areas the availability of the animal for observation should not delay the victim in seeking PEP.

Prompt administration of rabies vaccine after exposure, combined with proper wound management and administration of rabies immunoglobulins where indicated, is almost invariably effective in preventing rabies, even after high-risk exposure.

Further information

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