brain, spinal cord, and nerve disorders
Rabies
Prevention of Rabies
Avoiding being bitten by animals, especially wild animals, is best. Pets that are not known and wild animals should not be approached. Signs of rabies in wild animals may be subtle, but their behavior is typically abnormal, as in the following: Wild animals may not appear shy or afraid when people approach them. Nocturnal animals (such as bats, skunks, raccoons, and foxes) are out during the day. Bats make unusual noises or have difficulty flying. Animals bite without being provoked. Animals are weak or agitated and vicious. An animal that may be rabid should not be picked up to try to help it. A sick animal often bites. If an animal appears sick, people should call local health authorities, who can help remove it. Therabies vaccineshould be given to people who are likely to be exposed to the rabies virus before exposure. Such people include the following: Veterinarians Laboratory workers who handle animals that may be rabid People who live or stay more than 30 days in developing countries where rabies in dogs is widespread People who explorebatcaves Three doses of the vaccine are injected into a muscle. The first dose is given right away (called day 0). The other injections are given on day 7 and between days 21 and 28. The injection site may be painful and swollen but usually only slightly. Serious allergic reactions are rare. Vaccination protects most people to some degree for the rest of their life. However, protection decreases with time, and if exposure is likely to continue, people are tested periodically, and if the levels of protective antibodies are low, they are given a booster dose of vaccine. Immediately after being bitten, people should clean the wound thoroughly with soap and water. Deep puncture wounds are flushed out with running water. Then people should see a doctor. Doctors clean the wound further with an antiseptic calledbenzalkonium chloride. They may trim ragged edges of the wound. Doctors also try to determine the likelihood that rabies was transmitted. Early determination is essential because rabies can usually be prevented if appropriate measures are taken promptly. Immediately after an animal bite, no test can determine whether the rabies virus has been transmitted. Thus, people who have been bitten may be givenrabies immune globulinand vaccine by injection to prevent rabies.Rabies immune globulin, which consists of antibodies to the virus, provides protection immediately but only for a short time. The rabies vaccine stimulates the body to produce antibodies to the virus. The vaccine provides protection that begins more gradually but that lasts for a much longer time. Whether vaccine and immune globulin are needed depends on whether people have been previously immunized with rabies vaccine and what the type and status of animal are. For example, doctors determine the following: Whether the animal was abat, a dog, a raccoon, or something else Whether it appeared sick Whether the attack was provoked Whether the animal is available for observation In the United States, the decision to give the rabies vaccine to a person who has been bitten by an animal depends on the type and status of the animal. For people bitten by a pet dog, cat, or ferret:If the animal appears healthy and can be observed for 10 days, the vaccine is not given unless the animal develops symptoms of rabies. If the animal develops any symptom suggesting rabies, people are given the vaccine andrabies immune globulinimmediately. Animals that develop symptoms of rabies are put to sleep (euthanized), and their brain is examined for the rabies virus. If the animal is still healthy after 10 days, it did not have rabies at the time of the bite, and vaccine is not needed. If the status of an animal cannot be determined—for example, because it escaped—public health officials are consulted to determine how likely rabies is to be in that particular area and whether the vaccine should be given. If there are no local public health officials and rabies is possible, the vaccine is given immediately. Very rarely in the United States, if an animal has or appears to have rabies, the vaccine and the immune globulin are given immediately. For people bitten by skunks, raccoons, foxes, most other carnivores, or bats:Such an animal is considered rabid unless it can be tested and the results are negative. Usually, the vaccine and the immune globulin are given immediately. Waiting to observe wild animals for 10 days is not recommended. When possible, these animals are put to sleep (euthanized), and their brain is examined for the rabies virus as soon as possible. The vaccine is stopped if the animal tests negative for the rabies virus. Because people may not notice abatbite, they are given the vaccine if a bite seems possible. For example, if someone awakens and abatis in the room, the vaccine is given. For people bitten by livestock, small rodents, large rodents (such as woodchucks and beavers), rabbits, or hares:Each biting incident is considered individually, and public health officials are consulted. People who are bitten by hamsters, guinea pigs, gerbils, squirrels, chipmunks, rats, mice, other small rodents, rabbits, or hares almost never require rabies vaccination. If people who have been bitten need preventive treatment and have not been immunized previously, they are givenrabies immune globulinand rabies vaccine right away (on day 0). Immune globulin is injected around the wound if possible. They are given three more injections of the vaccine: on days 3, 7, and 14. People with a weakened immune system (by a disorder such as AIDS or a drug) are given an additional injection on day 28. If people have already been vaccinated, the risk of developing rabies is reduced. However, the wound must be cleaned promptly, and an injection of rabies vaccine is given immediately and on day 3. 