|
Because of the extremely serious nature of a
rabies infection, the need for rabies immunizations will be
carefully considered for anyone who has been bitten by an animal,
based on a personal history and results of diagnostic tests.
If necessary, treatment includes the following:
- The wound is washed thoroughly with medicinal soap and water.
Deep puncture wounds should be flushed with a catheter and soapy
water. Unless absolutely necessary, a wound should not be sutured.
- Tetanus toxoid and antibiotics will usually be administered.
- Rabies vaccination may or not be given, based on the available
information. If the individual was bitten by a domestic animal and
the animal was captured, the animal will be placed under
observation in quarantine for ten days. If the animal does not
develop rabies within four to seven days, then no immunizations
are required. If the animal is suspected of being rabid, it is
killed, and the brain is examined for evidence of rabies infection.
In cases involving bites from domestic animals where the animal is
not available for examination, the decision for vaccination is
made based on the prevalence of rabies within the region where the
bite occurred. If the bite was from a wild animal and the animal
was captured, it is generally killed because the incubation period
of rabies is unknown in most wild animals.
- If necessary, the patient is vaccinated immediately, generally
through the administration of human rabies immune globulin (HRIG)
for passive immunization, followed by human diploid cell vaccine (HDCV)
or rabies vaccine adsorbed (RVA) for active immunization. Passive
immunization is designed to provide the individual with antibodies
from an already immunized individual, while active immunization
involves stimulating the individual's own immune system to produce
antibodies against the rabies virus. Both rabies vaccines are
equally effective and carry a lower risk of side effects than some
earlier treatments. Unfortunately, however, in underdeveloped
countries, these newer vaccines are usually not available.
Antibodies are administered to the patient in a process called
passive immunization. To do this, the HRIG vaccine is administered
once, at the beginning of treatment. Half of the dose is given
around the bite area, and the rest is given in the muscle.
Inactivated viral material (antigenic) is then given to stimulate
the patient's own immune system to produce antibodies against
rabies. For active immunization, either the HDCV or RVA vaccine is
given in a series of five injections. Immunizations are typically
given on days one, three, seven, 14, and 28.
In those rare instances in which rabies has
progressed beyond the point where immunization would be effective,
the patient will be given medication to prevent seizures, relieve
some of the anxiety, and relieve painful muscle spasms. Pain
relievers will also be given. In the later stages, aggressive
supportive care will be provided to maintain breathing and heart
function. Survival is rare but can occur. |
