Rabies is a fatal infectious disease caused by the rabies virus. The key to treatment lies in preventive vaccination and prompt medical intervention. Currently, there is no cure for patients who have already developed symptoms. Therefore, treatment strategies are primarily divided into "Pre-Exposure Prophylaxis" and "Post-Exposure Emergency Management." Timely medical measures can effectively block the virus from invading the central nervous system, reducing the risk of infection.
The goal of treatment is to inhibit viral replication, alleviate symptoms, and maintain the patient's physiological functions. Post-exposure management must begin within 24 hours of contact with the virus, including local wound care, rabies vaccination, and immune globulin injection. Once symptoms appear, treatment shifts to supportive care to slow disease progression and sustain vital signs.
Preventive vaccination for high-risk groups (such as veterinarians and animal researchers) involves administering 3 doses of rabies vaccine. The injections are typically given in the deltoid muscle of the arm or thigh, with intervals varying depending on the vaccine type. This preventive measure helps establish baseline immunity, but antibody levels require regular monitoring post-vaccination.
Immediate wound cleaning is crucial after an animal bite. Wash the wound thoroughly with soap and water for at least 15 minutes, then disinfect with 70% alcohol or iodine. Concurrently, rabies vaccination and immune globulin injection should be administered to block the virus from spreading to the nervous system.
Immune globulin should be injected directly into the wound area, with the remaining dose administered intramuscularly in the gluteal muscle. The vaccination schedule typically involves five doses on days 0, 3, 7, 14, and 28, which can be adjusted in special cases. This combination therapy achieves a prevention success rate of over 99%.
The current vaccines mainly fall into two categories: "Purified Chick Embryo Cell Vaccine" and "Human Diploid Cell Vaccine." Vaccination must follow the prescribed schedule to stimulate the immune system to produce neutralizing antibodies. Local reactions such as redness, swelling, or fever may occur, but severe allergic reactions are rare.
Immunoglobulin (HRIG) provides immediate passive immunity by directly neutralizing the virus at the wound site. The dose is calculated based on body weight (20 IU/kg), with the remaining amount injected into the contralateral deltoid muscle. This medication should be administered concurrently with the vaccine to establish a "dual protection" mechanism of immediate antibodies and active immunity.
Immune globulin must be used within 72 hours after exposure; efficacy significantly decreases after expiration. It should not be injected at the same site as the vaccine to avoid interference with the vaccine-induced immune response.
Physical debridement of the wound is the first line of defense. Wash the wound repeatedly with soap and physiological saline, using a bacterial filter if necessary. Wound care should be performed immediately after exposure, even for wounds in the oral cavity or eyes, which are difficult to clean, using professional medical procedures.
Post-symptom treatment focuses on maintaining vital functions, including tracheostomy for respiratory failure, plasma exchange to remove viral antigens, and anticonvulsant medications to control neurological symptoms. Medical teams should closely monitor blood pressure, heart rhythm, and intracranial pressure, using ventilators if necessary to maintain respiration.
Experimental therapies such as the combination of Ribavirin and Acyclovir have shown brief cases of delayed death in reports but are not yet adopted as standard treatment by international health organizations.
During vaccination, avoid vigorous exercise and overexertion to prevent inflammatory reactions at the injection site. Water or chemicals contacting the wound within 48 hours post-vaccination may reduce absorption, so keep the wound dry and clean.
If taking immunosuppressants concurrently, inform the physician to adjust medication timing. It is recommended to keep a vaccination log to monitor antibody development.
Immediately record details of any animal contact, including species, bite location, and time. Strengthen home environment defenses by removing factors attracting rabies hosts (such as bats and dogs), such as sealing roof gaps or enhancing pet management.
Current research focuses on antibody engineering techniques that block the virus from binding to neuronal receptors. Gene therapy trials have shown that using adenovirus vectors to transfect antiviral RNAi can inhibit viral RNA replication. However, this technology is still in animal experiments and has not yet entered clinical trials.
Nanotherapeutic vaccine development is another research hotspot. This technology can precisely deliver antigens to lymph nodes, potentially shortening the time needed to generate immunity. Additionally, monoclonal antibody combinations targeting the viral G protein have shown promise in prolonging survival in mouse models.
Any animal bite, scratch, or saliva contact with mucous membranes requires immediate medical evaluation. Even minor wounds (such as superficial scratches) warrant post-exposure prophylaxis if the animal involved is a wild mammal. Those who have previously been vaccinated should also undergo re-evaluation for additional doses.
If symptoms such as hydrophobia or hallucinations occur, seek immediate medical attention and notify the disease control authorities. Medical institutions should activate isolation wards and infection control measures, and report cases to health authorities promptly to prevent community spread.
The timing of rabies vaccination is critical. If more than 48 hours pass after a high-risk animal bite without vaccination, the virus may have already invaded the nervous system, rendering the vaccine ineffective. Therefore, the wound should be cleaned immediately with soap and water, and medical evaluation for vaccination should be sought as soon as possible.
Are there any dietary or activity restrictions during rabies vaccination?There are no specific restrictions on diet or daily activities during vaccination, but strenuous exercise and alcohol consumption should be avoided to reduce side effects such as headache or fever. If severe discomfort occurs, contact healthcare providers to adjust the vaccination plan.
If I have completed the rabies vaccination series and am bitten again by an animal, do I need to restart the entire vaccination?If previously fully vaccinated, only two booster doses (on days 0 and 3) are needed after re-exposure, along with monitoring the health status of the biting animal. This "booster" quickly reactivates immune memory and avoids the complexity of re-vaccinating the entire series.
What is the difference between rabies immune globulin and the vaccine? When should they be used together?Vaccines stimulate the body’s immune system to produce antibodies, while immune globulin provides immediate external antibodies to neutralize the virus. Both are used together when the wound is near the head or neck or is severely contaminated. Immune globulin should be injected immediately into the wound area after vaccination.
Is rabies post-exposure treatment applicable to all animal bites? How to assess the risk of the animal?The treatment principle applies to all mammalian bites but requires risk assessment based on the animal species. Domestic dogs and cats observed for 10 days without abnormal behavior are considered low risk; bats and wild carnivores pose a higher risk and require immediate treatment, as they are more likely to carry the virus and cannot be observed.
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