When to use rabies prophylaxis
- Alfred DeMaria, Jr, MD
Alfred DeMaria, Jr, MD
- Medical Director
- Bureau of Infectious Disease and Laboratory Sciences
- State Epidemiologist
- Massachusetts Department of Public Health
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 .
Infection can be prevented with proper post-exposure prophylaxis, as first pioneered by Louis Pasteur in 1885. While 35,000 to 59,000 people worldwide die of rabies every year (40 percent are children younger than 15 years) , only 34 cases of human rabies were diagnosed in the United States from 2003 through 2013 [3,4]. The 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 post-exposure prophylaxis are reviewed here . 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".)
Several factors need to be considered in deciding whether to administer post-exposure rabies prophylaxis. These include [5,6]:
●The epidemiology of animal rabies in the regionTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- GENERAL PRINCIPLES
- ANIMAL RABIES EPIDEMIOLOGY
- Domestic animal rabies
- Wild terrestrial mammals
- TYPES OF EXPOSURE
- Bat exposures
- Non-bite animal exposures
- Human-to-human transmission
- - Risk for health care workers
- - Transplant recipients
- - Bite and non-bite exposures
- ANIMAL OBSERVATION AND TESTING
- VACCINATION STATUS OF DOMESTIC ANIMALS
- PROVOKED VERSUS UNPROVOKED EXPOSURE
- HIGH-RISK GROUPS
- Rationale for pre-exposure prophylaxis
- COUNSELING TRAVELERS
- Post-exposure prophylaxis in resource-limited settings
- DELAYS IN PROPHYLAXIS
- COST OF POST-EXPOSURE PROPHYLAXIS
- HOW SHOULD PROPHYLAXIS BE GIVEN?
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS