Rabies

Most often transmitted through the

bite of a rabid animal.
Rabies virus infects the central
nervous system.
Incubation period: 3-8 weeks , rarely
as short as 7 days or as long as 9
days

Forms of Rabies
Paralytic

Furious

Dumb rabies
Characterized by:

Characterized by:

Weakness
Loss of coordination
paralysis

Extreme behavioral
changes
Overt behavior
Attack behavior

Sign and Symptoms of Rabies in

People
Early

Fever
Headache
General weakness or
discomfort

Later (become more

specific)

Insomnia
Anxiety
Confusion
Slight or partial paralysis
Excitation
Hallucination
Agitation
Hypersalivation
Difficulty in swallowing
hydrophobia

Management:
1. Biting animal:
observed for 14 days

2. Consult a veterinarian whenever

possible, regarding animal biting
management especially when any of
the following is observed:
sudden change in behavior

 Characteristic hoarse howl

Watchful, apprehensive expression of

the eyes, staring blank gaze

 Drooling of saliva

Paralysis or uncoordinated gait of hind

legs

 Marked restlessness, pacing in cage

If at large runs aimlessly, biting anything
in its way

Depraved apetite, self mutilation

 In some cases, lies quiescent, biting

when provoked
Snaps at imaginary objects
Lower jaw and tongue paralysis; inability
to drink
Sudden death without associated signs
and symptoms

3. Post exposure treatment maybe

discontinued if the biting animal
remains healthy after the 14 day
observation period.
4. If the animal dies or get sick, the
head should be submitted to the
nearest rabies diagnostic laboratory
for testing.

Categories of Rabies Exposure with

Corresponding Management
Category Exposure

Management

Category 1
Touching and feeding of the
animal;
Licking by animal of the
intact skin (with reliable
history and thorough
physical examination)
Exposure to patient with
sign and symptoms of
rabies, sharing of eating or
drinking utensils, casual
contact, and routine
delivery of health care to
patient with sign and
symptoms.

1. Wash exposed skin

immediately with soap and
water.
2. No vaccine or RIG needed.
3. Pre-exposure prophylaxis
may be considered for high
risk persons.

Category Exposure

Management

Category 2
Nibbling of uncovered skin
with or without bruising or
hematoma
Minor scratches/abrasions
without bleeding
Minor scratches/abrasions
which are induced to bleed.

1. Wash with soap and water

2. Start vaccine immediately
a. Complete vaccination
regimen until Day 28/30 if:
o.Biting animal is laboratory
proven to be rabid OR
o.Biting animal is killed/died
without laboratory testing
OR
o.Biting animal has signs OR
o.Biting animal is not
available for observation for
14 days.

b. May omit day 28/30 dose if:

o Biting animal is alive AND
remains healthy after the
14-day observation period
OR
o Biting animal died within
the 14 days observation
period confirmed by
veterinarian to have no
signs and symptoms of
rabies and was FATnegative.
3. RIG is not indicated.

Category Exposure

Management

Category 3
Single or multiple
transdermal bites
Licking by animal of mucous
membranes
Head and neck exposures
Handling of infected
carcass, ingestion of
infected raw meat
Licks on broken skin

1. Wash wounds with soap

and water
2. Start vaccine and RIG
immediately.
a. Complete vaccination
regimen until day 28/30 if:
o.Biting animal is laboratory
proven to be rabid OR
o.Biting animal is killed/died
without laboratory testing
OR
o.Biting animal has signs and
symptoms of rabies OR
o.Biting animal is not
available for observation for
14 days

b. May omit day 28/30 dose if:

o Biting animal is alive AND
remains healthy after the
14-day observation period
OR
o Biting animal died within
the 14 days observation
period confirmed by
veterinarian to have no
signs and symptoms of
rabies and was FATnegative.

FAT Result

Signs and
Symptoms of
Rabies in
Biting Animal

Give 3 Doses
(Day 0, 3, 7)

Give 4th Dose

(Day 28/30)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Not done

Yes

Yes

Not done

Yes

Yes

Immunization
1. Active Immunization
. Purified Vero Cell Rabies Vaccine
. Purified Chick Embryo Cell Vaccine

2. Passive Immunization
. Human Rabies Immune Globulins (HRIG)
. Highly Purified Antibody Antigen Binding
Fragments
. Equine Rabies Immune Globulin (ERIG)

2 Site Intradermal Schedule

Day of
Immunization

PVRV / PCEV

Site of Injection

Day 0

0.1 ml

Left and right deltoids

or anterolateral
thighs in infant

Day 3

0.1 ml

Left and right deltoids

or anterolateral
thighs in infant

Day 7

0.1 ml

Left and right deltoids

or anterolateral
thighs in infant

Day 28/30

0.1 ml

Left and right deltoids

or anterolateral
thighs in infant

Standard Intramuscular
Schedule
Day of
Immunization

PVRV

PCEV

Site of Injection

Day 0

0.5 ml

1.0 ml

One deltoid or
anterolateral thighs in
infant

Day 3

0.5 ml

1.0 ml

One deltoid or
anterolateral thighs in
infant

Day 7

0.5 ml

1.0 ml

One deltoid or
anterolateral thighs in
infant

Day 14

0.5 ml

1.0 ml

One deltoid or
anterolateral thighs in
infant

Routine Booster Doses for

Previously Immunized Individuals
Involved Prepersonne exposure
l
immunizati
on

Serologic
testing

Booster Dose
With
exposure

Without definite
exposure

All
workers in
rabies
laboratori
es

Every 6
months

1 booster
each on
Day 0 and
3

No booster if
Ab titers
0.5 IU/ml
1 booster if
Ab titers fall
below 0.5
IU/ml
In the
absence of
serologic
testing, 1
booster

Recommend
ed

Involved Prepersonne exposure

l
immuniza
tion

Serolo
gic
testin
g

Recommend Every
All
veterinari ed
2
ans,
years
veterinary
students,
animal
handlers
(dog
trainers,
working in
pet shops,
zoos etc.)

Booster dose
With
exposure

Without definite
exposure

1 booster
each on
Day 0 and
3

No booster if
Ab titers 0.5
IU/ml
1 booster if Ab
titers fall
below 0.5
IU/ml
In the absence
of serologic
testing, 1
booster dose
every 5 years
is
recommended

Involved
personnel

Preexposure
immunizati
on

Serologic
testing

Booster dose
With
exposure

Without
definite
exposure

HCW
Recommende none
involved in
d
care of rabies
patients;
Individuals
involved in
rabies control
program;
field workers,
morticians

1 booster
each on Day
0 and 3

1 booster
dose every 5
years is
recommende
d.

General
Population

1 booster
each on Day
0 and 3.

none

Not
none
recommende
d but may be
considered as
an option in
young
children and
other
individuals

Treatment
1. Post-exposure treatment
a. Local wound treatment
. Wounds should be immediately and
vigorously washed and flushed with soap
and water preferably for 10 minutes.
. Suturing wounds should be avoided.
. Do not apply any ointment, cream or
wound dressing to the bite site.
. Anti tetanus immunization maybe given, if
indicated.