Postexposure Treatment for Rabies

Q&A

What is rabies?
Rabies is a disease that affects the central nervous system and is transmitted by coming into contact with the saliva of an infected animal.1

How is it contracted?
Rabies can be contracted if you are bitten, scratched, or come into contact with infected saliva from a wild animal, especially raccoons (which are the most common carriers of rabies). Skunks, bats, and foxes, as well as some domestic animals, such as dogs, can also transmit the disease.2,3

What are the symptoms?
Those suffering from rabies will experience symptoms that resemble the flu, such as fatigue, headaches, fever, and general feeling of illness. These symptoms will usually be followed by more serious symptoms such as overproduction of saliva, confusion, hallucinations, and slight or partial paralysis. Rabies, once contracted, is almost always fatal.4,5

How can I prevent rabies?
As soon as the incident with the animal has taken place, go directly to the hospital, and if possible, every effort should be made to capture the animal without risking another bite. If you are unable to capture the animal, proceed directly to the hospital.6

What is a rabies immune globulin and why isn't a vaccine enough?
A rabies immune globulin is a treatment that contains high levels of rabies antibodies. An immune globulin works much faster than a vaccine, but does not last as long. Because of the potentially life-threatening nature of rabies, doctors will give you a rabies immune globulin shot like HyperRAB S/D and a vaccine to make sure you get the comprehensive care you need.6,7

QUICK FACTS

  • If left untreated, rabies is essentially 100% fatal8
  • According to the CDC, the most common carriers of rabies in the United States are raccoons3
  • According to the CDC, wound cleansing and administration of a rabies immune globulin, such as HyperRAB S/D, as soon as possible after potential contact with an animal may prevent the onset of rabies8
  • Once the signs and symptoms of rabies start to appear, there is no treatment, and the disease is almost always fatal4

Rabies vaccine and HyperRAB® S/D (rabies immune globulin [human]) should be given to all persons suspected of exposure to rabies with one exception: persons who have been previously immunized with rabies vaccine and have a confirmed adequate rabies antibody titer should receive only vaccine. HyperRAB S/D should be administered as promptly as possible after exposure, but can be administered up to the eighth day after the first dose of vaccine is given.

HyperRAB S/D should be given with caution to patients with a history of prior systemic allergic reactions following the administration of human immunoglobulin preparations.

The attending physician who wishes to administer HyperRAB S/D to persons with isolated immunoglobulin A (IgA) deficiency must weigh the benefits of immunization against the potential risks of hypersensitivity reactions. Such persons have increased potential for developing antibodies to IgA and could have anaphylactic reactions to subsequent administration of blood products that contain IgA.

As with all preparations administered by the intramuscular route, bleeding complications may be encountered in patients with thrombocytopenia or other bleeding disorders.

Soreness at the site of injection and mild temperature elevations may be observed at times. Sensitization to repeated injections has occurred occasionally in immunoglobulin-deficient patients. Angioneurotic edema, skin rash, nephrotic syndrome, and anaphylactic shock have rarely been reported after intramuscular injection so that a causal relationship between immunoglobulin and these reactions is not clear.

Administration of live virus vaccines (e.g., MMR) should be deferred for approximately 3 months after rabies immune globulin (human) administration.

HyperRAB S/D is made from human plasma. Products made from human plasma may contain infectious agents, such as viruses, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent that can cause disease. There is also the possibility that unknown infectious agents may be present in such products.

Please see HyperRAB S/D full Prescribing Information for complete prescribing details.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.


References:

  1. Centers for Disease Control and Prevention (CDC). What materials can spread rabies? CDC website. http://www.cdc.gov/rabies/exposure/materials.html. Updated April 22, 2011. Accessed May 12, 2016.
  2. Centers for Disease Control and Prevention (CDC). How is rabies transmitted? CDC website. http://www.cdc.gov/rabies/transmission/index.html. Updated April 22, 2011. Accessed May 12, 2016.
  3. Dyer JL, Yager P, Orciari L, et al. Rabies surveillance in the United States during 2013. J Am Vet Med Assoc. 2014;245(10):1111-1123.
  4. Crowcroft NS, Thampi N. The prevention and management of rabies. BMJ. 2015;350:g7827.
  5. Centers for Disease Control and Prevention (CDC). What are the signs and symptoms of rabies? CDC website. http://www.cdc.gov/rabies/symptoms/index.html. Updated February 15, 2012. Accessed May 12, 2016.
  6. Centers for Disease Control and Prevention (CDC). What care will I receive? CDC website. http://www.cdc.gov/rabies/medical_care/index.html. Updated March 23, 2016. Accessed May 12, 2016.
  7. HyperRAB® S/D (rabies immune globulin [human]) prescribing information. Grifols Therapeutics Inc. September 2012.
  8. Centers for Disease Control. Human rabies prevention — United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2008;57(RR03);1-28.