Administration of the full course of Rabies immunoglobulin and vaccine after thoroughly washing the wounds with soap and water can prevent rabies in almost 100% of cases.

Since the steps of prevention are taken after an exposure it is called Post-Exposure Prevention.

Post-Exposure Prevention:

As per World Health Organization (WHO), there are 3 types of exposures which are described in the table below along with actions to be taken for its prevention:

Category Types of Exposure Prevention
Category I
  • Touching or feeding of animals
  • Licks on intact skin
  • Contact of intact skin with secretions or excretions of rabid animal or person
1 Action to be taken -
  • No treatment required except doctor advice
Category II
  • Nibbling of uncovered skin
  • Minor scratches or abrasions without bleeding
2 Actions to be taken -
  • Thorough wound wash with soap and water followed by an antiseptic
  • Administration of anti-Rabies vaccination immediately (WHO also recommends Rabies Immunoglobulin in patients with weak immune response)
Category III
  • Any bite or scratch with ooze of blood
  • Licks on broken skin & contamination with saliva from licks
3 Actions to be taken -
  • Thorough wound wash with soap and water followed by an antiseptic
  • Administration of Rabies Immunoglobulin into and around all wounds
  • Administration of anti-Rabies vaccination immediately

Category I (no risk) exposure does not need any medical attention. All patients with Category II and Category III exposure need to visit a doctor immediately for further treatment in order to prevent the rabies virus from entering the nervous system, which would result in death.

Importance of Wound Wash: Washing the wound thoroughly with soap and water removes the saliva and the virus that may be present and thereby reduces the risk of rabies. Although it is important, it does not eliminate the risk of rabies.

Importance of Rabies Immunoglobulin: Rabies can occur as early as 4-5 days after an exposure with an infected animal and therefore immediate protection is critical in those with category III exposures. However, vaccination may take up to 14 days to provide protection against the rabies virus. During this lag period, only the Rabies Immunoglobulin acts immediately and neutralizes the virus and therefore plays an important role in preventing rabies.

Types of Rabies Immunoglobulins:

Rabies Immunoglobulins currently used are derived from immunized horses (ERIG) or humans (HRIG). The problems faced by using these products are:

  • High risk for severe allergic reactions
  • Potential risk of blood borne pathogens
  • Skin sensitivity test required (for ERIG)
  • High cost
  • Limited availability

To address these critical issues, Serum Institute of India, in collaboration with MassBiologics, USA has developed the Worlds First Recombinant Rabies Monoclonal Antibody (R-Mab). The benefits of R-Mab over ERIG & HRIG are:

  • Safest, purest and most potent form of Rabies Immunoglobulin
  • Proven to inactivate all known rabies virus isolates in India
  • Does not require any prior skin testing nor do patients suffer from the potential risk of transmission of blood-borne pathogens
  • Victims need a significantly lower dose than ERIG or HRIG
  • No availability issue
  • More cost effective than HRIGs

Importance of Vaccination: Like Rabies Immunoglobulin, vaccines are an equally important part of anti-rabies treatment. A full course of the vaccine provides an adequate level of protection throughout the incubation period and for a long time.

All category II and III exposures need immediate anti-rabies vaccination. As per World Health Organization (WHO), the schedule consists of 5 vaccine doses that are given on:

  • Day 0 (day of first dose of vaccine and not the day of bite)
  • Day 3,
  • Day 7,
  • Day 14 &
  • Day 28

These injections are given in the shoulder muscle (intramuscular) in older children and adults. In young children, it is given in the thigh muscles.

Pre-Exposure Prevention:

One can take advance protection especially if they are at high risk of animal exposure. This is called Pre-exposure (before a bite) protection. It is very useful for individuals at high risk such as:

  • Children, due to their playful nature they are more likely to be bitten by dogs and cats.
  • Veterinarians and animal handlers like zoo staff
  • Postal, Sales and Courier staff

Pre-Exposure prevention consists of only 3 vaccine doses, given on

  • Day 0 (day of first dose of vaccine)
  • Day 7 and
  • Day 21 or 28

Advantage of pre-exposure vaccination:

If a bite occurs, the body already has some protection that greatly reduces the risk. A doctor must be consulted immediately to manage the wound. Only two doses of the vaccine are required on days 0 and 3 to get protected against rabies (instead of five doses).

Rabies Immunoglobulin is not needed in these cases.

Time is of essence in case of Rabies prevention and one must never neglect any scratch or bite from an animal. It is in ones interest to contact a doctor at the earliest. Following the doctor's advice correctly and on time can save lives from rabies.