Health Teaching Rabies

Meryl Encarnacion BN2_C
NCM RLE November 2009
Ms. Solatorio
Health Teaching-Rabies
M edications
There are 2 types of rabies vaccine injections.
1. Injection of the human rabies immune globulin (HRIG) for immediate protection is based on exact weight. This is not a situation where
more is better. Therefore, you should not overestimate your weight. If the exact weight is not known, you will be weighed at the hospital.
Once the dose is determined, as much as possible is injected into and around the bite site. If the entire volume does not fit into the
tissue in that area (for example, the tip of the finger), then the remaining volume will be injected into some other site in your
body, such as the arm, leg, or buttocks. The doctor may use numbing medicine to decrease the pain associated with injection of
HRIG into the tissues at the bite site.
If you have been previously immunized adequately against rabies, then the HRIG is not needed. You would need only the vaccine
described next.
2. Injection of the vaccine will begin during this initial visit to the emergency department and will proceed on a schedule over the next 28
days, with a total of 5 small injections.
There are 3 different types of rabies vaccines licensed for use in the United States (human diploid cell [HDCV], rabies vaccine absorbed
[RVA], and purified chick embryo cell culture vaccine [PCEC]). If given properly and on schedule, any of these 3 types will protect
you against rabies.
The dose for each is 1 cc, or milliliter, delivered into the muscle. This vaccine must be delivered into the deltoid, or shoulder
muscle, in adults or older children. The front, outside aspect of the thigh muscle is acceptable in younger children. It must
never be injected into the buttocks. Injection into the proper site ensures absorption. It must be administered in a site
different from the remainder of the immune globulin that is not injected into the bite site.
If you have never been vaccinated against rabies, then vaccine shots will be given on the day of the visit (day zero), and again on days 3, 7,
14, and 28. If you have already been adequately immunized against rabies, a series of 2 booster vaccine injections will be given on day zero
and again on day 3 only. This is sufficient to stimulate your body's immune system, or memory, and provide protection against rabies.
E xercises
No exercise needed.
T reatment
Prehospital Care
Prehospital care is supportive depending on the stage of the virus. Typically, patients present with an unknown febrile illness with signs of
encephalitis. Body fluid isolation should take place for these patients.
Emergency Department Care
Treatment discussed here focuses on animal exposures where rabies transmission is a possibility. This is the primary concern of the
emergency physician. Treatment of human rabies is supportive and often involves therapy for other possible etiologies before specific
diagnosis is made, usually postmortem or well into an intensive care unit (ICU) hospitalization.
Most recent patients described in the literature were initially sent home by the emergency department. This reinforces the important role of a
history of recent animal or bite exposures.
Immediate therapy consists of thoroughly cleaning all bite and scratch wounds with soap and water and/or 2% benzalkonium chloride. Provide
wound care as needed. Tetanus prophylaxis is indicated; measures to prevent bacterial infection when warranted also are indicated. A
decision must then be made regarding postexposure prophylaxis.
H ygiene
When bitten by an animal, you should always care for the wound immediately by washing it out with soap, water, and some sort of commercial
antiseptic iodine solution, if available. This will help kill the common bacterial germs that may be passed by the bite but also has been shown
to decrease the likelihood of transmission of the rabies virus, should the animal be rabid.
O utpatient
If you have been exposed to rabies, maintain contact with the local health authorities and stick to the schedule of prescribed rabies vaccine
shots. Contact your doctor after treatment in the emergency department. Your doctor may refer you for the additional doses of the vaccine if
the doctor does not have them on hand.
Local discomfort at the site of the injection is expected. You may apply warm compresses and take over-the-counter pain remedies. Any
reactions differing from this should be discussed with your doctor.
D iet
The Philippines has a unique vector for rabies infection, which is the fondness of some Filipinos for raw dog meat, in the dish called kilawin.
Kilawin or kinilaw is a Filipino style of "cooking" raw meat, fish or other ingredients by immersing them in vinegar. The eating of raw dogmeat
leaves Filipinos open to the deadly risk of rabies, as some of these animals are stray dogs with rabies, or dogs that are bred for eating but are
prepared in unsanitary warehouses. So we should avoid these kind of food to prevent rabies.

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Health Teaching Rabies

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Meryl Encarnacion BN2_C

NCM RLE November 2009

There are 2 types of rabies vaccine injections.

Emergency Department Care

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