• Cause: Rabies virus (RNA virus, genus Lyssavirus)
• Transmission: Saliva of infected animals via bites, scratches, or mucous membrane contact
• Symptoms: Early flu-like symptoms, then progressing to anxiety, confusion, hallucinations, hydrophobia (fear of water), paralysis, and coma
• Outcome: Nearly 100% fatal once symptoms appear, but preventable with timely post-exposure prophylaxis (PEP) - vaccines and immunoglobulin given after exposure
• Prevention: Pre-exposure vaccination (for high-risk groups), animal vaccination programs, and avoiding contact with wild/stray animals

Note: You may have meant "Rabies" (not "Rabbies") - the common spelling has a single "b."

Rabies Post-Exposure Prophylaxis (PEP)

Key principle: Every rabies exposure is a medical emergency. PEP must start immediately - the goal is to neutralize the virus before it enters the nervous system.

Step 1 - Assess the Exposure Category (WHO Classification)

Step 2 - Local Wound Treatment (First and Most Important Step)

• Flush and wash all wounds thoroughly with soap and water under running tap for at least 15 minutes
• For puncture wounds, use a catheter to irrigate deep inside
• If no soap is available, flush heavily with plain water

• Apply a virucidal agent to kill residual virus:
  • Alcohol (40-70%)
  • Tincture of iodine, or
  • 0.01% povidone-iodine solution

• Do NOT immediately suture bite wounds - this can drive virus deeper
• If suturing is needed, wait 24-48 hours and use minimum stitches, under RIG cover locally

• Administer antibiotics if indicated (bite wounds are prone to infection)
• Give anti-tetanus prophylaxis as needed

Step 3 - Rabies Vaccination

• Essen regimen (5-dose): 1 dose each on Days 0, 3, 7, 14, and 28
• Zagreb regimen (4-dose / 2-1-1): 2 doses on Day 0 (one in each arm), then 1 dose on Day 7, and 1 dose on Day 21

• 0.1 ml at 2 sites on Days 0, 3, 7, and 28 (Day 14 dose skipped)
• Used in countries where ID route is nationally endorsed; saves vaccine (one-fifth of IM dose)

Step 4 - Rabies Immunoglobulin (RIG) - for Category III only

• Administered only once, as early as possible (ideally at Day 0 with first vaccine)
• Do NOT give after Day 7 (active antibody response will have begun by then)
• Dose:
  • Human RIG (HRIG): 20 IU/kg body weight
  • Equine RIG (ERIG): 40 IU/kg body weight
• How to give: Infiltrate as much as possible directly into and around the wound site(s); remaining portion injected IM at a site distant from the vaccine injection site
• Modern purified equine RIG preparations are safe with low risk of adverse reactions

Step 5 - Special Situations

• Only 2 doses needed - on Day 0 and Day 3
• RIG is NOT required

• Full 5-dose IM course required regardless
• Check rabies-neutralizing antibody titre 2-4 weeks after vaccination
• Additional doses may be needed if titre is inadequate (<0.5 IU/ml)

When Can PEP Be Stopped?

• Laboratory examination confirms the suspected animal is free of rabies, OR
• A domestic dog, cat, or ferret remains healthy throughout a 10-day observation period after the bite

Important Notes

• Rabies has no contraindications to PEP - even pregnancy and infancy are not contraindications, since the disease is nearly 100% fatal
• PEP works only before symptoms appear - once clinical rabies begins, it is almost universally fatal
• WHO-prequalified vaccines available as of 2024 include RABIVAX-S, VaxiRab N, and VERORAB