CURRENT RECOMMENDATIONS FOR THE PROPHYLAXIS AND TREATMENT OF RABIES

Once onset of clinical rabies develops in an individual; death is inev itable. Thus, it is imperative that, for persons exposed or potentiall y exposed to rabies virus, prophylaxis must be instituted as soon as p ossible following the exposure. Local wound management is an essential part of postexposure rabies prophylaxis. Exposed persons should recei ve a recommended series of a tissue culture or cell culture origin vac cine. The number of doses and route of vaccination differ in various r egions of the world and are discussed in the text. The administration of a rabies immune globulin is generally recommended in conjunction wi th the first dose of the rabies vaccine. Nerve tissue origin vaccines, although used extensively in some parts of the world, are not recomme nded if cell or tissue culture vaccines are available. Decision trees are presented in the text to aid in determining if rabies vaccine is n ecessary following a known or presumed exposure to the virus, along wi th a table outlining the various rabies vaccines available in the Worl d. Rabies pre-exposure immunisation is recommended for those individua ls at risk of exposure to the virus. Pre-exposure prophylaxis consists of 3 doses of an approved rabies vaccine administered either intramus cularly or intradermally on days 0, 7, and 21 or 28 with periodic boos ter doses or titre determination depending on the level of risk of pot ential exposure to the virus.