Adults: First-aid treatment
Bite wounds and scratches that may be contaminated with rabies virus need prompt local treatment, however much time has passed since the contact. The recommended first-aid measures are to flush and wash the wound straight away with soap and water, detergent or another substance of proven lethal effect on rabies virus. Rabies immune globulin should be injected as soon as possible after exposure.
The recommended dose of Rabies Immunoglobulin for both adults and children is 40 IU/kg of body weight. If it is anatomically feasible, infiltrate as much of the dose as possible around and into the wound(s). Give the remainder intramuscularly, into the gluteal region, in a single injection.
For children, particularly when there are multiple wounds, it has been proposed to dilute the dose 2-3 times in a 0.9% sodium chloride solution. This gives enough equine rabies immune globulin to infiltrate the wound(s) properly. Wounds in certain anatomical sites, such as the fingertips, should be infiltrated with care so that the pressure in the tissue does not rise locally.
To prevent rabies, combined immune globulin and vaccine treatment is recommended. The 1st dose of the rabies vaccine should be given at the same time as the Rabies immunoglobulin, but in a different part of the body. If Rabies immunoglobulin is not available when the vaccine is given, it can be given up to the 7th or 8th day after the first dose of rabies vaccine. When indicated, start anti-tetanus treatment and give anti-microbial drugs to control infections other than rabies.
The WHO expert committee on rabies has issued the following recommendations. They apply to contact with a suspect or confirmed rabid domestic or wild animal, or an animal that is not available for observation.
Touching or feeding the animal, or licks on intact skin: no treatment, if a reliable case history is available.
Nibbling of uncovered skin, minor scratches, superficial bites (except on the head, neck, shoulder girdle, arms or hands) or abrasions without bleeding: give the vaccine immediately on Day 0, D3, D7, D14 and D28. Stop treatment if the animal stays healthy throughout the observation period of 10 days, or if it is killed humanely and found negative by appropriate laboratory techniques.
Single or multiple transdermal bites or scratches, especially on the head, neck, shoulder girdle, arms or hands, and contamination of a mucous membrane with saliva: give the rabies vaccine immediately on Day 0, D3, D7, D14 and D28 or D90 (optional), and give rabies immune globulin immediately on D0. Stop treatment if the animal stays healthy throughout the observation period of 10 days, or if it is killed humanely and found negative by appropriate laboratory techniques.
