Prevention of rabies in humans
Because of the high fatality rate, the prevention of rabies infection is of utmost importance.
Cell culture derived vaccines are preferably used for pre-exposure immunization. Generally pre-exposure vaccination should be offered to people at high risk of exposure such as those working in rabies diagnostic or research laboratories, veterinarians, animal handlers (including bat handlers), animal rehabilitators and wildlife officers, as well as other people (especially children) living in or travelling to high-risk areas.
After exposure, prevention of infection is virtually assured by post-exposure prophylaxis consisting of local treatment of the wound (see below), initiated as soon as possible after an exposure, followed by the administration of a potent and effective rabies vaccine that meets WHO criteria and a passive immunization, if indicated (category III). A risk assessment conducted by a medical expert knowledgeable in the epidemiology of rabies in the area should be performed. Depending on adequate laboratory surveillance authorities may not recommend post-exposure prophylaxis.
Local treatment of wounds
Any bite wound or scratches that might be contaminated with rabies virus should immediately be flushed with rinsing water. Thorough washing for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances of proven lethal effect on rabies virus or other detergents should follow. Suturing of the wound should be avoided. In case suturing is essential, local administration of passive rabies immunization products and suturing delayed for several hours is recommended
Type of contact, exposure and recommended post-exposure prophylaxis
|Category||Type of contact with a suspect or confirmed rabid domestic or wild animal, or animal unavailable for testing||Type of exposure||Recommended post-exposure prophylaxis|
|I||Touching or feeding of animals Licks on intact skin||None||None, if reliable case history is available|
|II||Nibbling of uncovered skin Minor scratches or abrasions without bleeding||Minor||Administer vaccine immediately Stop treatment if animal remains healthy throughout an observation period of 10 days or if animal is proven to be negative for rabies by a reliable laboratory using appropriate diagnostic techniques|
Single or multiple transdermal bites or scratches, licks on broken skin
Contamination of mucous membrane with saliva (i.e. licks)
Exposures to bats
|Severe||Administer rabies immunoglobulin and vaccine immediately. Stop treatment is animal remains healthy throughout an observation period of 10 days or if animal is found to be negative for rabies by a reliable laboratory using appropriate diagnostic techniques
For detailed information on vaccination regimens ask your national health authorities or see WHO-pages on rabies: www.who.int/rabies