Rabies in a Thai child treated with the eight-site post-exposure regimen without rabies immune globulin

Rabies is endemic worldwide, and causes approximately 30 000 deaths per year. In the past 20 years, 12 deaths have occurred in the UK, although all but one case were contracted overseas. We have reviewed the current literature regarding the management of possible rabies exposure in the setting of a UK emergency department. The article offers an overview of rabies, including pathology, risk assessment, and current treatment, including both preexposure and post-exposure prophylaxis. We have also included a form online, which allows the correct information to be obtained and recorded prior to seeking advice from the local virology services.

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“…Whether this could have been avoided with HRIG is unclear. 35 Intradermal injections must be given correctly if they are to be used.…”

Section: Vaccination In the Ukmentioning

confidence: 99%

Rabies: a review of UK management

McKay

Wallis²

2005

Emergency Medicine Journal

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“…A recent rabies-related death involving a 7-year-old Thai girl, who had received the 8-site schedule but no RIG after incurring multiple facial bites, emphasizes the importance of administering RIG in such cases. She died of encephalitic rabies (determined on the basis of clinical evidence) 15 days after having been bitten [30]. However, it is not known whether optimal treatment (including RIG injected into wounds) would have saved her life.…”

mentioning

confidence: 99%

Rabies Update for Travel Medicine Advisors

Wilde

Briggs

Meslin

et al. 2003

Clinical Infectious Diseases

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Rabies is a neglected disease in many developing countries. It is preventable, and the tools to prevent it are known. There is urgent need for more funding, for study of innovative dog population-control measures, and for sustainable canine immunization. Safe and effective tissue-culture rabies vaccines and human and equine rabies immunoglobulins (HRIG and ERIG) are not readily available in many regions where rabies is endemic. This and the continuing presence and spread of rabies have increased the risk for travelers, who cannot rely on being able to receive optimal postexposure treatment in many parts of the world. Alternatives to HRIG or ERIG are not available. Travelers who leave the safe environments of tourist hotels and buses in regions of Asia, Russia, Africa, and Latin America where canine rabies is endemic may be at risk of life-threatening exposure to rabies.

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“…Failures of postbite therapy despite adherence to WHO treatment guidelines have been reported [6][7][8][9]. An 8-site intradermal vaccination schedule without administration of rabies immune globulin was unsuccessful in PEP [10].…”

Section: Methodsmentioning

confidence: 99%