From the Guidelines
Rabies is not always fatal if treated promptly before symptoms appear. Once a person is exposed to rabies through an animal bite or scratch, they need immediate post-exposure prophylaxis (PEP), which includes thorough wound washing, rabies immune globulin (RIG) administered at the wound site, and a series of four rabies vaccine doses given on days 0,3,7, and 14, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1. However, once clinical symptoms of rabies develop (such as fever, anxiety, confusion, hypersalivation, and hydrophobia), the disease is almost always fatal, with only a handful of documented survivors worldwide.
The virus works by traveling through peripheral nerves to the central nervous system, where it causes fatal inflammation of the brain and spinal cord. This is why immediate treatment after exposure is critical - the goal is to neutralize the virus before it reaches the nervous system. According to a study published in MMWR Recommendations and Reports, prompt wound care and the administration of RIG and vaccine are highly effective in preventing human rabies following exposure 1.
Some key points to consider:
- Anyone who has been bitten or scratched by an animal, especially bats, raccoons, skunks, foxes, or unvaccinated dogs or cats, should seek medical attention immediately, even if the wound seems minor.
- The ACIP recommends a 4-dose vaccination regimen for rabies PEP in previously unvaccinated persons, which has been shown to be effective in preventing human rabies 1.
- Even when PEP is administered imperfectly or not according to established scheduled dose recommendations, it might be generally effective, as reported in several studies 1.
Overall, prompt treatment with PEP is crucial in preventing rabies, and seeking medical attention immediately after exposure is essential to prevent the disease.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Rabies Fatalities
- Rabies is nearly 100% fatal if prophylactic measures are not followed 2
- Human rabies is essentially a fatal disease once clinical signs develop 3
- Death from rabies can be prevented by timely and appropriate post-exposure prophylaxis, including wound cleaning and administration of vaccine and rabies immunoglobulin 4
- Primary care physicians must always consider the risk of rabies when treating patients who have had animal-to-human exposures, and if indicated, postexposure prophylaxis must be administered as soon as possible because the infection is fatal once clinical symptoms develop 5
Exceptions to Fatalities
- If used in a timely and accurate fashion, postexposure prophylaxis is nearly 100% effective 2
- Only seven individuals have survived rabies virus infection 2
- Treatment of clinical rabies consists of medical support in an intensive care unit, using a multifaceted approach that includes supportive care, heavy sedation, analgesics, anticonvulsants, and antivirals 2
Prevention and Treatment
- Preexposure prophylaxis entails the administration of the rabies vaccine to individuals at high risk for exposure to rabies viruses 2
- Postexposure prophylaxis consists of a multimodal approach to decrease an individual's likelihood of developing clinical rabies after a possible exposure to the virus 2
- Rabies postexposure prophylaxis (PEP) consists of thorough wound care in combination with administration of rabies immunoglobulin and rabies vaccine 3
- Monoclonal antibodies produced through recombinant DNA technologies could potentially overcome the limitations of current rabies immunoglobulin 4