Abstract
Rabies is a viralzoonosis that causes approximately 50,000 to 100,000 deaths per year worldwide. Most deaths occur in developing countries. Dogs are the major vector, especially in developing countries. The virus is usually transmitted to humans by infected saliva through the bite of a rabid animal; the incubation period averages 30 to 90 d. Hyperexcitability, autonomic dysfunction, hydrophobia, and aerophobia are characteristic of encephalitic rabies, which accounts for 80% of cases. The paralytic form is characterized by flaccid paralysis in the bitten limb, which ascends symmetrically or asymmetrically. Once symptoms develop, the disease is invariably fatal. Animal rabies can be controlled by proper induction of herd immunity, humane removal of stray animals, promotion of responsible pet ownership through education, and enactment of leash laws. Preexposure vaccination with modern cell culture vaccine is recommended for people at high risk of exposure to rabies and for travelers who spend longer than 1 mo in countries where rabies is a constant threat, or who travel in a country where immediate access to appropriate care is limited. Postexposure prophylaxis consists of prompt and thorough wound cleansing and immunization with modern cell culture vaccine, together with administration of rabies immune globulin to those individuals who have not previously received preexposure prophylaxis.
Similar content being viewed by others
References
Hankins DG, Rosekrans JA. Overview, prevention, and treatment of rabies.Mayo Clin Proc. 2004; 79:671–676.
Moore SM, Wilkerson MJ, Davis RD, et al. Detection of cellular immunity to rabies antigens in human vaccines.J Clin Immunol. 2006;26:533–545.
Bronnert J, Wilde H, Tepsumethanaon V, et al. Organ transplantations and rabies transmission.J Travel Med. 2007;14:177–180.
Rupprecht CE, Willoughby R, Slate D, et al. Current and future trends in the prevention, treatment and control of rabies.Expert Rev Anti Infect Ther. 2006;4:1021–1038.
Pounder D. Avoiding rabies.BMJ. 2005;331:469–470.
Meslin FX. Rabies as a traveler’s risk, especially in high-endemicity areas.J Travel Med. 2005; 12:S30-S40.
Toltzis P. Rabies. In: Kliegman RM, Behrman RE, Jenson HB, et al, eds.Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders Elsevier; 2007:1423–1426.
Mani CS, Murray DL. Rabies.Pediatr Rev. 2006;27:129–136.
Committee to Advise on Tropical Medicine and Travel (CATMAT). Statement on travelers and rabies vaccine.CCDR. 2002;28(ACS-4):1–12.
Hon KL, Fu CC, Chor CM, et al. Issues associated with dog bite injuries in children and adolescents assessed at the emergency department.Pediatr Emerg Care. 2007;23:445–449.
Rupprecht CE, Hanlon CA, Hemachudha T, et al. Rabies re-examined.Lancet Infect Dis. 2002; 2:327–343.
Plotkin SA. Rabies (hydrophobia, rage, lyssa). In: Gershon AA, Hotez PJ, Katz SL, eds.Krugman’s Infectious Diseases of Children. 11th ed. Philadelphia: Mosby; 2004:477–491.
Dietzschold B, Faber M, Schnell MJ, et al. New approaches to the prevention and eradication of rabies.Expert Rev Vaccines. 2003;2:399–406.
Jackson AC. Rabies virus infection: an update.J Neurovirol. 2003;9:253–258.
Hemachudha T, Wacharapluesadee S, Laothamatas J, et al. Rabies.Curr Neurol Neurosci Rep. 2006;6:460–468.
Warrell MJ, Warrell DA. Rabies and other lyssavirus diseases.Lancet. 2004;363:959–969.
McKay N, Wallis L. Rabies: a review of UK management.Emerg Med J. 2005;22:316–321.
Durai R, Venkatraman R. Human rabies and its prevention.Br J Hosp Med. 2006;67:588–593.
Rupprecht CE, Gibbons RV. Prophylaxis against rabies.N Engl J Med. 2004;351:2626–2635.
Leung AK, Robson WL. Penile dog bite in an adolescent.Adv Pediatr. 2005;22:363–367.
Hendekli CM. Current therapies in rabies: brief review.Arch Virol. 2005;150:1047–1057.
Virk A, Jong EC. Rabies vaccine. In: Keystone JS, Kozarsky PE, Freedman DO, et al, eds.Travel Medicine. Philadelphia: Mosby; 2004:106–109.
Jackson AC. Update on rabies.Curr Opin Neurol. 2002;15:327–331.
National Advisory Committee on Immunization (NACI). Update on rabies vaccine.CCDR. 2005;31(ACS-5):1–8.
Paul R, O’Connell CB. Current approaches to rabies prevention and prophylaxis.JAAPA. 2002;15:16–35.
World Health Organization (WHO) Expert Committee on Rabies.Technical Report 931. Geneva, Switzerland: WHO; 2005.
Gherardin A, Lau S. Intradermal rabies vaccine.Med J Aust. 2007;187:58–59.
Nicholson KG, Farrow RR, Bijok U, et al. Pre-exposure studies with purified chick embryo cell culture rabies vaccine and human diploid cell vaccine: serological and clinical responses in man.Vaccine. 1987;5:208–210.
Sudarshan MK, Ananda Giri MS, Mahendra BJ, et al. Assessing the safety of post exposure rabies immunization in pregnancy.Human Vaccines. 2007;3:61–63.
Dreesen DW. A global review of rabies vaccine for human use.Vaccine. 1997;15(suppl):S2-S6.
Dobardzic A, Izurieta H, Woo EJ, et al. Safety review of the purified chick embryo cell rabies vaccine: data from the Vaccine Adverse Event Reporting System (VAERS), 1997–2005.Vaccine. 2007;25:4244–4251.
Wilde H, Briggs DJ, Meslin FX, et al. Rabies update for travel medicine advisors.Clin Infect Dis. 2003;37:96–100.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Leung, A.K.C., Davies, H.D. & Hon, KL.E. Rabies: Epidemiology, pathogenesis, and prophylaxis. Adv Therapy 24, 1340–1347 (2007). https://doi.org/10.1007/BF02877781
Issue Date:
DOI: https://doi.org/10.1007/BF02877781