Medical Microbiology

470 8 VirusesasHumanPathogen

Personsexposedtoanincreasedriskofcontractingrabiescanalsobegiv-

enpre-exposureprotectionwiththreedosesofHDCV.Postexposuretreat-

mentisthenlimitedtothewoundtoiletandHDCVinjections.

Postexposureprophylaxisisimpracticableinanimals.Dogsandcatsin

particularmustbevaccinatedwithlivingvaccinegrowninduckembryos.

Inwildanimals(foxes),oralbaitvaccinationprogramshavebeensuccessful.

Ifthebaitcontainstheattenuatedrabiesvirus,exposuretoitmustbecon-

sideredrabiesexposureandthepostexposureprophylacticproceduremust

becarriedout.Thisdoesnotapplytouseoftherecombinantvacciniavirus.

However,seep. 428 onthepathogenicityofthevacciniavirus.

Table8. 7 Rabies:PostexposureProphylaxis(accordingtoWHOrecommenda-

tionsissuedinGeneva, 1 992)

Animalspecies,

epidemiologicalsituation

Conditionofanimals Treatmentofexposed

person^1

Domesticpet

Endemicarea – HDCVandRIG^2

Notfromendemicarea:

Dog,cat Healthy,canbeobserved

for 10 days

None;ifanimaldevelops

rabieswithin 10 days,begin

immediatelywithHDCV/RIG

Suspectedrabiesorrabid,

unknown,escaped

HDCVandRIG

Otherpets – Dependsonepidemiological

situation

Wildanimal

Wildcarnivore,bats Alwaysconsiderrabid

pendingnegativelab

results

HDCVandRIG

Otherwildanimals:

Fromendemicarea – HDCVandRIG

Notfromendemicarea – Dependsonepidemiological

situation

HDCV:humandiploidcellvaccine(activevaccination);RIG:rabiesimmunoglobulin

fromhumansource(passivevaccination).

(^1) TreatmentcomprisesadministrationofRIGandHDCV(seetext).WHOrecommen-
dationsalsoallowuseofHDCValoneincasesofminorexposure(lickingofskin).
(^2) Discontinuetreatmentifanimalunderobservationremainshealthyfor 10 days.
8
Kayser, Medical Microbiology © 2005 Thieme