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Rabies
vaccine and immune globulin
There is
no treatment for rabies after symptoms of the disease appear. However,
two decades ago scientists developed an extremely effective new rabies
vaccine regimen that provides immunity to rabies when administered after
an exposure (postexposure prophylaxis) or for protection before an exposure
occurs (preexposure prophylaxis). Although rabies among humans is rare
in the United States, every year an estimated 18,000 people receive
rabies preexposure prophylaxis and an additional 40,000 receive postexposure
prophylaxis.
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Preexposure
prophylaxis
Preexposure vaccination is recommended for persons in high-risk groups,
such as veterinarians, animal handlers, and certain laboratory workers.
Other persons whose activities bring them into frequent contact with rabies
virus or potentially rabid bats, raccoons, skunks, cats, dogs, or other
species at risk of having rabies should also be considered for preexposure
prophylaxis. In addition, international travelers likely to come in contact
with animals in areas of enzootic dog rabies which lack immediate access
to appropriate medical care, including biologics, should be considered
for preexposure prophylaxis. (For more information about preexposure
prophylaxis, see Human
Rabies Prevention - United States, 1999 Recommendations of the Immunization
Practices Advisory Committee (ACIP).)
People who
work with live rabies virus in research laboratories or vaccine production
facilities are at the highest risk of inapparent exposures. Such persons
should have a serum (blood) sample tested for antibody every 6 months
and receive booster vaccine, when necessary. Routine preexposure prophylaxis
for other situations may generally not be indicated.
Purpose of preexposure prophylaxis
Preexposure prophylaxis is given for several reasons. First, although
preexposure vaccination does not eliminate the need for additional medical
attention after a rabies exposure, it simplifies therapy by eliminating
the need for human rabies immune globulin (HRIG) and decreasing the number
of vaccine doses needed a point of particular importance for persons
at high risk of being exposed to rabies in areas where immunizing products
may not be available, and it minimizes adverse reactions to multiple doses
of vaccine. Second, it may enhance immunity in persons whose postexposure
therapy might be delayed. Finally, it may provide protection to persons
with inapparent exposures to rabies.
Preexposure prophylaxis regimen
Preexposure prophylaxis consists of three doses of rabies vaccine given
on days 0, 7, and 21 or 28.
Postexposure
prophylaxis
Postexposure prophylaxis (PEP) is indicated for persons possibly exposed
to a rabid animal. Possible exposures include animal bites, or mucous
membrane contamination with infectious tissue, such as saliva. {For more
information on types of exposures, see Human
Rabies Prevention - United States, 1999 Recommendations of the Immunization
Practices Advisory Committee (ACIP).} PEP should begin as soon as
possible after an exposure. There have been no vaccine failures in the
United States (i.e. someone developed rabies) when PEP was given promptly
and appropriately after an exposure.
Administration
of rabies PEP is a medical urgency, not a medical emergency. Physicians
should evaluate each possible exposure to rabies and as necessary consult
with local or state public health officials regarding the need for rabies
prophylaxis.
Postexposure prophylaxis regimen
In the United States, PEP consists of a regimen of one dose of immune
globulin and five doses of rabies vaccine over a 28-day period. Rabies
immune globulin and the first dose of rabies vaccine should be given as
soon as possible after exposure. Additional doses of rabies vaccine should
be given on days 3, 7, 14, and 28 after the first vaccination. Current
vaccines are relatively painless and are given in your arm, like a flu
or tetanus vaccine.
What
to do after a possible exposure
If you are exposed to a potentially rabid animal, wash the wound thoroughly
with soap and water, and seek medical attention immediately. A health
care provider will care for the wound and will assess the risk for rabies
exposure. The following information will help your health care provider
assess your risk:
- the geographic
location of the incident
- the type
of animal that was involved
- how the
exposure occurred (provoked or unprovoked)
- the vaccination
status of animal
- whether
the animal can be safely captured and tested for rabies
Steps taken
by the health care practitioner will depend on the circumstances of the
bite. Your health care practitioner should consult state or local health
departments, veterinarians, or animal control officers to make an informed
assessment of the incident and to request assistance. The important
factor is that you seek care promptly after you are bitten by any animal.
What
you can do to help prevent the spread of rabies
Be a responsible
pet owner:
- Keep vaccinations
up-to-date for all dogs, cats and ferrets. This requirement is important not
only to keep your pets from getting rabies, but also to provide a barrier
of protection to you, if your animal is bitten by a rabid wild animal.
- Keep your
pets under direct supervision so they do not come in contact with wild
animals. If your pet is bitten by a wild animal, seek veterinary assistance
for the animal immediately.
- Call your
local animal control agency to remove any stray animals from your neighborhood. They
may be unvaccinated and could be infected by the disease.
- Spay or
neuter your pets to help reduce the number of unwanted pets that may
not be properly cared for or regularly vaccinated.
Avoid direct
contact with unfamiliar animals:
- Enjoy
wild animals (raccoons, skunks, foxes) from afar. Do not handle,
feed, or unintentionally attract wild animals with open garbage cans
or litter.
- Never
adopt wild animals or bring them into your home. Do not try to
nurse sick animals to health. Call animal control or an animal rescue
agency for assistance.
- Teach
children never to handle unfamiliar animals, wild or domestic,
even if they appear friendly. "Love your own, leave other animals
alone" is a good principle for children to learn.
- Prevent
bats from entering living quarters or occupied spaces in homes, churches,
schools, and other similar areas, where they might come in contact with
people and pets.
- When traveling
abroad, avoid direct contact with wild animals and be especially careful
around dogs in developing countries.
Rabies is common in developing countries in Asia, Africa, and Latin
America where dogs are the major reservoir of rabies. Tens of thousands
of people die of rabies each year in these countries. Before traveling
abroad, consult with a health care provider, travel clinic, or your
health department about the risk of exposure to rabies, preexposure
prophylaxis, and how you should handle an exposure, should it arise.
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