Rabies (cont.)
Medical Author:
Charles Patrick Davis, MD, PhD
Charles Patrick Davis, MD, PhDDr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications. Medical Editor:
Mary D. Nettleman, MD, MS, MACP
Mary D. Nettleman, MD, MS, MACPMary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University. Medical Editor:
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MDMelissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology. In this Article
 What is the treatment for rabies in humans?
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Treatment for rabies (or more accurately, prevention of rabies before the symptoms can develop) consists of giving a person an injection of rabies immune globulin and another injection of rabies vaccine as soon as possible after the bite or exposure to saliva from an infected animal. As of 2010, the CDC recommends additional doses (injections) of rabies vaccine on the third, seventh, and 14th day after exposure. This schedule is for people who have had no previous treatment (vaccination) against rabies. For people previously vaccinated against rabies, only two doses of the vaccine are recommended; one as soon as possible after the exposure (no rabies immune globulin is recommended) and one more three days later. Most researchers and clinicians suggest that the treatment begin as soon as possible after exposure. No one who has begun this treatment within 48 hours of exposure and has followed it appropriately has ever developed a fatal case of rabies in the U.S. The following table is from the CDC that provides a recent (2010) update of a treatment schedule and is the new four-dose schedule:
The reason human rabies immune globulin is used (and sometimes even injected into the bite area) is that it immediately attacks the virus and slows or stops viral progression through the nerves. Vaccine is used to stimulate the body's immune response enough to make the body develop enough of an immune response to eventually kill all of the virus population in the body. Timing and the ability of the patient to respond by making a good immune response is a key to patient survival. If human rabies immune globulin and vaccine are started more than about 48 hours after the exposure, the viral proliferation in the nerves may outpace the immune response and the person has a greater chance of developing fatal rabies. However, even late attempts at treatment can be successful and always should be tried. Untreated or inappropriately treated rabies is almost always fatal; treatment is supportive only to limit the patient's pain, suffering, harm to the caregivers and self, and exposure of saliva to other humans. Barrier precautions (for example, gloves, gowns, and mask) are usually recommended for caregivers. Side effects may occur with any vaccine. Mild local reactions to the rabies vaccine (for example, mild pain, redness, swelling, or itching at the injection site) may occur in 5%-40% of patients, according to the CDC. Rarely, other symptoms such as headache, nausea, abdominal pain, muscle aches, dizziness, allergic reactions, and Guillain Barré disease may happen. Rabies immune globulin may cause local pain and low-grade fever following its injection in some patients. Treatment protocols should always be started in all people (children, pregnant females, immunosuppressed people) especially when they are known to be exposed to the virus; otherwise if they develop rabies, the patient will likely die. Infectious-disease consultants can help develop specific treatment plans for patients who have other health complications. Researchers may develop a more effective vaccine that may require only one dose with less side effects, but such vaccines are not available currently. Reviewed by Mary D. Nettleman, MD, MS, MACP on 4/18/2012 Patient CommentsViewers share their comments
Rabies - Treatment
Question: What kinds of treatment have you received to treat rabies? Describe what the experience is like.
Rabies - Vaccine for Prevention
Question: Has your pet received a rabies vaccine? Please share reasons for or against vaccinating your pet for this disease.
Rabies - Symptoms
Question: Did you or someone you know have rabies? What were the main symptoms and when did they appear?
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