Rabies

Human rabies is fatal except in the small number of patients who received rabies immunization before the onset of clinical rabies. Therapy has been futile in all other cases once rabies has developed. Rabies is always preventable after an exposure if current recommendations are followed. After a potential rabies exposure, details about the contact, the animal, and the local epidemiologic situation are important in making a decision whether to initiate postexposure prophylaxis (PEP). Rabies PEP includes thorough local wound cleansing and both active and passive immunization. Five doses of rabies vaccine should be administered intramuscularly in the deltoid muscle on days 0, 3, 7, 14, and 28 in individuals previously unimmunized against rabies virus. Human rabies immune globulin (20 IU/kg) should be given on day 0 with administration into and around the wounds; the remaining volume is given intramuscularly at a site distant from the vaccine site. Certain individuals at high risk for rabies exposure are candidates for preexposure prophylaxis with three doses of rabies vaccine. Booster doses should be given as required.