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Prophylaxis for exposure to rabies in humans.

Experience in dealing with patients who have had possible exposure to rabies has disclosed a large variation in their presentation. Variables include the type of exposure, the time of exposure versus the time of treatment, the history of previous immunization, sensitivity to equine antiserum, and pregnancy. Other problems arising during treatment include drug allergies, drug side effects other than allergy, and poor antibody response to treatment. The physician responsible for the patient must be aware of these possibilities and be prepared to deal with them logically. In determining treatment the schedule published by the World Health Organization (WHO) should be followed precisely in all cases,1 otherwise treatment in some patients will be delayed and in others will be inadequate. This should not occur, because rabies is considered to be fatal. (There is one reported case of survival following clinical rabies in the United States.2) The incubation period for rabies in man is extremely variable, periods of 2 weeks to 1 year having been reported.3 The virus has been shown in experiments to penetrate oral, nasal and intestinal mucosa of animals, and rabies virus can cross the placental barrier and infect the fetus.4 Rabies vaccine can be given safely to pregnant women.5