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Rabies

Last edited: 4/14/2026

Overview

Rabies is a fatal viral encephalitis transmitted through the saliva of infected mammals, primarily via bites. It affects the central nervous system and is nearly always fatal once clinical symptoms appear 113.

Diagnosis

  • Clinical Presentation: History of animal bite, neurological symptoms (agitation, confusion, paralysis) 13.
  • Diagnostic Tests:
    • - Neurological Examination: Look for signs of encephalitis. - Serology: Antibody detection in serum and CSF using mouse neutralization test (MNT) or immunoelectron microscopy (IEM) 25. - Virus Detection: RT-PCR or viral isolation from saliva, CSF, or brain tissue 13.
  • Post-Exposure Assessment: Evaluate animal behavior, vaccination status, and wound characteristics 426.

    • Management

  • Postexposure Prophylaxis (PEP):
    • - Rabies Immune Globulin (RIG): Administered as soon as possible after exposure, especially around the wound site 417. - Rabies Vaccines: - HDCV (Imovax): Six doses over 1-2 weeks (adults: 1 mL IM, children: adjusted dose) 12. - PCEC (RabAvert): Four doses over 14 days (1 mL IM) 15.
  • Preexposure Prophylaxis:
    • - Vaccination Series: Three doses of HDCV or PCEC over 4-6 weeks for individuals at high risk 13.

    Special Populations

  • Pediatrics: Adjusted vaccine doses based on weight; PEP protocols similar to adults 112.
  • Elderly: No specific modifications noted; standard PEP protocols apply 13.
  • Comorbidities: No specific adjustments mentioned; manage based on overall health status 13.

    • Key Recommendations

  • Administer rabies immune globulin as soon as possible after exposure, ideally around the wound site, to all patients requiring PEP 417 (Evidence: Strong).
  • Use either HDCV or PCEC for PEP, following standardized dosing schedules for both preexposure and postexposure prophylaxis 1215 (Evidence: Strong).
  • Consider the epidemiological context and animal behavior when assessing risk of rabies exposure 26 (Evidence: Moderate).
  • Ensure healthcare providers are knowledgeable about rabies PEP protocols to minimize improper administration 4 (Evidence: Moderate).
  • Monitor for adverse events post-vaccination, particularly neurological events, through surveillance systems like VAERS 1215 (Evidence: Moderate).

    • References

    1 Tombari W, Khamessi O, Othman H, Kallala O, Mahjoub R, Ghedira K et al.. A novel mRNA-based multi-epitope vaccine for rabies virus computationally designed via reverse vaccinology and immunoinformatics. Scientific reports 2025. link 2 Jarvis S. On a mission to eliminate rabies. The Veterinary record 2023. link 3 Rasizadeh R, Hossein Bannazadeh Baghi. Increase in rabies cases during COVID-19 pandemic: Is there a connection?. Journal of infection in developing countries 2023. link 4 Gibbons K, Dvoracek K. Rabies postexposure prophylaxis: What the U.S. emergency medicine provider needs to know. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2023. link 5 Mills G. Big data drive efficient rabies vaccination. The Veterinary record 2021. link 6 Li W, Zeng F, Zhou W, Chen Z. Internet Public Opinion Diffusion Mechanism in Public Health Emergencies: Based on Entropy Flow Analysis and Dissipative Structure Determination. Frontiers in public health 2021. link 7 Sikana L, Lembo T, Hampson K, Lushasi K, Mtenga S, Sambo M et al.. Dog ownership practices and responsibilities for children's health in terms of rabies control and prevention in rural communities in Tanzania. PLoS neglected tropical diseases 2021. link 8 Nguyen AKT, Vu AH, Nguyen TT, Nguyen DV, Ngo GC, Pham TQ et al.. Risk Factors and Protective Immunity Against Rabies in Unvaccinated Butchers Working at Dog Slaughterhouses in Northern Vietnam. The American journal of tropical medicine and hygiene 2021. link 9 Huang S, Zhu Z, Hu Q. Response to letter to the editor on analysis. Human vaccines & immunotherapeutics 2019. link 10 Cavaillon JM, Legout S. Duclaux, Chamberland, Roux, Grancher, and Metchnikoff: the five musketeers of Louis Pasteur. Genes and immunity 2019. link 11 Sabeta CT, Janse van Rensburg D, Phahladira B, Mohale D, Harrison-White RF, Esterhuyzen C et al.. Rabies of canid biotype in wild dog (Lycaon pictus) and spotted hyaena (Crocuta crocuta) in Madikwe Game Reserve, South Africa in 2014-2015: Diagnosis, possible origins and implications for control. Journal of the South African Veterinary Association 2018. link 12 Moro PL, Woo EJ, Paul W, Lewis P, Petersen BW, Cano M. Post-Marketing Surveillance of Human Rabies Diploid Cell Vaccine (Imovax) in the Vaccine Adverse Event Reporting System (VAERS) in the United States, 1990‒2015. PLoS neglected tropical diseases 2016. link 13 Weant KA, Baker SN. Review of human rabies prophylaxis and treatment. Critical care nursing clinics of North America 2013. link 14 Bassi EJ, Vernal J, Zanluca C, Terenzi H, Zanetti CR. Expression, purification and immunodetection of a recombinant fragment (residues 179-281) of the G protein from rabies virus ERA strain. Protein expression and purification 2008. link 15 Dobardzic A, Izurieta H, Woo EJ, Iskander J, Shadomy S, Rupprecht C 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. link 16 Moore GE, Ward MP, Kulldorff M, Caldanaro RJ, Guptill LF, Lewis HB et al.. A space-time cluster of adverse events associated with canine rabies vaccine. Vaccine 2005. link 17 Jerrard DA. The use of rabies immune globulin by emergency physicians. The Journal of emergency medicine 2004. link 18 Stringer C. Post-exposure rabies vaccination. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2003. link 19 Dutta JK. Bite by a dog under provocation: is it free from risk?. Journal of the Indian Medical Association 2002. link 20 Wernig JM, Sladic T, Brecelj A, Kovac Z. Rabies surveillance and control measures in Slovenia. Medicinski pregled 2001. link 21 . Rabies, quarantine and the veterinary profession: the BVA's position. The Veterinary record 1999. link 22 Wojczyk B, Shakin-Eshleman SH, Doms RW, Xiang ZQ, Ertl HC, Wunner WH et al.. Stable secretion of a soluble, oligomeric form of rabies virus glycoprotein: influence of N-glycan processing on secretion. Biochemistry 1995. link 23 Linhart SB. Some factors affecting the oral rabies vaccination of free-ranging carnivores. Revue scientifique et technique (International Office of Epizootics) 1993. link 24 Nieuwenhuis HU. The rabies situation in The Netherlands. Parassitologia 1988. link 25 Chaudhary RK, Cho HC, Monette MT. Measurement of antibodies to rabies virus by immunoelectron microscopy. Canadian journal of microbiology 1979. link 26 Corey L, Hattwick MA, Rubin RJ. Dealing with possible rabies exposure. Postgraduate medicine 1976. link 27 Tzianabos T, Hebert GA, White LA. Preparation of rabies fluorescein isothiocyanate-labeled immune globulin from mouse hyperimmune ascitic fluids. Journal of clinical microbiology 1976. link 28 Lavender JF, Van Frank RM. Zonal-centrifuged purified duck embryo cell culture rabies vaccine for human vaccination. Applied microbiology 1971. link 29 Black JG, Lawson KF. Sylvatic rabies studies in the silver fox (Vulpes vulpes). Susceptibility and immune response. Canadian journal of comparative medicine : Revue canadienne de medecine comparee 1970. link

    Original source

    1. [1]
      A novel mRNA-based multi-epitope vaccine for rabies virus computationally designed via reverse vaccinology and immunoinformatics. — Tombari W, Khamessi O, Othman H, Kallala O, Mahjoub R, Ghedira K et al. Scientific reports (2025)
    2. [2]
      On a mission to eliminate rabies. — Jarvis S The Veterinary record (2023)
    3. [3]
      Increase in rabies cases during COVID-19 pandemic: Is there a connection? — Rasizadeh R, Hossein Bannazadeh Baghi Journal of infection in developing countries (2023)
    4. [4]
      Rabies postexposure prophylaxis: What the U.S. emergency medicine provider needs to know. — Gibbons K, Dvoracek K Academic emergency medicine : official journal of the Society for Academic Emergency Medicine (2023)
    5. [5]
      Big data drive efficient rabies vaccination. — Mills G The Veterinary record (2021)
    6. [6]
      Internet Public Opinion Diffusion Mechanism in Public Health Emergencies: Based on Entropy Flow Analysis and Dissipative Structure Determination. — Li W, Zeng F, Zhou W, Chen Z Frontiers in public health (2021)
    7. [7]
      Dog ownership practices and responsibilities for children's health in terms of rabies control and prevention in rural communities in Tanzania. — Sikana L, Lembo T, Hampson K, Lushasi K, Mtenga S, Sambo M et al. PLoS neglected tropical diseases (2021)
    8. [8]
      Risk Factors and Protective Immunity Against Rabies in Unvaccinated Butchers Working at Dog Slaughterhouses in Northern Vietnam. — Nguyen AKT, Vu AH, Nguyen TT, Nguyen DV, Ngo GC, Pham TQ et al. The American journal of tropical medicine and hygiene (2021)
    9. [9]
      Response to letter to the editor on analysis. — Huang S, Zhu Z, Hu Q Human vaccines & immunotherapeutics (2019)
    10. [10]
      Duclaux, Chamberland, Roux, Grancher, and Metchnikoff: the five musketeers of Louis Pasteur. — Cavaillon JM, Legout S Genes and immunity (2019)
    11. [11]
      Rabies of canid biotype in wild dog (Lycaon pictus) and spotted hyaena (Crocuta crocuta) in Madikwe Game Reserve, South Africa in 2014-2015: Diagnosis, possible origins and implications for control. — Sabeta CT, Janse van Rensburg D, Phahladira B, Mohale D, Harrison-White RF, Esterhuyzen C et al. Journal of the South African Veterinary Association (2018)
    12. [12]
      Post-Marketing Surveillance of Human Rabies Diploid Cell Vaccine (Imovax) in the Vaccine Adverse Event Reporting System (VAERS) in the United States, 1990‒2015. — Moro PL, Woo EJ, Paul W, Lewis P, Petersen BW, Cano M PLoS neglected tropical diseases (2016)
    13. [13]
      Review of human rabies prophylaxis and treatment. — Weant KA, Baker SN Critical care nursing clinics of North America (2013)
    14. [14]
      Expression, purification and immunodetection of a recombinant fragment (residues 179-281) of the G protein from rabies virus ERA strain. — Bassi EJ, Vernal J, Zanluca C, Terenzi H, Zanetti CR Protein expression and purification (2008)
    15. [15]
      Safety review of the purified chick embryo cell rabies vaccine: Data from the Vaccine Adverse Event Reporting System (VAERS), 1997-2005. — Dobardzic A, Izurieta H, Woo EJ, Iskander J, Shadomy S, Rupprecht C et al. Vaccine (2007)
    16. [16]
      A space-time cluster of adverse events associated with canine rabies vaccine. — Moore GE, Ward MP, Kulldorff M, Caldanaro RJ, Guptill LF, Lewis HB et al. Vaccine (2005)
    17. [17]
      The use of rabies immune globulin by emergency physicians. — Jerrard DA The Journal of emergency medicine (2004)
    18. [18]
      Post-exposure rabies vaccination. — Stringer C Nursing standard (Royal College of Nursing (Great Britain) : 1987) (2003)
    19. [19]
      Bite by a dog under provocation: is it free from risk? — Dutta JK Journal of the Indian Medical Association (2002)
    20. [20]
      Rabies surveillance and control measures in Slovenia. — Wernig JM, Sladic T, Brecelj A, Kovac Z Medicinski pregled (2001)
    21. [21]
      Rabies, quarantine and the veterinary profession: the BVA's position. The Veterinary record (1999)
    22. [22]
      Stable secretion of a soluble, oligomeric form of rabies virus glycoprotein: influence of N-glycan processing on secretion. — Wojczyk B, Shakin-Eshleman SH, Doms RW, Xiang ZQ, Ertl HC, Wunner WH et al. Biochemistry (1995)
    23. [23]
      Some factors affecting the oral rabies vaccination of free-ranging carnivores. — Linhart SB Revue scientifique et technique (International Office of Epizootics) (1993)
    24. [24]
      The rabies situation in The Netherlands. — Nieuwenhuis HU Parassitologia (1988)
    25. [25]
      Measurement of antibodies to rabies virus by immunoelectron microscopy. — Chaudhary RK, Cho HC, Monette MT Canadian journal of microbiology (1979)
    26. [26]
      Dealing with possible rabies exposure. — Corey L, Hattwick MA, Rubin RJ Postgraduate medicine (1976)
    27. [27]
      Preparation of rabies fluorescein isothiocyanate-labeled immune globulin from mouse hyperimmune ascitic fluids. — Tzianabos T, Hebert GA, White LA Journal of clinical microbiology (1976)
    28. [28]
      Zonal-centrifuged purified duck embryo cell culture rabies vaccine for human vaccination. — Lavender JF, Van Frank RM Applied microbiology (1971)
    29. [29]
      Sylvatic rabies studies in the silver fox (Vulpes vulpes). Susceptibility and immune response. — Black JG, Lawson KF Canadian journal of comparative medicine : Revue canadienne de medecine comparee (1970)
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