Question
Prophylaxis of rabies
Answer
Rabies prophylaxis combines wound management, active immunization (vaccine), and passive immunization (Rabies Immunoglobulin), tailored to the WHO exposure category.
Wound management: immediate, thorough washing of the wound with soap and water for at least 15 minutes, followed by a virucidal agent (povidone-iodine or alcohol); suturing is generally avoided/delayed.
WHO exposure categories: Category I (touching/feeding animals, licks on intact skin) — no prophylaxis needed; Category II (minor scratches/abrasions without bleeding) — wound care plus vaccine alone; Category III (transdermal bites/scratches, mucous membrane licks, bat contact) — wound care, vaccine PLUS Rabies Immunoglobulin (RIG).
Active immunization: modern cell-culture-derived vaccines (HDCV, PCECV, PVRV) given intramuscularly or intradermally on a defined multi-dose schedule (e.g., days 0, 3, 7, 14, ± 28).
Passive immunization: RIG for Category III exposures — infiltrated around the wound with any remainder given intramuscularly at a distant site, providing immediate neutralizing antibody before the patient’s own active immune response develops; human RIG is preferred over equine RIG given lower hypersensitivity risk.
Pre-exposure prophylaxis: recommended for high-risk occupational groups (veterinarians, animal handlers).
General prevention: animal (dog) vaccination programmes and public health education.