From the Guidelines
Rabies infection requires immediate medical attention as it is almost always fatal once symptoms appear, and treatment should include prompt and thorough wound cleansing followed by passive rabies immunization with human rabies immune globulin (HRIG) and vaccination with a cell culture rabies vaccine, as recommended by the Advisory Committee on Immunization Practices 1. The symptoms of rabies infection include fever, headache, and general weakness, progressing to anxiety, confusion, agitation, hallucinations, hydrophobia, and eventually coma and death.
- Early symptoms can be non-specific, making prompt medical attention crucial after suspected exposure to rabies.
- The virus attacks the central nervous system after entering through a bite or scratch from an infected animal, typically dogs, bats, raccoons, or skunks.
- The virus travels along nerve pathways to the brain, causing encephalitis.
Treatment options for rabies infection include:
- Postexposure prophylaxis (PEP) with HRIG and a series of vaccinations, specifically a 5-dose course of human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) administered intramuscularly on days 0,3,7,14, and 28, as recommended by the Advisory Committee on Immunization Practices 1.
- For persons who have previously received complete vaccination regimens, a 2-dose course of vaccine is recommended, with doses administered on days 0 and 3 1.
- HRIG is administered only once, at the beginning of antirabies prophylaxis, to provide immediate, passive, rabies virus neutralizing antibody coverage until the patient responds to HDCV or PCECV by actively producing antibodies 1.
- Prevention through pre-exposure vaccination is recommended for high-risk individuals, consisting of three doses on days 0,7, and 21 or 28 1.
From the FDA Drug Label
The essential components of rabies postexposure prophylaxis are prompt local treatment of wounds and administration of both HRIG and vaccine. Local Treatment of Wounds: Immediate and thorough washing of all bite wounds and scratches with soap and water is an important measure for preventing rabies Thoroughly wash and flush all bite wounds and scratches immediately or as early as possible (for about 15 minutes, if possible) with soap or a cleansing agent and copious amounts of water.
The symptoms of Rabies infection are not directly mentioned in the provided drug labels. Treatment options for Rabies infection include:
- Local treatment of wounds: immediate and thorough washing of all bite wounds and scratches with soap and water
- Administration of HRIG and vaccine: for previously unvaccinated persons, the administration of both human rabies immune globulin (HRIG) and vaccine is recommended
- Post-exposure antirabies vaccination: with rabies vaccine, in addition to administering Rabies Immune Globulin (RIG)
- Tetanus prophylaxis and measures to control bacterial infection: as indicated 2, 3
From the Research
Symptoms of Rabies Infection
- The symptoms of rabies infection are not explicitly described in the provided studies, but it is mentioned that once clinical manifestations of rabies have developed, treatment options are limited 4.
- Rabies is a life-threatening disease caused by an RNA virus that is usually transmitted to humans through bites from rabid animals 4.
- Clinical rabies is almost universally fatal if prophylactic measures are not followed 4, 5.
Treatment Options for Rabies Infection
- Postexposure prophylaxis consists of a multimodal approach to decrease an individual's likelihood of developing clinical rabies after a possible exposure to the virus 4.
- Regimens depend on the vaccination status of the victim and involve a combination of:
- Wound cleansing
- Administration of the rabies vaccine
- Administration of human rabies immune globulin 4
- 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
- Antivirals 4
- The Milwaukee Protocol, which adds induction of therapeutic coma to supportive care measures and antivirals, has shown inconsistent outcomes 4.
- Local wound management is an essential part of postexposure rabies prophylaxis, and the administration of a rabies immune globulin is generally recommended in conjunction with the first dose of the rabies vaccine 6.
- The use of human rabies immunoglobulin (HRIG) has been shown to be safe and clinically effective in post-exposure prophylaxis for category III animal exposures 7.