**4.2 Rabies**

Fortunately, rabies infections are a rare occurrence. Prevention is critical, particularly when the outcome is approximately 100% mortality when infection


#### **Table 3.**

*Guideline for tetanus vaccines and immunoglobin<sup>1</sup> .*

develops [9, 25]. Post-exposure rabies prophylaxis is provided to approximately 40,000 people per year [9]. Between 1 and 3 people die per year in the United States from a rabies infection [25]. When an animal infected with rabies bites a person, the saliva containing the rabies is deposited into the tissues and incubates for 20 to 90 days [4, 25]. The virus then travels to the central nervous system where it causes the rapid development of symptoms [4, 25]. The first step in determining what type of rabies prophylaxis is needed is to evaluate the health of the dog. If the pet is healthy and able to be observed for 10 days, then prophylaxis only needs to be administered if the animal begins exhibiting signs of rabies development [9, 25]. If the dog is known or suspected to be rabid, rabies immunization and rabies immunoglobulin should be administered as soon as possible [9, 25]. The animal itself should be euthanized and tested for rabies as soon as possible [9, 25]. Immunization can be discontinued if there are negative test results [9, 25]. If the status of the animal is unknown, consult the local public health department for guidance.

Use of both active and passive prophylaxis is warranted once wound care has been completed and the patient is categorized as needing postexposure prophylaxis [9, 25]. Unvaccinated or immunocompetent children need the full 4-dose series of rabies vaccinations along with the human rabies immune globulin [9, 25]. Rabies immunoglobulin should be administered around the wound and given only on day 0 [9, 25]. The vaccinations should be scheduled on days 0, 3, 7, and 14 of wound infliction [9, 25]. Children who have previously undergone rabies vaccination should receive only a vaccine booster shot and do not require rabies immunoglobulin [9, 25]. All animal bites should be reported to the county and state health department and local animal control for record maintenance [25].
