From the Guidelines
Testing for rabies should be performed by submitting the brain of a suspected rabid animal for examination, as signs of rabies among wildlife cannot be interpreted reliably. This approach is supported by the recommendations of the Advisory Committee on Immunization Practices (ACIP) 1. The brain should be submitted for rabies testing, and if the results of testing are negative by immunofluorescence, it can be assumed that the saliva contains no virus, and the person bitten does not require postexposure prophylaxis.
Key Considerations for Rabies Testing
- The most definitive test for rabies is the direct fluorescent antibody (DFA) test, which detects rabies virus antigens in brain tissue.
- For animals, this requires euthanasia and removal of the brain, as there is no reliable ante-mortem test for rabies in animals.
- In humans, several tests may be used, including skin biopsies from the nape of the neck, saliva tests using RT-PCR, serum and spinal fluid antibody tests, and brain biopsies in rare cases.
- Testing is usually performed at specialized public health laboratories.
Importance of Prompt Testing and Treatment
- Rabies testing is crucial because once symptoms appear, the disease is almost always fatal.
- Prompt post-exposure treatment is essential when exposure is suspected, making it critical to test the animal if available and make post-exposure prophylaxis decisions based on the circumstances of exposure and animal testing results, as recommended by the ACIP 1.
From the Research
Testing for Rabies
- There are no direct tests for rabies mentioned in the provided studies, however, the focus is on post-exposure prophylaxis (PEP) to prevent the disease.
- The studies emphasize the importance of prompt and proper wound care, including washing the wound with water and soap for 15 minutes 2.
- Assessment of the need for rabies biologicals, such as rabies immunoglobulin or monoclonal antibodies, is crucial in preventing the disease 2, 3.
Post-Exposure Prophylaxis (PEP)
- PEP consists of a series of steps, including wound washing, administration of rabies immunoglobulin or monoclonal antibodies, and vaccination 2, 4.
- The World Health Organization (WHO) recommends an intradermal 1-week vaccination regimen, which is considered safe and effective 2, 4.
- Abridged vaccination schedules, such as the 1-week, 2-site ID PEP schedule, have been found to be advantageous in terms of cost, dose, and time-sparing benefits 4.
Diagnosis and Management
- Rapid recognition of potential exposures is vital to patient care and protection of public health 5.
- A comprehensive exposure history is necessary to determine the category of the encounter, the type of animal, and the location of the bite 6.
- Consulting outside expert resources may be necessary to determine whether the rabies PEP series is indicated 6.