Management of Rabies
Rabies is an acute viral infection resulting in encephalomyelitis and almost invariably in death. The incubation period is usually between 2 to 8 weeks (range 9 days to 2 years). Infection is usually through the bite of a rabid animal. Rarely, transmission of the virus can also occur through mucous membranes. Person to person spread of the disease is extremely rare but there had been instances of transmission through corneal grafts.
Pre-exposure prophylaxis should be offered to all those whose work may lead to potential contact with rabid animals. It should be given to all health workers caring for a patient with confirmed or suspected rabies. Three 1 ml doses (0, 7, 28) by deep subcutaneous or i.m, is normally used. The vaccine may also be given in smaller doses by the intradermal route (0.1 ml) with the same intervals. The intradermal route may also be used for the rapid immunization of staff caring for a patient with rabies by giving 0.1 ml into each limb (0.4 ml in all) on the first day of exposure to the patient. Intradermal immunization is only reliable if the whole of the 0.1 ml dose is given into the dermis and should only be given by a person experienced in the technique. The use of the intradermal route is not covered by the manufacturers license. Booster doses of the vaccine should be given every 2 to 3 years. The three-dose course gives virtually 100% protection and thus routine post-immunization testing is unnecessary. However, serological testing is advised for those who work with live virus and this should be carried out every 6 months.
In the event of a possible exposure, the following protocol should be observed in the UK;-
Management of patient diagnosed or suspected of having rabies