Rabies virus - Revision history

Aidan: /* Encephalitic (furious) rabies */

2020-08-19T20:12:07Z

Encephalitic (furious) rabies

← Older revision		Revision as of 20:12, 19 August 2020
Line 53:		Line 53:
	* 80% of cases, lasts 2 to 7 days		* 80% of cases, lasts 2 to 7 days
	* Hydrophobia is a well-known feature		* Hydrophobia is a well-known feature
	** Starts as involuntary oropharyngeal or esophageal spasm when ~~drinknig~~ water, then develops strong association with water, such that even the sound of water drops can cause agitation		** Starts as involuntary oropharyngeal or esophageal spasm when drinking water, then develops strong association with water, such that even the sound of water drops can cause agitation
	** Also aerophobia, such as fans or other moving air		** Also aerophobia, such as fans or other moving air
	* Episodic hyperactivity, seizures, and aerophobia		* Episodic hyperactivity, seizures, and aerophobia
	* Water balance disorders, including SIADH and DI		* Water balance disorders, including [[SIADH]] and [[diabetes insipidus]]
	* Hyperventilation, then periodic ataxic respiration, then ~~apnea~~		* Hyperventilation, then periodic ataxic respiration, then apnoea
	* Autonomic dysregulation, including mydriasis, anisocoria, piloerection, salivation, sweating, and rarely priapism		* Autonomic dysregulation, including mydriasis, anisocoria, piloerection, salivation, sweating, and rarely priapism
	* Myocarditis and arrhythmias, including SVT and bradycardia		* Myocarditis and arrhythmias, including SVT and bradycardia

Aidan: /* Clinical Manifestations */

2020-08-05T14:07:15Z

Clinical Manifestations

← Older revision		Revision as of 14:07, 5 August 2020
Line 38:		Line 38:

	== Clinical Manifestations ==		== Clinical Manifestations ==
	* Incubation period ranges from days to more than 19 years, with 75% developing symptoms within 90 days		* Incubation period ranges from [[Incubation period range::days to more than 19 years]], with 75% developing symptoms [[Usual incubation period::within 90 days]]
	** The initial contact is usually a bite but can also be direct contact without history of bite; rarely no exposure remembered		** The initial contact is usually a bite but can also be direct contact without history of bite; rarely no exposure remembered
	* Prodrome is nonspecific, with fever, headache, malaise, coryza, and GI disturbance		* Prodrome is nonspecific, with fever, headache, malaise, coryza, and GI disturbance

Aidan: /* Microbiology */

2020-07-29T15:43:41Z

Microbiology

← Older revision		Revision as of 15:43, 29 July 2020
Line 8:		Line 8:
	** N protein: nucleocapsid protein		** N protein: nucleocapsid protein
	** P protein (or nonstructural (NS) protein): involved in phosphorylation		** P protein (or nonstructural (NS) protein): involved in phosphorylation
	** M or M<s>2</s> protein: matrix protein		** M or M<sub>2</sub> protein: matrix protein
	** G protein: glycoprotein, the primary immunogenic antigen		** G protein: glycoprotein, the primary immunogenic antigen
	** L protein: large RNA-dependent RNA polymerase		** L protein: large RNA-dependent RNA polymerase

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-19T23:36:40Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 23:36, 19 July 2020
Line 37:		Line 37:
	* The virus doesn't tolerate extremes of pH (<3 or >11), and is killed by UV light, sunlight, desiccation, and numerous chemicles		* The virus doesn't tolerate extremes of pH (<3 or >11), and is killed by UV light, sunlight, desiccation, and numerous chemicles

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	* Incubation period ranges from days to more than 19 years, with 75% developing symptoms within 90 days		* Incubation period ranges from days to more than 19 years, with 75% developing symptoms within 90 days
	** The initial contact is usually a bite but can also be direct contact without history of bite; rarely no exposure remembered		** The initial contact is usually a bite but can also be direct contact without history of bite; rarely no exposure remembered

Aidan: /* Diagnosis */

2019-11-14T23:53:25Z

Diagnosis

@@ Line 69: / Line 69: @@
 == Diagnosis ==
-* Current standard diagnostic test is direct fluorescent antibody (DFA) staining of a neck nape full-thickness skin biopsy that contains 10 hair follicles
+** Direct fluorescent antibody (DFA) staining of a neck nape full-thickness skin biopsy that contains 10 hair follicles
-** Sensitivity about 50% in first week, increasing over time
+*** Sensitivity about 50% in first week, increasing over time
 * Other investigations
 ** CSF may be normal, or have a mild lymphocytosis with elevated protein

Aidan: rearranged titles

2019-11-14T16:50:20Z

rearranged titles

← Older revision		Revision as of 16:50, 14 November 2019
Line 1:		Line 1:
	== ~~Microbiology~~ ==		== Background ==
			=== Microbiology ===

	* A neurotropic single-stranded, negative-sense RNA virus that causes a zoonotic and universally-fatal encephalitis		* A neurotropic single-stranded, negative-sense RNA virus that causes a zoonotic and universally-fatal encephalitis
	* Within the Rhabdoviridae family, the ''Lyssavirus'' genus includes multiple serotypes, including the rabies virus (serotype 1) and Australian bat lyssavirus (ABLV) (serotype 7)		* Within the Rhabdoviridae family, the ''Lyssavirus'' genus includes multiple serotypes, including the rabies virus (serotype 1) and Australian bat lyssavirus (ABLV) (serotype 7)
	** Other Rhabdoviridae genera include ''Vesiculovirus'' (vesicular stomatitis virus), ''Ephemerovirus'' (bovine ephemeral fever virus), and ''Novirhabdovirus'' (infectious hematopoietic necrosis virus)		** Other Rhabdoviridae genera include ''Vesiculovirus'' (vesicular stomatitis virus), ''Ephemerovirus'' (bovine ephemeral fever virus), and ''Novirhabdovirus'' (infectious hematopoietic necrosis virus)
	* Lyssaviruses are bullet-shaped, with a nucleocapsid enclosed in a lipoprotein envelope with glycoprotein (G protein) spikes		* Lyssaviruses are bullet-shaped, with a nucleocapsid enclosed in a lipoprotein envelope with glycoprotein (G protein) spikes
	* Five genes		* Five genes:
	** N protein: nucleocapsid protein		** N protein: nucleocapsid protein
	** P protein (or nonstructural (NS) protein): involved in phosphorylation		** P protein (or nonstructural (NS) protein): involved in phosphorylation
Line 12:		Line 12:
	** L protein: large RNA-dependent RNA polymerase		** L protein: large RNA-dependent RNA polymerase

	== Pathophysiology ==		=== Pathophysiology ===

	* The virus enters through a break in the skin, over a mucosal membrane, or through the respiratory tract		* The virus enters through a break in the skin, over a mucosal membrane, or through the respiratory tract
	* Multiple mechanisms involved in cell attachment, after which it is brought into the cell and escapes from the lysosome into the cytoplasm		* Multiple mechanisms involved in cell attachment, after which it is brought into the cell and escapes from the lysosome into the cytoplasm
Line 27:		Line 26:
	** Otherwise, there's only vascular congestion without evidence of necrosis or other acute damage		** Otherwise, there's only vascular congestion without evidence of necrosis or other acute damage

	== Epidemiology ==		=== Epidemiology ===

	* Worldwide distribution, except Antarctica, New Zealand, Sweden, Norway, Spain, Taiwan, Japan, and some islands		* Worldwide distribution, except Antarctica, New Zealand, Sweden, Norway, Spain, Taiwan, Japan, and some islands
	** An underestimated 55,000 annual deaths worldwide		** An underestimated 55,000 annual deaths worldwide
Line 40:		Line 38:

	== Clinical Presentation ==		== Clinical Presentation ==

	* Incubation period ranges from days to more than 19 years, with 75% developing symptoms within 90 days		* Incubation period ranges from days to more than 19 years, with 75% developing symptoms within 90 days
	** The initial contact is usually a bite but can also be direct contact without history of bite; rarely no exposure remembered		** The initial contact is usually a bite but can also be direct contact without history of bite; rarely no exposure remembered
Line 54:		Line 51:

	=== Encephalitic (furious) rabies ===		=== Encephalitic (furious) rabies ===

	* 80% of cases, lasts 2 to 7 days		* 80% of cases, lasts 2 to 7 days
	* Hydrophobia is a well-known feature		* Hydrophobia is a well-known feature
Line 67:		Line 63:

	=== Paralytic (dumb) rabies ===		=== Paralytic (dumb) rabies ===

	* 20% of cases, lasts 2 to 7 days		* 20% of cases, lasts 2 to 7 days
	* No hydrophobia, hyperactivity, or seizures		* No hydrophobia, hyperactivity, or seizures
Line 74:		Line 69:

	== Diagnosis ==		== Diagnosis ==

⚫	* CSF may be normal, or have a mild lymphocytosis with elevated protein
	* Current standard diagnostic test is direct fluorescent antibody (DFA) staining of a neck nape full-thickness skin biopsy that contains 10 hair follicles		* Current standard diagnostic test is direct fluorescent antibody (DFA) staining of a neck nape full-thickness skin biopsy that contains 10 hair follicles
	** Sensitivity about 50% in first week, increasing over time		** Sensitivity about 50% in first week, increasing over time
Line 82:		Line 75:
	** Sensitivity increases to 100% by day 14		** Sensitivity increases to 100% by day 14
	** Serum antibodies seen first, followed by CSF antibodies		** Serum antibodies seen first, followed by CSF antibodies
			* Other investigations
⚫	* MRI can be suggestive but not diagnostic
		⚫	** CSF may be normal, or have a mild lymphocytosis with elevated protein
		⚫	** MRI can be suggestive but not diagnostic

	== Management ==		== Management ==

	* Supportive care; almost uniformly fatal		* Supportive care; almost uniformly fatal

	=== Milwaukee protocol ===		=== Milwaukee protocol ===

	* It exists but isn't helpful		* It exists but isn't helpful

	== Prevention ==		== Prevention ==

	=== Vaccination ===		=== Vaccination ===

	* All dogs are vaccinated		* All dogs are vaccinated
	* Public health attempts have been made to vaccinate wild animals		* Public health attempts have been made to vaccinate wild animals
Line 104:		Line 95:

	=== Post-exposure Prophylaxis ===		=== Post-exposure Prophylaxis ===

	* First aid of the wound		* First aid of the wound
	** Flush the wound with water for 15 minutes		** Flush the wound with water for 15 minutes

Aidan at 19:42, 15 August 2019

2019-08-15T19:42:49Z

← Older revision		Revision as of 19:42, 15 August 2019
Line 1:		Line 1:
	= Microbiology =		== Microbiology ==

	* A neurotropic single-stranded, negative-sense RNA virus that causes a zoonotic and universally-fatal encephalitis		* A neurotropic single-stranded, negative-sense RNA virus that causes a zoonotic and universally-fatal encephalitis
Line 12:		Line 12:
	** L protein: large RNA-dependent RNA polymerase		** L protein: large RNA-dependent RNA polymerase

	= Pathophysiology =		== Pathophysiology ==

	* The virus enters through a break in the skin, over a mucosal membrane, or through the respiratory tract		* The virus enters through a break in the skin, over a mucosal membrane, or through the respiratory tract
Line 27:		Line 27:
	** Otherwise, there's only vascular congestion without evidence of necrosis or other acute damage		** Otherwise, there's only vascular congestion without evidence of necrosis or other acute damage

	= Epidemiology =		== Epidemiology ==

	* Worldwide distribution, except Antarctica, New Zealand, Sweden, Norway, Spain, Taiwan, Japan, and some islands		* Worldwide distribution, except Antarctica, New Zealand, Sweden, Norway, Spain, Taiwan, Japan, and some islands
Line 39:		Line 39:
	* The virus doesn't tolerate extremes of pH (<3 or >11), and is killed by UV light, sunlight, desiccation, and numerous chemicles		* The virus doesn't tolerate extremes of pH (<3 or >11), and is killed by UV light, sunlight, desiccation, and numerous chemicles

	= Clinical Presentation =		== Clinical Presentation ==

	* Incubation period ranges from days to more than 19 years, with 75% developing symptoms within 90 days		* Incubation period ranges from days to more than 19 years, with 75% developing symptoms within 90 days
Line 53:		Line 53:
	** Both forms can also include GI distubance (including bleeding, vomiting, diarrhea, and ileus), cerebral edema, myocarditis, arrhytmias, and heart failure		** Both forms can also include GI distubance (including bleeding, vomiting, diarrhea, and ileus), cerebral edema, myocarditis, arrhytmias, and heart failure

	== Encephalitic (furious) rabies ==		=== Encephalitic (furious) rabies ===

	* 80% of cases, lasts 2 to 7 days		* 80% of cases, lasts 2 to 7 days
Line 66:		Line 66:
	* Eventually coma and death, usually within 1 to 2 weeks		* Eventually coma and death, usually within 1 to 2 weeks

	== Paralytic (dumb) rabies ==		=== Paralytic (dumb) rabies ===

	* 20% of cases, lasts 2 to 7 days		* 20% of cases, lasts 2 to 7 days
Line 73:		Line 73:
	* The patient becomes confusion, then comatose, then dies		* The patient becomes confusion, then comatose, then dies

	= Diagnosis =		== Diagnosis ==

	* CSF may be normal, or have a mild lymphocytosis with elevated protein		* CSF may be normal, or have a mild lymphocytosis with elevated protein
Line 84:		Line 84:
	* MRI can be suggestive but not diagnostic		* MRI can be suggestive but not diagnostic

	= Management =		== Management ==

	* Supportive care; almost uniformly fatal		* Supportive care; almost uniformly fatal

	== Milwaukee protocol ==		=== Milwaukee protocol ===

	* It exists but isn't helpful		* It exists but isn't helpful

	= Prevention =		== Prevention ==

	== Vaccination ==		=== Vaccination ===

	* All dogs are vaccinated		* All dogs are vaccinated
Line 103:		Line 103:
	** Usually reserved for high-risk groups, including vets, lab workers that handle rabies virus, cavers, and international travelers to places with high dog rabies		** Usually reserved for high-risk groups, including vets, lab workers that handle rabies virus, cavers, and international travelers to places with high dog rabies

	== Post-exposure Prophylaxis ==		=== Post-exposure Prophylaxis ===

	* First aid of the wound		* First aid of the wound

Aidan at 11:09, 13 August 2019

2019-08-13T11:09:48Z

← Older revision		Revision as of 11:09, 13 August 2019
Line 1:		Line 1:
	= ~~Rabies virus~~ =		= Microbiology =

	== Microbiology ==

	* A neurotropic single-stranded, negative-sense RNA virus that causes a zoonotic and universally-fatal encephalitis		* A neurotropic single-stranded, negative-sense RNA virus that causes a zoonotic and universally-fatal encephalitis
Line 14:		Line 12:
	** L protein: large RNA-dependent RNA polymerase		** L protein: large RNA-dependent RNA polymerase

	== Pathophysiology ==		= Pathophysiology =

	* The virus enters through a break in the skin, over a mucosal membrane, or through the respiratory tract		* The virus enters through a break in the skin, over a mucosal membrane, or through the respiratory tract
Line 29:		Line 27:
	** Otherwise, there's only vascular congestion without evidence of necrosis or other acute damage		** Otherwise, there's only vascular congestion without evidence of necrosis or other acute damage

	== Epidemiology ==		= Epidemiology =

	* Worldwide distribution, except Antarctica, New Zealand, Sweden, Norway, Spain, Taiwan, Japan, and some islands		* Worldwide distribution, except Antarctica, New Zealand, Sweden, Norway, Spain, Taiwan, Japan, and some islands
Line 41:		Line 39:
	* The virus doesn't tolerate extremes of pH (<3 or >11), and is killed by UV light, sunlight, desiccation, and numerous chemicles		* The virus doesn't tolerate extremes of pH (<3 or >11), and is killed by UV light, sunlight, desiccation, and numerous chemicles

	== Clinical Presentation ==		= Clinical Presentation =

	* Incubation period ranges from days to more than 19 years, with 75% developing symptoms within 90 days		* Incubation period ranges from days to more than 19 years, with 75% developing symptoms within 90 days
Line 55:		Line 53:
	** Both forms can also include GI distubance (including bleeding, vomiting, diarrhea, and ileus), cerebral edema, myocarditis, arrhytmias, and heart failure		** Both forms can also include GI distubance (including bleeding, vomiting, diarrhea, and ileus), cerebral edema, myocarditis, arrhytmias, and heart failure

	=== Encephalitic (furious) rabies ===		== Encephalitic (furious) rabies ==

	* 80% of cases, lasts 2 to 7 days		* 80% of cases, lasts 2 to 7 days
Line 68:		Line 66:
	* Eventually coma and death, usually within 1 to 2 weeks		* Eventually coma and death, usually within 1 to 2 weeks

	=== Paralytic (dumb) rabies ===		== Paralytic (dumb) rabies ==

	* 20% of cases, lasts 2 to 7 days		* 20% of cases, lasts 2 to 7 days
Line 75:		Line 73:
	* The patient becomes confusion, then comatose, then dies		* The patient becomes confusion, then comatose, then dies

	== Diagnosis ==		= Diagnosis =

	* CSF may be normal, or have a mild lymphocytosis with elevated protein		* CSF may be normal, or have a mild lymphocytosis with elevated protein
Line 86:		Line 84:
	* MRI can be suggestive but not diagnostic		* MRI can be suggestive but not diagnostic

	== Management ==		= Management =

	* Supportive care; almost uniformly fatal		* Supportive care; almost uniformly fatal

	=== Milwaukee protocol ===		== Milwaukee protocol ==

	* It exists but isn't helpful		* It exists but isn't helpful

	== Prevention ==		= Prevention =

	=== Vaccination ===		== Vaccination ==

	* All dogs are vaccinated		* All dogs are vaccinated
Line 105:		Line 103:
	** Usually reserved for high-risk groups, including vets, lab workers that handle rabies virus, cavers, and international travelers to places with high dog rabies		** Usually reserved for high-risk groups, including vets, lab workers that handle rabies virus, cavers, and international travelers to places with high dog rabies

	=== Post-exposure Prophylaxis ===		== Post-exposure Prophylaxis ==

	* First aid of the wound		* First aid of the wound
Line 125:		Line 123:
	** Give the vaccine into the contralateral ''deltoid''		** Give the vaccine into the contralateral ''deltoid''
	** If previously vaccinated, no need for RIG but still gets vaccine on day 0 and 3		** If previously vaccinated, no need for RIG but still gets vaccine on day 0 and 3

			[[Category:Rhabdoviridae]]

Aidan: Aidan moved page RNA Rabies virus to Rabies virus without leaving a redirect

2019-08-13T11:09:11Z

Aidan moved page RNA Rabies virus to Rabies virus without leaving a redirect

← Older revision	Revision as of 11:09, 13 August 2019
(No difference)

Maintenance script: Imported from text file

2019-08-11T18:05:57Z

Imported from text file

New page

= Rabies virus =

== Microbiology ==

* A neurotropic single-stranded, negative-sense RNA virus that causes a zoonotic and universally-fatal encephalitis
* Within the Rhabdoviridae family, the ''Lyssavirus'' genus includes multiple serotypes, including the rabies virus (serotype 1) and Australian bat lyssavirus (ABLV) (serotype 7)
** Other Rhabdoviridae genera include ''Vesiculovirus'' (vesicular stomatitis virus), ''Ephemerovirus'' (bovine ephemeral fever virus), and ''Novirhabdovirus'' (infectious hematopoietic necrosis virus)
* Lyssaviruses are bullet-shaped, with a nucleocapsid enclosed in a lipoprotein envelope with glycoprotein (G protein) spikes
* Five genes
** N protein: nucleocapsid protein
** P protein (or nonstructural (NS) protein): involved in phosphorylation
** M or M<s>2</s> protein: matrix protein
** G protein: glycoprotein, the primary immunogenic antigen
** L protein: large RNA-dependent RNA polymerase

== Pathophysiology ==

* The virus enters through a break in the skin, over a mucosal membrane, or through the respiratory tract
* Multiple mechanisms involved in cell attachment, after which it is brought into the cell and escapes from the lysosome into the cytoplasm
* It replicates locally, first, likely in muscle cells initially, then spreads to the nerve that innervates it
* It spreads from peripheral to central via axons, reaching the dorsal root ganglia within 60 to 72 hours
** Reportedly spreads 0.5 to 1 cm per day
* From the spinal cord, it reaches the CNS and eventually involves almost every neuron
* From the CNS, it spreads back out to the peripheral nerves, including to the oral mucosa, where it replicates in the salivary glands
* Unclear mechanism of damage to the neurons themselves
* Whether the presentation is encephalitic or paralytic depends in large part on the presence of cellular immune response, which favours encephalitic
** The virus causes apoptosis of CD4+ cells
* Brain histopathology is characterised by Negri bodies in the hippocampal pyramidal cells
** Otherwise, there's only vascular congestion without evidence of necrosis or other acute damage

== Epidemiology ==

* Worldwide distribution, except Antarctica, New Zealand, Sweden, Norway, Spain, Taiwan, Japan, and some islands
** An underestimated 55,000 annual deaths worldwide
* Numerous animal reservoirs, including dogs, bats, raccoons, skunks, and foxes
** No risk with small rodents, since they tend to be killed at the time they're innoculated by the larger animal's mouth
** In the developed world, wild animals are the major reservoir since domestic dogs are all vaccinated
*** In Ontario, 3.5% of bats have rabies
** In the developing world, dogs are the major reservoir
* Case reports of transplantation-associated rabies
* The virus doesn't tolerate extremes of pH (<3 or >11), and is killed by UV light, sunlight, desiccation, and numerous chemicles

== Clinical Presentation ==

* Incubation period ranges from days to more than 19 years, with 75% developing symptoms within 90 days
** The initial contact is usually a bite but can also be direct contact without history of bite; rarely no exposure remembered
* Prodrome is nonspecific, with fever, headache, malaise, coryza, and GI disturbance
** May include subtle personality changes or confusion, with parasthesias near the exposure site
** Myoedema with deep tendon reflexes begins
** Prodrome lasts for 4 days (2 to 10 days)
* Up to 10 days after the prodrome, the patient develops either encephalitic (furious) rabies or paralytic (dumb) rabies
** Depends on host immune response
** Both terminate in coma and death within a few weeks
** Rare atypical cases may present with sensory or motor deficits, choreiform movements, focal brainstem signs, cranial nerve palsies, myoclonus, and seizures
** Both forms can also include GI distubance (including bleeding, vomiting, diarrhea, and ileus), cerebral edema, myocarditis, arrhytmias, and heart failure

=== Encephalitic (furious) rabies ===

* 80% of cases, lasts 2 to 7 days
* Hydrophobia is a well-known feature
** Starts as involuntary oropharyngeal or esophageal spasm when drinknig water, then develops strong association with water, such that even the sound of water drops can cause agitation
** Also aerophobia, such as fans or other moving air
* Episodic hyperactivity, seizures, and aerophobia
* Water balance disorders, including SIADH and DI
* Hyperventilation, then periodic ataxic respiration, then apnea
* Autonomic dysregulation, including mydriasis, anisocoria, piloerection, salivation, sweating, and rarely priapism
* Myocarditis and arrhythmias, including SVT and bradycardia
* Eventually coma and death, usually within 1 to 2 weeks

=== Paralytic (dumb) rabies ===

* 20% of cases, lasts 2 to 7 days
* No hydrophobia, hyperactivity, or seizures
* Rather, presents as an ascending paralysis similar to Guillain-Barré syndrome, that is more severe in the bitten limb
* The patient becomes confusion, then comatose, then dies

== Diagnosis ==

* CSF may be normal, or have a mild lymphocytosis with elevated protein
* Current standard diagnostic test is direct fluorescent antibody (DFA) staining of a neck nape full-thickness skin biopsy that contains 10 hair follicles
** Sensitivity about 50% in first week, increasing over time
* Diagnosis may be made with rtPCR of tissue or saliva
* Antibodies may be detectable as early as day 6 of illness, with rapid fluorescent focus inhibition test (RFFIT) for rabies G protein
** Sensitivity increases to 100% by day 14
** Serum antibodies seen first, followed by CSF antibodies
* MRI can be suggestive but not diagnostic

== Management ==

* Supportive care; almost uniformly fatal

=== Milwaukee protocol ===

* It exists but isn't helpful

== Prevention ==

=== Vaccination ===

* All dogs are vaccinated
* Public health attempts have been made to vaccinate wild animals
* In humans, a vaccine exists
** Three doses, on days 0, 7, and 21-28
** Requires serology every 2 to 3 years, with a bosster if titres <0.5 IU/mL
** Usually reserved for high-risk groups, including vets, lab workers that handle rabies virus, cavers, and international travelers to places with high dog rabies

=== Post-exposure Prophylaxis ===

* First aid of the wound
** Flush the wound with water for 15 minutes
** Consider iodine or alcohol
** Give tetanus as appropriate
* The decision to get rabies PEP (RPEP) depends on a number of factors
** Prevalence of rabies in the community
** The animal, and whether it can be observed or biopsied
* For domestic dogs, can usually watch the animal for 10 days
* For wild animals, usually need to start within 48 hours while waiting for testing
* For bats specifically, it is recommended to give RPEP when there has been direct contact with the bat, and a scratch or bite cannot be ruled out
* The regimen includes passive rabies immunoglobulin (RIG) as well as vaccine
** RIG 20 IU/kg IM on day 0 (and not after day 7), if not previously immunized
** Vaccine on days 0, 3, 7, and 14
*** Another dose at day 28 for immunocompromised patients
*** If previously immunized, give only on days 0 and 3
** Give at different sites, including RIG near or infiltrated around the wound itself
** Give the vaccine into the contralateral ''deltoid''
** If previously vaccinated, no need for RIG but still gets vaccine on day 0 and 3