rabies /rā″bēz/ [L, rabere, to rave] , an acute, usually fatal viral disease of the central nervous system of mammals. It is transmitted from animals to people through infected saliva. −rabid /rab′id/, adj. ▪ OBSERVATIONS: The reservoir of the virus is chiefly wild animals, including skunks, bats, foxes, and raccoons, and unvaccinated dogs and cats. After introduction into the human body, often by a bite of an infected animal, the virus travels along nerve pathways to the brain and later to other organs. An incubation period ranges from 10 days to 1 year and is followed by a prodromal period characterized by fever, malaise, headache, paresthesia, and myalgia. After several days severe encephalitis, delirium, agonizingly painful muscular spasms, seizures, paralysis, coma, and death ensue. ▪ INTERVENTIONS: Few nonfatal cases have been documented in humans; survival in those cases has been the result of intensive supportive care by the health care team. There is no treatment once the virus has reached the tissue of the nervous system. Local treatment of wounds inflicted by rabid animals may prevent the disease. The wound is cleansed with soap, water, and a disinfectant. A deep wound may be cauterized and rabies immune globulin injected directly into the base of the wound. For active immunization a series of three intramuscular injections with adsorbed vaccine (RVA), purified chick embryo cell vaccine, or human diploid cell rabies vaccine is begun. If vaccine is administered, intramuscular injection is given on days 0, 7, and 21 or 28. Great effort is made to locate and examine the animal. The animal that is suspected of being rabid is not immediately killed but put in isolation and carefully observed. If the animal is well in 10 days, there is little danger of rabies developing from the bite. Tissue from the animal’s brain may be examined microscopically or by fluorescent antibody screening techniques. ▪ PATIENT CARE CONSIDERATIONS: Rabies virus infection can be eradicated from most communities by prophylactic immunization of domestic animals, stringent measures for the control of domestic animals, and elimination of any wild animals acting as reservoirs of infection. A preexposure vaccination is advised for those at risk, such as veterinarians, animal handlers, and some laboratory workers. Health care professionals may encourage compliance with such efforts and teach the necessity of avoiding direct contact with wild animals and the importance of immediate first aid for any animal bite and reporting such contact to health care providers.
