Two different types of treatment can be used in cases of rabies:
- post-exposure prophylaxis – treatment is given to prevent a rabies infection taking place
- supportive care – treatment is given to make someone with an active rabies infection feel as comfortable as possible
These two types of treatment are described in more detail below.
Post-exposure prophylaxis
Post-exposure prophylaxis consists of three stages:
- cleaning the wound
- administering rabies immunoglobulin – this special preparation of antibodies protects against the rabies virus
- administering a course of the rabies vaccine
Cleaning the wound
Immediately after being bitten, you should:
- wash the wound thoroughly with soap and water under a running tap
- use antiseptic or alcohol to clean the wound, apply ethanol, tincture or aqueous solution of iodine, if available
- leave the wound open – do not 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 have been bitten
Where possible, the animal that bit you should be captured and observed for five to 10 days (see rabies - diagnosis), and you should inform the police and relevant authorities.
Rabies immunoglobulin
After being bitten, you should be given an injection of rabies immunoglobulin as soon as possible. This should help to neutralise the virus and prevent it from travelling to your nervous system. The immunoglobulin works by stimulating the production of antibodies that can stop the virus from spreading.
Aside from some temporary soreness at the site of the injection, rabies immunoglobulin does not usually cause any side effects.
Vaccination
The length of your course of vaccinations will depend on whether you have previously been vaccinated.
If you have 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 have previously been vaccinated, you should receive two doses of the vaccine. The first dose is given at the start of your treatment and it will be followed by the second one three 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 site of the injection that 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 is created by using samples of nerves taken from animal brains
The World Health Organisation (WHO) recommends that only HDCV or PCEC should be used.
This is because safety concerns have arisen over the nerve tissue vaccine. Researchers have found that this type of vaccine has a 1 in a 650 chance of causing serious complications, such as muscle paralysis, which can result in permanent disability.
A small number of countries have not followed WHO’s recommendation and still use the nerve tissue vaccine. They include:
- Argentina
- Bangladesh
- Burma
- Pakistan
- Peru
Also, in many developing countries the HDCV or PCEC vaccine may only be available if you are willing to pay for private treatment.
If you are offered the nerve tissue vaccine, it is recommended that you should refuse and ask for one of the alternative vaccines.
Supportive treatment
If a person who is infected with rabies is not treated and they have developed symptoms (see rabies - symptoms), rabies is said to be established.
In this situation, there is 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 is theoretically possible, so anyone who has been exposed to the bodily fluids of someone with a rabies infection may be advised to have post-exposure prophylaxis as a precaution.
