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10.21 Rabies Prophylaxis


Presentation

A possibly contagious animal has bitten the patient, or the animal's saliva, brain tissue or cerebrospinal fluid contaminated an abrasion or mucous membrane.

What to do:

What not to do:

Discussion

The older duck embryo vaccine for rabies required 21 injections, and produced more side effects and less of an antibody response than the new human diploid cell vaccine. Sometimes, neurological symptoms would arise from DEV treatment, raising the agonizing question of whether they represented early signs of rabies or side effects of the treatment, and thus whether treatment should be continued or discontinued. It is much easier nowadays to initiate immunization with HDCV and follow through, because side effects are minimal and antibody response excellent. Roughly 25% of patients experience redness, tenderness and itching around the injection site and another 20% experience headaches, myalgia or nausea.

Patients with an immunosupressive illness or those taking corticosteroids, immunosupressive agents or antimalarial drugs may have an inadequate immune response to vaccination, and should have assays of serum antibodies. Pregnancy is not a contraindication to postexposure prophylaxis.

The incubation period of rabies varies from weeks to months roughly in proportion to the length of the axons up which the virus must propagate to the brain, which is why prophylaxis is especially urgent in facial bites.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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