Rabies Treatment and Prevention Guidelines

Introduction to Rabies

The Advisory Committee on Immunization Practices (ACIP) states that no proven effective medical treatment is recognized after the development of clinical signs of rabies 1, 2, 3, 4
Rabies is associated with the highest case fatality rate of any infectious disease and is not considered curable 1, 2, 3, 4

When a definitive diagnosis of rabies is obtained, primary health considerations should focus, at a minimum, on comfort care and adequate sedation of the patient in an appropriate medical facility 1, 2, 3, 4
Sedation is necessary because patients become extremely agitated in the presence of stimuli such as loud noises, air currents, and the sight or sound of running water during the acute neurologic phase 1, 2, 3, 4
Patient stress may be compounded by psychological trauma from isolation and hopelessness during fluctuating periods of lucidity 1, 2, 3, 4

Medical staff at specialized tertiary care hospitals might consider aggressive experimental therapies only in confirmed cases in young healthy persons at an early stage of clinical disease, after in-depth discussions and informed consent 1, 2, 3, 4
Families must be aware of the high probability for treatment failure, anticipated expenses, and that rare survivors may have serious neurological sequelae requiring lengthy rehabilitation 1, 2, 3, 4
Survival has been well documented for only six patients total 1, 2, 3, 4
Five of these six survivors had received rabies vaccination before the onset of disease 1, 2, 3, 4
Only one patient has recovered from rabies without prior rabies vaccination 1, 2, 3, 4

Postexposure prophylaxis combining wound treatment, local infiltration of rabies immune globulin, and vaccination is uniformly effective when appropriately administered before symptom onset 5