Rabies is a rare, yet nearly universally fatal diagnosis, responsible for over 59,000 deaths worldwide annually. Appropriate use of pre- and postexposure prophylaxis can eliminate the risk of developing rabies if administered according to the United States Centers for Disease Control and Prevention Advisory Committee on Immunization Practices guidelines. Though rabies is very rare, rapid recognition of potential exposures is vital to patient care and protection of public health. This review focuses on the challenges of managing patients who are at risk for or have had a potential rabies exposure, indications and guidelines for administering pre- or postexposure prophylaxis, and requirements for reporting, testing, and monitoring. Evidence regarding management of patients presenting with suspected clinical rabies is also reviewed.
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Following are the most informative references cited in this paper, as determined by the authors.
1. * Pieracci EG, Pearson CM, Wallace RM, et al. Vital signs: trends in human rabies deaths and exposures - United States, 1938-2018. MMWR Morb Mortal Wkly Rep. 2019;68(23):524-528. (Surveillance) DOI: 10.15585/mmwr.mm6823e1
3. * Fooks AR, Cliquet F, Finke S, et al. Rabies. Nat Rev Dis Primers. 2017;3(1):17091. (Review) DOI: 10.1038/nrdp.2017.91
5 * Nigg AJ, Walker PL. Overview, prevention, and treatment of rabies. Pharmacotherapy. 2009;29(10):1182-1195. (Review) DOI: 10.1592/phco.29.10.1182
8. US Centers for Disease Control and Prevention. “Domestic Animals.“ 2018. Accessed March 10, 2021. (CDC website)
12. * Hemachudha T, Laothamatas J, Rupprecht CE. Human rabies: a disease of complex neuropathogenetic mechanisms and diagnostic challenges. Lancet Neurol. 2002;1(2):101-109. (Review) DOI: 10.1016/s1474-4422(02)00041-8
25. * Manning SE, Rupprecht CE, Fishbein D, et al. Human rabies prevention--United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2008;57(RR-3):1-28. Accessed March
29. * Rupprecht CE, Briggs D, Brown CM, et al. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices. MMWR
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Keywords: rabies, bite, wild, animal, canine, bat, travel, pre-exposure prophylaxis, PrEP, post-exposure prophylaxis, PEP, vaccination, saliva, prodrome, encephalitis, furious, paralytic, dumb, hydrophobia, aerophobia, hnRT-PCR, HRIG, rabies immune globulin
Management of Suspected Rabies Exposure in the Emergency Department: An Interview With Dr. Bess Storch
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Dr. Ashoo is a practicing emergency physician, board-certified in emergency medicine and clinical informatics. Join him as he takes you through the April 2021 issue of Emergency Medicine Practice: Management of Suspected Rabies Exposure in the Emergency Department (Infectious Disease CME)
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Bess Storch, MD
Jason Chu, MD; Edward Otten, MD, FACMT, FAWM
April 1, 2021
April 30, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits
Date of Original Release: April 1, 2021. Date of most recent review: March 10, 2021. Termination date: April 1, 2024.
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Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits.
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