Rabies is caused by a rhabdovirus often present in the saliva of rabid animals that attacks the central nervous system. Transmission is by inoculation into a wound, usually introduced through the bite of a rabid animal, and rarely by exposure of a mucous membrane or fresh skin abrasion to infected saliva. Treatment is largely symptomatic and includes vigorous supportive treatment.

Rabies is an entirely preventable disease. Prevention includes:

• Pre-exposure immunisation of all persons at risk e.g. vets, animal handlers
• Immunisation of dogs
• Correct post-exposure prophylaxis for all non-immune persons.

Post-exposure treatment:

The combination of:
1. Prompt local treatment of the wound
2. Passive immunisation with rabies immunoglobulin
3. Active immunisation with the vaccine
is the recommended protocol for all severe exposures (see below)

Local Treatment of the wound should include:

• Scrubbing with soap and water for 5 minutes
• Removal of foreign material
• Application of a virucidal agent such as povidone iodine or aqueous iodine, if possible
• Do not suture the wound
• Anti-tetanus treatment and/or antibiotics where indicated

Passive immunisation
Rabies immunoglobulin is indicated for all persons known or suspected to have been exposed to the rabies virus and is used in conjunction with the rabies vaccine (active immunisation administered at the same time, but at a different anatomical site). Rabies immunoglobulin must be given for any mucous membrane exposure to saliva i.e. licks, and all single and multiple bites or scratches inflicted by a suspected rabid animal, especially if associated with any signs of bleeding, irrespective of the interval between exposure and initiation of treatment. Individuals previously immunised with rabies vaccine and whose antibody titre has been recently confirmed as adequate should be treated with vaccine only.

Category	Type of contact with a suspected rabid domestic or wild animala or animal unavailable for observation	Recommended treatment
I	Touching or feeding of animals Licks on intact skin	None, if reliable case history is available
II	Nibbling of uncovered skin Minor scratches or abrasions without bleeding Licks on broken skin	Administer vaccine immediatelyb Stop treatment if animal remains healthy throughout an observation period c of 10 days or if animal is killed humanely and found to be negative for rabies by appropriate laboratory techniques
III	Single or multiple transdermal bites or scratches	Administer rabies immunoglobulin and vaccine immediatelyb.
	Contamination of mucous membrane with saliva (i.e. licks)	Stop treatment if animal remains healthy throughout an observation period c of 10 days or if animal is killed humanely and found to be negative for rabies by appropriate laboratory technique

Rabies immunoglobulin can only be obtained with a doctor's prescription. Discuss with your doctor why it has been prescribed for you and the benefits and risks of this medicine.

Click here for further information on rabies and its management in South Africa.