Rabies

Treatment

All cases of suspected exposure to rabies should be treated as soon as possible to prevent the onset of symptoms and death. Post-exposure prevention consists of local treatment of the wound, administration of rabies immunoglobulin (if indicated), and immediate vaccination.

Removing the rabies virus at the site of the infection by chemical or physical means is an effective means of protection. Therefore, prompt local treatment of all bite wounds and scratches that may be contaminated with rabies virus is important.

Recommended first-aid procedures include immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.

The recommended post-exposure prophylaxis depends on the type of contact with the suspected rabid animal (see table).

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

Other factors that should be taken into consideration when deciding whether to initiate post-exposure prevention include:

  • the likelihood of the implicated animal being rabid
  • the clinical features of the animal and its availability for observation and laboratory testing.

In developing countries, the vaccination status of the suspected animal alone should not be considered when deciding whether to initiate prophylaxis or not.

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