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When to use rabies prophylaxis

INTRODUCTION

Rabies is a fatal viral disease primarily acquired from the bite of a rabid animal, with only six cases of documented human survival prior to 2004. However, since that time there have been three documented survivors who had not received any pre-exposure rabies vaccine [1].

Infection can be prevented with proper postexposure prophylaxis, as first pioneered by Louis Pasteur in 1885. While up to 50,000 people worldwide die of rabies every year, only 69 cases of human rabies were diagnosed in the United States from 1980 through 2010, an average of approximately two per year [2,3]. This low rate of human cases in the United States reflects the success of domestic animal control and vaccination programs. The predominant reservoir of rabies in the United States is now wildlife, with most cases occurring in raccoons, skunks, foxes and bats.

The recommendations of the Advisory Committee on Immunization Practices (ACIP) for rabies postexposure prophylaxis are reviewed here [4]. These guidelines can be accessed through the Centers for Disease Control and Prevention's website at http://www.cdc.gov/rabies/ and should be checked periodically for updates. The use of rabies biologics (vaccine and immunoglobulin) and the clinical features and treatment of human rabies are presented separately. (See "Rabies immune globulin and vaccine" and "Clinical manifestations and diagnosis of rabies".)

GENERAL PRINCIPLES

Several factors need to be considered in deciding whether to administer postexposure rabies prophylaxis. These include [4,5]:

  • The epidemiology of animal rabies in the region
  • The type of exposure
  • Whether the exposure was provoked or unprovoked
  • The species and vaccination status of the animal

                          

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Literature review current through: Apr 2013. | This topic last updated: Aug 20, 2012.
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