Rabies

If you have been exposed (bitten, scratched or licked) by an animal that might have rabies, you'll need to seek medical advice to determine whether you need to have a course of treatment to prevent rabies.

This is called post-exposure treatment. It can usually prevent a rabies infection from becoming established and producing symptoms.

Post-exposure treatment

Post-exposure treatment 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 as this could expose your nerve endings to the rabies virus
• go to the nearest hospital or medical centre and explain 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 you've been in a high-risk situation, you may alsobe given an injection of rabies immunoglobulin as well as the rabies vaccination. Thishelps protectyou against the virus while your body is developing antibodiesafter vaccination.

The immunoglobulin works by providingready-made antibodies designed to neutralise the rabies virus and prevent it spreading. Apart 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.

You should receive five doses of the vaccine if you've never been vaccinated. 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 seconddosethree tosevendays 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

Worldwide, 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, whichis created by using samples of nerves taken from animal brains

TheWorld Health Organization (WHO)only recommendspurified 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 foundthis type of vaccine has a 1 in 650 chance of causing serious complicationsthat can result in permanent disability, such as muscle paralysis. Despite this, it should be takenif it is the only vaccine available.

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

Supportive treatment

Once a person develops symptoms, the disease is usually fatal. Treatment involves keeping the person comfortable and treating complications.

To date, there have been no reported cases of human-to-human transmission of rabies. However, it'stheoretically possible, so anyone who has beenin close contactwithsomeone who has a rabies infection may be advised to have post-exposure treatment as a precaution.