Management of rabies exposure in pediatric practice

The incidence of human rabies in the United States has fallen dramatically over the past 4 decades. This is directly related to the universal immunization of domestic cats and dogs. Recently, a number of cases of human rabies have been associated with the appearance of a previously rare strain of the virus in the silver-haired bat. There have been other recent changes in the epizoology of rabies with the expansion of raccoon rabies from a small pocket around northern Virginia to most of the northeastern United States. Postexposure prophylaxis using rabies immune globulin and rabies vaccine is effective in preventing rabies following a bite by a rabid animal when given according to current recommendations. There has been considerable debate, however, surrounding the cost of prophylaxis and the possibility of reducing the recommended number of doses of rabies immune globulin.