DEFINITION

● Rabies is a dangerous virus that causes brain and spinal inflammation in humans and
other mammals. Animals carrying the infection can spread rabies to humans through bites
and scratches which often results in death if not prevented.

● Rabies Virus is most commonly transmitted through direct contact with the infected (such
as through broken skin, mucous membrane in the eyes, nose or mouth). With saliva or
brain tissue, it is possible for people to get rabies from non-bite exposure which includes
scratches, or any type of open wound that came in contact with a saliva or other possible
infectious materials.

FORMS OF RABIES

1. Furious rabies – It results in signs of hyperactivity, excitable behavior, hydrophobia

and sometimes aerophobia. Death occurs after a few days due to cardio-respiratory arrest.

2. Paralytic rabies – This type of rabies accounts for 20% of the total cases. This form of
rabies runs a less dramatic and usually longer course than the furious form. Muscles
gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly
develops and eventually death.

PATHOPHYSIOLOGY

● The human or an uninfected animal gets exposed to the saliva of a rabid animal through a
bite.
● The RV from the infected saliva enters the wound and into the bloodstream then the nerves.
● The RV travels through the nerves to the spinal cord and brain. This process could last from
3-12 weeks. The infected human or animal would show no sign or symptom during this
period
● When it reaches the brain, the virus multiplies rapidly then passes through the salivary
glands and symptoms arise.
● Death usually occurs within 7 days after the symptoms have been detected.

SIGNS AND SYMPTOMS

 ● After exposure to the virus, incubation inside the body may last from 2-3 months or
1month-1year for symptoms to arise. Symptoms arising may depend on how far away the
wound is to the brain, type of rabies virus and existing immunity.

● There are 2 stages of symptoms: first is the flu-like symptoms then the next target is the
CNS which then leads to cerebral dysfunction, anxiety, confusion and agitation.

CAUSATIVE FACTORS

Rabies Lyssavirus – form of virus that causes encephalitis which effects the saliva and the central
nervous system

● bite or scratch from an infected animal.

● rare to get infected from materials like saliva that gets directly into the mouth, eyes,
nose, or a wound.
● breathing air inside a cave that has a number of infected bats.
● cornea transplant from undiagnosed donor.
● domestic animals like dogs, cats, and cattle.
● racoons, skunks, bats, foxes, and coyotes.

PREDISPOSING FACTORS

● The exposure occurs in a geographical area where rabies is still present such as Asia and
Africa.
● The animal may look sick or display abnormal behavior .

● A wound or mucous membrane was contaminated by the animal's saliva.

● The bite could be provoked or unprovoked.
● There are multiple bite marks.

DIAGNOSTIC PROCEDURE

● Current diagnostic tools are not suitable for detecting rabies infection before the onset of
clinical disease.
● Human rabies can be confirmed intra-vitam and post mortem by various diagnostic
techniques that detect whole viruses, viral antigens, or nucleic acids in infected tissues
(brain, skin or saliva).

DFA TEST

● The Direct fluorescent antigen test is done post mortem of an animal which looks for
the presence of rabies virus antigens in brain tissue. They usually take 2 sample
tissues of the brain and most commonly they test the brainstem and cerebellum.

PCR TEST
 ● In humans, several tests are required. Tests are performed on samples of saliva,
serum, spinal fluid, and skin biopsies of hair follicles at the nape of the neck. Saliva
can be tested by virus isolation or reverse transcription followed by polymerase
chain reaction (RT-PCR). Amplification method PCR test results for rabies virus.
The arrows indicate positions of positive bands.

HISTOLOGIC EXAMINATION

● Histopathologic evidence of rabies encephalomyelitis (inflammation) in brain tissue and

meninges includes the following:
1. Mononuclear infiltration
2. Perivascular cuffing of lymphocytes or polymorphonuclear cells
3. Lymphocytic foci
4. Babes nodules consisting of glial cells
5. Negri bodies

DRUG OF CHOICE

1. RabAvert
Generic Name: Rabies vaccine (purified chick embryo cell)
Drug Class: Viral vaccines

● Rabies purified chick embryo cell vaccine is used to protect people who have been bitten
by animals (post-exposure) or otherwise may be exposed to the rabies virus
(pre-exposure). This vaccine works by exposing you to a small dose of the virus, which
causes the body to develop immunity to the disease. RabAvert is for use in adults and
children.
● Dosage form: After reconstitution, each 1 mL dose of suspension contains approximately
2.5 international units of rabies antigen.
● Route: Deltoid muscle
● Side effects: Abdominal pain, diarrhea, headache, muscle aches, nausea, pain, redness,
and swelling or itching at the injection site, tiredness, vomiting.

2. Bayrab

Generic Name: Rabies immune globulin (human) (test)

Drug Class: Viral vaccine

● Bayrab is used to protect people who have been bitten by animals (post-exposure).
Bayrab is given together with a full series of rabies vaccination. This medicine by itself
will not protect against rabies.
● Dosage form: Intramuscular solution (150 intl units/mL; 300 intl units/mL)
● Route: Upper arm (deltoid) or thigh muscle
● Side effects: Headache, cold symptoms, stomach pain, gas, diarrhea, muscle pain, pain,
swelling, itching, redness, or a hard lump at the injection site.

3. Imovax Rabies

Generic Name: Human diploid cell

Drug Class: Viral Vaccine

● This vaccine increases your defenses against the rabies virus by stimulating the
production of your own antibodies, which will remain in the body until needed to fight
off any rabies virus you are exposed to in the future. Antibodies usually develop within 7
to 14 days after being immunized.
● Dosage form: Intramuscular solution (150 intl units/mL; 300 intl units/mL)
● Route: Deltoid muscle
● Side effects: Pain, swelling, itching, or redness at the injection site, headache, dizziness,
muscle pain, nausea, stomach pain.
● Before taking this medicine, tell the doctor if you have: (a) a weak immune system
(caused by disease or by using certain medicine); (b) any type of infection or severe
illness; or (c) an allergy to neomycin.

4. HyperRAB
Generic Name: Rabies Immune Globulin, Human
Drug Class: Immune Globulin

● HyperRAB is an HRIG that provides rapid immune coverage, indicated for postexposure
prophylaxis (PEP), along with rabies vaccine, for all persons suspected of exposure to
rabies.
● Dosage form: 300 IU/mL (1mL, 3mL, and 5mL vials)
● Route: Deltoid muscle (IM)
● Side effects: injection site pain, headache, muscle pain, upper respiratory tract infection,
joint pain, dizziness, fatigue, abdominal pain.
● Patients who can document previous complete rabies pre-exposure prophylaxis or
complete postexposure prophylaxis should only receive a booster rabies vaccine without
RIG, owing to RIG interference with anamnestic response to the vaccine.

5. Speeda

Generic Name: Vero Cell

Drug Class: Rabies viral vaccine

● The vaccine can induce immunity against rabies virus in recipients following
immunization, it is used to protect against rabies. Preventive or pre- exposure
vaccination injection on days 0, 7, 28 with days during the second and sixth year of life.
 Post- exposure the person is bitten or scratched by a rabid dog or other rabid animals. The
treatment is adapted to the type of wound and status of the animal.
● Dosage form: Speeda vaccine (inj) 2.5 IU
● Route: Deltoid muscle (IM)
● Side effects: Pain, redness or swelling at the injection site, headache, fatigue, muscle
aches, nausea.

NURSING INTERVENTIONS AND PROCESS

Nursing Assessment
Assessment of a patient with rabies includes:
1. History – identify any suspected case of rabies virus exposure.
2. Physical exam – Identify if a patient has symptoms of rabies (such as symptoms
of furious rabies).

Categories of Exposure

Nursing Diagnosis
 From the assessment data gathered, the nursing diagnosis should be the following:
● Ineffective breathing pattern related to asphyxia
● Risk for injury related to seizures and weakness
● Risk for infection associated with open wound

Nursing Care Plan and Goals

The major nursing care plan goals for a patient with rabies includes:
● Patient remains free of injuries
● Patient has breathing pattern improvement
● Patient remains free from infection
● Patient identifies strategies to reduce anxiety
● Patient maintains body temperature below 39°

Nursing Intervention
● Improve breathing pattern
● Improve nutritional intake
● Maintain body temperature
● Reduce anxiety
● Prevent injury
● Prevent infection

Nursing Evaluation
Goals are met for a patient with rabies as evidenced by:
● Patient displayed improvement in breathing pattern
● Patient able to take adequate amount of calories and nutrients
● Patient maintained body temperature below 39 degrees Celsius
● Patient identified strategies to reduce anxiety
● Patient remained free of injuries
● Patient remained free of infection
Documentation

Documentation in a patient with rabies includes:

● Individual findings, including factors affecting, interactions, nature of social
exchanges, specifics of individual behavior.
● Cultural and religious beliefs, and expectations.
● Plan of care.
● Teaching plan.
● Responses to interventions, teaching, and actions performed.
● Attainment or progress toward the desired outcome.

NURSING RESPONSIBILITIES
● Nursing personnel should be warned against possible risk of contamination.
● They should wear gloves, a mask, goggles, and an apron to protect themselves.
● Nurses having bruises, cuts, or open wounds should not be entrusted to look after
the patient.
● Darken the room, provide a quiet environment.
● The patient should not be bathed and must not have any running water in the
room.
● Continuously monitor cardiac and respiratory function.

MEDICAL MANAGEMENT
Medical care of a patient with rabies includes:
● In patient care
● Pre-exposure prophylaxis Post-exposure approach to an animal bite.
● Post-exposure prophylaxis
● Medical treatment after symptoms.
● Rabies has an almost 100% mortality rate when symptoms have already been
detected. There is no effective treatment yet for rabies just preventive measures, if
exposed to rabies then an appropriate PEP therapy is needed.

TREATMENT
Immediate Treatment- The term ''immediate'' means without an unreasonable delay. And
"treatment" means the action or way of treating a patient or a condition medically or surgically.

Post- Exposure Prophylaxis- The immediate treatment of a bite victim after rabies exposure.
This prevents virus entry into the central nervous system, which results in imminent death.
● PEP includes: Immediate and thorough flushing and washing of the wound for a
minimum of 15 minutes with soap and water, detergent, povidone iodine or other
substances that remove and kill the rabies virus.

Rabies vaccinations include:

● A fast-acting vaccination (rabies immune globulin) to keep the virus from infecting you.
If you have not received the rabies vaccine, you will be given this. This injection is
administered as soon as possible after the bite, preferably near the site where the animal
bit you.
● Rabies vaccines are given as an injection on your arm. If you haven’t previously had the
Rabies vaccine you’ll receive four shots over the course of 14 days (O, 3, 7 & 14).

UPDATES

● July 5, 2022
According to Cleveland Clinic around 59,000 people die all over the world from
rabies. The areas most prone to get rabies are rural areas in Asia and Africa and dogs and
wild animals are the ones leading cause of animal to human transmission of rabies virus.
Also children are more likely to get rabies than adults.

● January 19, 2023

From the World Health Organization, rabies virus occurs in more than 150
countries and territories as of the moment. It causes tens of thousands of deaths every
year and mainly in countries in Asia and Africa, 40% of whom are children under 15
years old. Dogs are the main source of human rabies deaths with a total of 99% of
transmission to humans. Globally rabies causes an estimated cost of 8.6 billion US
dollars per year.

● March 13, 2023

Reported by Richa Noriega, GMA integrated news. Rabies cases and deaths in the
country have begun to increase with 55 cases reported so far this year, according to the
Department of Health (DOH). This reported cases are 8% higher than last year according
to the Bureau director Dr. Alethea De Guzman and all those 55 cases resulted in deaths.
But Dr. De Guzman said that right now those numbers are still not alarming since it is a
possible sign that the surveillance is improving. Her basis is that for the past 3 years
almost all the manpower focused on the COVID-19 pandemic and it was just recently
that we have space and resources for other diseases. She also said that they will continue
 to observe if there is an increase in the cases or just the surveillance of the DOH
improved.

PROGNOSIS

● In unvaccinated humans, rabies is almost always fatal after neurological symptoms have
developed. Vaccination after exposure, PEP, is highly successful in preventing the disease
if administered promptly (in general within 6 days of infection). Death will occur 3 days
to 1 week from the first sign of symptoms.

REFERENCES

https://nurseslabs.com/rabies/
https://www.gmanetwork.com/news/topstories/nation/863458/rabies-cases-deaths-increase-in-20
23-doh/story/
https://my.clevelandclinic.org/health/diseases/13848-rabies
https://www.who.int/news-room/fact-sheets/detail/rabies
https://www.medicalnewstoday.com/articles/181980#diagnosis
https://www.mayoclinic.org/diseases-conditions/rabies/symptoms-causes/syc-20351821
https://rnspeak.com/rabies-nursing-management/
https://www.mims.com/myanmar/drug/info/speeda?type=full#:~:text=The%20vaccine%20can%
20induce%20immunity,used%20to%20protect%20against%20rabies.