Rabies

• Acute illness with rapidly progressive CNS manifestations, including anxiety, dysphagia, and seizures.
• Incubation period ranges from 5 days up to 1 year (avg. 4-6 weeks)
• No treatment once symptoms develop; illness almost invariably progresses to death
• Bats, skunks, racoons, foxes, woodchucks regarded as rabid until proven negative
• Test animal brain tissue with virus-specific fluorescent antigen

Rabies Treatment and Post-Exposure Prophylaxis

• Exposure results from break in skin caused by teeth of rabid animal or by contamination of scratches, abrasions, or mucous membranes with saliva from rabid animal
• Wound care is essential (reduces incidence 90%); flush thoroughly and clean with soap and water; avoid suturing if possible
• Post-exposure prophylaxis is recommended for all people bitten by high-risk animals, or people who report an open wound, scratch, or mucous membrane that has been contaminated by saliva.
• Because the injury of a bat bite or scratch may be small and not evident or the circumstances of contact may preclude accurate recall (e.g., a bat in a room of a sleeping person or unattended child), prophylaxis is indicated for situations in which a bat is physically present if a bite or mucous membrane exposure cannot reliably be excluded, unless prompt testing of the bat has excluded rabies infection
• Immunoprophylaxis involves concurrent use of passive and active immunization. Prophylaxis should begin as soon as possible after exposure, ideally within 24 hours
• Passive immunization
  • Rabies IG infiltrated into bite wound(s), or distant from vaccine site if no bite
  • Administer immediately, up to 7 days later
• Active immunization
  • 3 vaccines available, given IM
  • Doses on days #1, 3, 7, 14, & 28

CHLA Board Review 2005