Treating rabies 

The treatment given for rabies depends on whether you've started to show signs or symptoms.

If you show no signs or symptoms, but infection is suspected, a course of treatment called post-exposure prophylaxis (PEP) is used. This can usually prevent a rabies infection from becoming established and producing symptoms.

If you have symptoms of rabies, treatment usually focuses on making you as comfortable as possible. This is because rabies is almost always fatal when it reaches this stage.

These two types of treatment are described in more detail below.

Post-exposure prophylaxis

Post-exposure prophylaxis involves three stages:

  • cleaning the wound
  • administering rabies immunoglobulin – a special preparation of antibodies
  • administering a course of the rabies vaccine

Cleaning the wound

Immediately after being bitten, you should:

  • wash the wound thoroughly under a running tap
  • use antiseptic or alcohol to clean the wound and apply ethanol, tincture or aqueous solution of iodine, if available
  • leave the wound open – use a simple dressing, but don't try to stitch it, because this could expose your nerve endings to the rabies virus
  • go to the nearest hospital or medical centre and explain that you've been bitten

If you think your eye may have been infected with the saliva of an animal, wash it thoroughly with clean water and seek medical help.

Rabies immunoglobulin

If there is a high risk of you being infected with rabies, you should be given an injection of rabies immunoglobulin. This should help to protect you against the virus and prevent it travelling to your nervous system.

The immunoglobulin works by providing ready-made antibodies designed to neutralise the rabies virus and prevent it from spreading.

Aside from some temporary soreness at the injection site, rabies immunoglobulin doesn't usually cause any side effects.

Vaccination

The rabies vaccine should be given in every case of suspected exposure to rabies. The length of your vaccination course will depend on whether you have previously been vaccinated.

If you've never been vaccinated, you should receive five doses of the vaccine. The first dose is given at the beginning of the treatment, followed by four further doses, which are given three, seven, 14 and 30 days after the start of treatment.

If you've previously been vaccinated, you should receive two doses of the vaccine. The first dose is given at the start of your treatment, followed by a second dose three to seven days later. The doses are given by injection into the shoulder muscle.

A common side effect of the rabies vaccine is redness, swelling and pain at the injection site, which occurs 24 to 48 hours after the injection has been given.

Choice of vaccine

There are three types of rabies vaccine:

  • human diploid cell vaccine (HDCV), which is created by using samples of human cells
  • purified chick embryo cell rabies vaccine (PCEC), which is created by using samples of chicken embryos 
  • nerve tissue vaccine, which is created using samples of nerves taken from animal brains

The World Health Organization (WHO) recommends that only purified cell culture or embryonated egg-based vaccines (CCEEVs), which include HDCV or PCEC, should be used. This is because there are safety concerns over the nerve tissue vaccine. Researchers have found that this type of vaccine has a one in 650 chance of causing serious complications that can result in permanent disability, such as muscle paralysis.

A small number of countries have not followed the WHO recommendation and still use the nerve tissue vaccine. They include Ecuador, Peru, Myanmar (Burma) and Pakistan.

In many developing countries, the HDCV or PCEC vaccine may only be available if you're willing to pay for private treatment.

If you're offered the nerve tissue vaccine, it's recommended that you refuse and ask for one of the alternative vaccines.

Supportive treatment

If a person who is infected with rabies isn't treated and they have developed symptoms, rabies is said to be established.

In this situation, there is almost nothing that can be done apart from keeping them comfortable. This is usually done by using powerful tranquilisers and sedatives to keep them free from physical pain and emotional upset.

To date, there have been no reported cases of human-to-human transmission of rabies. However, it's theoretically possible, so anyone who has been in close contact with someone who has a rabies infection may be advised to have post-exposure prophylaxis as a precaution.

Page last reviewed: 17/02/2015

Next review due: 17/02/2017