Rabies is an acute viral infection. Rabies is present in animals in many countries worldwide. Most cases of human infection occur in developing countries.
Causative agent: The rabies virus, a rhabdovirus of the genus Lyssavirus
Transmission: Through the bite of an infected animal or any other contact involving penetration of the skin occurring in an area where rabies is present. The virus is present in the saliva.
Incubation period: usually 3-8 weeks, rarely as short as 9 days or as long as 7 years.
In rabies endemic areas, travelers may be at risk if there is contact with both wild and domestic animals including dogs and cats.
Sign & Symptoms
An acute viral encephalomyelitis
Initial signs include a sense of apprehension, headache, fever malaise and sensory changes around the site of the animal bite.
Excitability, hallucinations and aerophobia are common followed in some cases by fear of water (hydrophobia) due to spasms of the swallowing muscles, progressing to delirium, convulsions and death a few days after onset.
A less common form, paralytic rabies, is characterized by loss of sensation, weakness, pain and paralysis.
Respiratory paralysis leads to death.
Post exposure treatment
To prevent the establishment of rabies infection
- First aid treatment of the wound by immediate vigorous washing and flushing with soap or detergent and water or water alone. Following washing, apply either ethanol (70%) or tincture or aqueous solution of iodine or povidone iodine.
Antirabies Immunoglobulin (RIG) is applied by instillation into the depth of the wound and by infiltration of the surrounding tissues.
Vaccine is applied by intradermal or intramuscular injection in schedules requiring several doses (4 or 5 doses by intramuscular injection, depending on the vaccine used) with the first dose being administered as soon as possible after exposure and the last dose within 28 days for intramuscular or 90 days for intradermal vaccination
- Tetanus prophylaxis and anti-bacterial treatment when required
- No sutures or wound closure advised unless unavoidable
Prevention & Precautions
Vaccination as Prophylaxis
For travelers with a foreseeable significant risk of exposure to rabies or traveling to a hyper-endemic area where modern rabies vaccine may not be available
Type of vaccine: Modern vaccine (cell cultured or embryonated egg vaccine)
Number of doses: Three (3), on days 0, 7 and 21-28, given i.m. (1 ml/dose) or i.d. (0.1ml/dose)
Booster: After one year, and thereafter every 5-10 years, depending upon risk of exposure
Contraindications: Severe adverse reaction to previous dose
Adverse reactions: Minor local or systemic reactions
Before departure: Pre-exposure prophylaxis for those planning a prolonged stay or visiting hyperendemic areas, parks and game reserves in endemic countries.
Avoid contact with wild animals and stray domestic animals particularly dogs and cats in rabies endemic areas.
If bitten by an animal that is potentially infected with rabies, or after other suspect contact, immediately clean the wound thoroughly with disinfectant or with soap or detergent and water.
Medical assistance should be sought immediately.
References organisation/ support
International Travel & Health, WHO 2006
Control of Communicable Diseases Manual, 18th Edition by David L. Heymann, MD, Editor, 2004
|Last Reviewed||:||26 April 2012|
|Writer||:||Dr. Norhayati bt. Rusli|
|Accreditor||:||Dr. Nor Mimiroslina bt Che Omar|
|Reviewer||:||Dr. Muhaini bt. Othman|