When do rabies symptoms appear in humans

Fortunately, standard rabies vaccination elicits good neutralizing antibody to viruses from bats. Aside from transmission through transplanted tissues, human-to-human transmission lies largely in the realm of folklore. However, rabies virus may be present in the saliva of humans with rabies, and possible contact transmission has been reported recently and in the past.

Thus, bites, scratches, and mucous membrane exposures to a rabid patient are considered indications for vaccination. The latter indication includes sexual exposure shortly before the onset of symptoms. Reactions to human RIG are uncommon. Nerve tissue vaccines may induce local, systemic, or neuroparalytic reactions. The latter reactions are based on the induction of antibodies to myelin proteins or gangliosides.

Reactions to cell culture vaccines are relatively mild, although local pain, erythema, and swelling at the injection site are commonly seen. Systemic reactions with headache and malaise occur less frequently. These reactions can be treated with the usual drugs employed for allergic reactions, and another rabies vaccine can be substituted for HDCV. The use of steroids should be avoided, but if these agents are administered, titers of antibody should be measured after completion of the vaccine series.

There are no true contraindications, and vaccination is safe in pregnancy. Antibody titers can be monitored to verify responses. In nearly all cases of rabies occurring despite vaccination, some aspect of the treatment did not follow the guidelines. The common faults are late start of prophylaxis, insufficient cleansing of the wound, total omission of antiserum administration, or failure to inject antiserum into all wound sites.

One treatment failure did occur in a person prevaccinated by the intradermal route; in that case, concomitant chloroquine medication may have suppressed the patient's response. However, it should be recognized that the size and placement of the challenge dose of rabies virus are influential on the outcome. A highly contaminated bite on the face, for example, may allow for rapid CNS invasion, and failures of protection have been reported in that situation despite standard treatment.

The best solution to human rabies still lies in the suppression or vaccination of animal reservoirs where feasible, particularly among domestic animals.

More than years after the description of hydrophobia by Celsus, human rabies is far from extinct. I thank Dr. Charles Rupprecht and Dr. Henry Wilde for critical reading of the manuscript. Google Scholar. Google Preview. Publication of this State-of-the-Art Clinical Article has been made possible by an educational grant from Roche Laboratories. David A. In addition, he serves on the Scientific Advisory Board of Cepheid.

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Clinical Description. Immune Responses. Preexposure Vaccination. Postexposure Prophylaxis. Intradermal Vaccination. Bats or the Return of Dracula. Human-to-Human Transmission. Reactions and Contraindications to Vaccination. Treatment Failures. Plotkin Stanley A. Reprints or correspondence: Dr.

Oxford Academic. Cite Cite Stanley A. Select Format Select format. Permissions Icon Permissions. Clinical Description The incubation period of rabies in humans is generally 20—60 days. Virology Rabies virus is serotype 1 of 7 serotypes of the genus Lyssavirus , which belongs to the larger classification of rhabdoviruses. Pathogenesis Although much is known about the pathogenesis of rabies, some essential points yet remain mysterious. Immune Responses During the incubation period, rabies virus is evidently segregated from the immune system, since no antibody responses are seen.

Diagnosis As in many diseases, clinical suspicion is critical to a timely diagnosis of rabies. Table 1. Open in new tab Download slide. Important past and present rabies vaccines for humans. Regimens for preexposure and postexposure vaccination with rabies vaccines.

Human rabies vaccines—United States, Guide for postexposure prophylaxis for rabies in the United States, Schedule of postexposure prophylaxis for rabies in the United States, Google Scholar Crossref. Search ADS. Antibody persistence following preexposure regimens of cell-culture rabies vaccines: year follow-up and proposal for a new booster policy. Economical multiple-site intradermal immunisation with human diploid-cell strain vaccine is effective for post-exposure rabies prophylaxis.

Issue Section:. Download all slides. Comments 0. Add comment Close comment form modal. I agree to the terms and conditions. You must accept the terms and conditions. Add comment Cancel. Submit a comment. Comment title. You have entered an invalid code. Submit Cancel. Thank you for submitting a comment on this article. Your comment will be reviewed and published at the journal's discretion. Please check for further notifications by email. View Metrics.

Email alerts Article activity alert. Advance article alerts. New issue alert. Receive exclusive offers and updates from Oxford Academic. Related articles in Web of Science Google Scholar.

All workers at potential risk of contracting rabies should be informed about the disease, its characteristics, and the nature of the risk. Agricultural, public health, veterinarian, and occupational health officials share the responsibility to control rabies in animals and to protect people. Vaccination programs, established to immunize dogs and cats, have been effective in reducing rabies in pets.

However, rabies will continue to be a threat until the virus can be eliminated from the wild animals that spread the virus to pets and people. Some workers such as veterinarians or animal control officers have continuing risk of encountering a rabid animal.

These workers should be immunized to ensure that they have protection before having contact with any animal. For other workers much less likely to encounter rabid animals, it might be sufficient to provide education on the risks, and training on protection if they encounter an animal with rabies.

Specific recommendations depend on the individual situation. The following general recommendations apply to all workers who risk contacting rabid animals. Workers who have contact with animals must know how to deal with rabid animals and how to protect themselves from the rabies virus. With the development of an oral vaccine for animals, vaccinating of local wildlife has become a common way to manage outbreaks.

Do not approach or kill an animal suspected of having rabies except to defend yourself, other people, or other animals.

If an animal must be killed, try to avoid damaging its head. An undamaged brain is important for a quick laboratory diagnosis. If an animal suspected of having rabies is responsive or manageable, keep it alive and away from other animals or people. Do not touch it with bare hands. If an animal is unmanageable and dangerous and cannot be restrained or killed, observe its movements and seek help from qualified experts as soon as possible. If you must handle the animal or carcass, wear protective gloves to prevent infectious material from having contact with cuts or rashes on the skin.

Also wear protective masks and goggles to protect against infectious aerosols. When there is a need for personal protective equipment PPE , then there should be a PPE program in place where you work. Responsibility for the management of rabies is shared by the public, the veterinary profession and all levels of government. Canadian federal regulations requires all pets, livestock or wild animals that may be rabid, or had contact with a potentially rabid animal, to be reported to a veterinarian, veterinary clinic, local medical health officer or public health authority immediately.

Workers who have come into contact with saliva, body fluids, or tissue of animals suspected of having rabies must take the following steps without delay. Immediately clean and flush their skin even if there is no obvious bite or scratch with water for several minutes. Cleaning will help wash out the virus.

If available, use soap or detergent to help kill the virus. Washing the area or wound is probably the most effective procedure in the prevention of rabies. While cleaning is being done, shield the eyes, nose, and mouth from spray.

Remove any clothing that may be contaminated, place it in a plastic bag properly labelled and wash it promptly and separately from other clothing. Get medical advice as soon as possible. Contact the police, your local health unit and district veterinarian or local office of the Canadian Food Inspection Agency.

If possible, provide the following information:. Biosafety containment level 3 is recommended when working with the rabies virus includes full coverage protective clothing, front gowns with tight fitting wrists, gloves, respiratory protection, and eye protection if risk of splashes.

Additional precautions may be necessary. In Canada, pre-exposure immunization with a rabies vaccination should be offered as a choice to workers at possible high risk of contacting rabid animals. These workers include veterinarians, animal handlers, and certain laboratory workers dealing with rabies. Workers with continuing high risk should have their blood tested every two years to determine if booster injections are required.

Laboratory workers who could have accidental contact with the rabies virus without knowing it should be tested every six months. Immunization is usually recommended if the animal makes contact by biting, or if the animal's saliva, body fluid or tissue makes contact with a rash, scratch, open wound, eyes, nose, or mouth. Wild animals or unwanted dogs or cats suspected of having rabies are humanely killed without delay.

Their heads are submitted for laboratory examination. Vaccination may be discontinued if tests of animals killed at the time of attack are negative. Medical professionals generally do not recommend immunization if the animal had no contact with a person's skin or mucous membranes.

Nor is immunization recommended if workers have had only casual contact with the animal such as petting, with no possible contamination of broken skin or mucous membranes. Healthy dogs or cats involved in biting incidents are held in confinement for at least days, according to provincial regulations.

If rabies does not develop in that time, no immunization is required for the injured worker. If signs of rabies do develop, the Canadian Food Inspection Agency should be notified, the animal humanely killed and analyzed; and the person's immunization started without delay. Develop procedures to prevent contact with the rabies virus within the workplace. Where appropriate, have workplace procedures posted for disinfecting or sterilizing areas that may be contaminated with the rabies virus.

Quarantine all wild animals before introducing them into an animal research program. Facebook Twitter LinkedIn Syndicate. What are the signs and symptoms of rabies? Minus Related Pages. Rabies in the Americas external World Rabies Day. Links with this icon indicate that you are leaving the CDC website. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.

You will be subject to the destination website's privacy policy when you follow the link.