II. Epidemiology
- Worldwide: Responsible for 59,000 deaths worldwide per year
- Children under age 15 years account for 40% of cases
- U.S.
- Eight human cases of Rabies per year
- Up to 8000/year in U.S. of documented cases of Rabies in animals
III. Pathophysiology
- Transmitted by bite of infected mammals
- Saliva, brain and other nerve tissue are infectious
- Blood, urine, and stool are not infectious
- Highest risk animals
- Bats
- See Bat Bite
- Responsible for most U.S. cases of Rabies (87% of cases 1980-2015)
- Dogs
- See Dog Bite
- Worldwide, these are main vector for infection
- Responsible for 11 of 31 U.S. human Rabies cases 2003-2016
- Rabies is less common in dogs (70 cases/year in U.S.)
- Cats
- See Cat Bite
- Most common domesticated animal with Rabies in U.S. (257 cases of cats with Rabies in 2012)
- Raccoons
- Skunks
- Foxes
- Coyotes
- Bobcats
- Woodchucks
- Ferrets
- Bats
IV. Symptoms
- Early
- Local radiating Paresthesia from bite site
- Malaise
- Nausea
- Pharyngitis
- Late
- Restlessness
- Hallucinations
- Aerophobia and hydrophobia are pathognomonic
V. Signs
- Early
- Wound Inflammation
- Hyperesthesia at wound site
- Late
- Dysarthria
- Hoarseness
- Aphonia
- Dysphagia for fluids
- Shallow or irregular breathing
- Seizure
- Delirium
- Opisthotonos stimulated by lights or noises
- Hyperactive Deep Tendon Reflexes
- Nuchal Rigidity
- Abnormal Babinski reflex (Up-going toes)
- Terminal signs
- Flaccid Paralysis
- Hospitalization <1 week after symptom onset
- Coma within one week of encephalopathy signs
- Death
VI. Labs
-
Saliva
- Contains virus
- Microscopic exam
- Brain and spinal cord of suspected infected animal
- Live Observation of suspected infected mammal
VII. Management
- See Rabies Prophylaxis
- See Dog Bite
VIII. Prevention
-
Rabies Vaccine
- For Rabies Postexposure Prophylaxis and preexposure prophylaxis
- Rabies Immunoglobulin
- Avoid bat exposure
- Remove bat roosts from home
- Bats trapped within a home living space are more likely to be sick (disabled navigation)
- Pets should be vaccinated against Rabies
- In U.S., of pets causing a bite evaluated in ER, only 45% of dogs and 8% of cats were vaccinated against Rabies
- Test for Rabies in pets who succumb to illness quickly
IX. References
- Swaminathan and Hope in Herbert (2018) EM:Rap 18(12): 11-2
- Messenger (2002) Clin Infect Dis 35:738-47 [PubMed]
- Wilde (2003) Clin Infect Dis 37:96-100 [PubMed]
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| Definition (HL7V3.0) | <p>rabies vaccine, NOS</p> |
| Definition (MSH) | Vaccines or candidate vaccines used to prevent and treat RABIES. The inactivated virus vaccine is used for preexposure immunization to persons at high risk of exposure, and in conjunction with rabies immunoglobulin, for postexposure prophylaxis. |
| Definition (CSP) | vaccines or candidate vaccines used to prevent and/or treat rabies. |
| Concepts | Pharmacologic Substance (T121) , Immunologic Factor (T129) , Organic Chemical (T109) |
| MSH | D011819 |
| SnomedCT | 333606008, 396437008 |
| CPT | 90676, 90675 |
| HL7 | 90 |
| English | Rabies Human Diploid Cell Vaccine, Rabies Vaccine, Vaccine, Rabies, rabies vaccine, human diploid cell, Rabies Vaccines [Chemical/Ingredient], rabies vaccines, vaccines rabies, Vaccines, Rabies, Rabies vaccines, rabies vaccine, vaccines viral rabies, rabies vaccine (medication), rabies vaccine, human diploid, Rabies vaccine, Rabies vaccine (product), Rabies vaccine (substance), rabies, NOS, Rabies Vaccines, RABIES VACCINE |
| Spanish | Vacunas Antirrábicas, Vacunas contra la Rabia, vacuna antirrábica (producto), vacuna antirrábica (sustancia), vacuna antirrábica |
| Swedish | Rabiesvacciner |
| Czech | vzteklina - vakcíny, rabies - vakcíny |
| Finnish | Vesikauhurokotteet |
| Russian | VAKTSINY PROTIV BESHENSTVA, ВАКЦИНЫ ПРОТИВ БЕШЕНСТВА |
| Japanese | 狂犬病ワクチン, ワクチン-狂犬病 |
| Italian | Vaccino rabico, Vaccino rabico su cellule umane diploidi, Vaccini rabici |
| Croatian | BJESNOĆA, CJEPIVA |
| Polish | Szczepionki przeciw wściekliźnie |
| Portuguese | Vacinas Antirrábicas, Vacinas contra Raiva |
| French | Vaccins antirabiques |
| German | Impfstoffe, Rabies-, Impfstoffe, Tollwut-, Rabiesvakzinen, Tollwutimpfstoffe, Tollwutvakzinen, Vakzinen, Rabies-, Vakzinen, Tollwut- |
