Mayo Clin Proc, May 2004, Vol 79
Concise Review for Clinicians
Overview, Prevention, and Treatment of Rabies
DANIEL G. HANKINS, MD, AND JULIA A. ROSEKRANS, MD
Rabies is a uniformly fatal viral encephalitis that causes
30,000 to 70,000 deaths worldwide each year. Prevention is
the primary approach to the disease. In the United States,
25,000 to 40,000 people are treated annually for exposure
to rabid or potentially rabid animals at a per-patient cost
exceeding $1000. Rabies is transmitted usually by saliva
from infected animal bites. However, recent findings that
rabies can be transmitted from bats to humans by rela-
tively casual contact has resulted in dramatic changes in
guidelines from the Centers for Disease Control and Pre-
vention for postexposure prophylaxis. We review the 5
clinical stages of rabies, current methods of diagnosis, and
R abies is one of the oldest diseases known in recorded
human history. The term rabies has been variously
attributed to derivation from the Sanskrit rabhas (“to
rage”) or the Latin rabere (“to rave”). Rabies was referred
to in the Eshuma Code in Babylon more than 4000 years
ago. Modern literature (eg, Old Yeller, To Kill a Mocking-
bird, and Cujo) is replete with the horrors of this ancient
illness. For the vast majority of human existence, a bite
from a rabid animal was uniformly fatal. Because of fear of
the disease, persons bitten by a rabid animal frequently
committed suicide. The original rabies vaccine, developed
by Louis Pasteur in 1885, dramatically changed the natural
history of rabid contact, at least in the developed world.
Despite that monumental development 120 years ago and
the current availability of 3 effective vaccines, the World
Health Organization estimates that between 30,000 and
70,000 people die worldwide of rabies every year. Contrast
this with the United States’ death rate of 1 to 3 fatal human
cases per year during the past 20 years.1
THE VIRUS
Rabies is caused by a bullet-shaped RNA rhabdovirus that
is a member of the Rhabdoviridae family, genus Lyssa-
virus. Previously, a single virus type was believed respon-
From the Department of Emergency Medicine (D.G.H., J.A.R.) and
Division of Pediatric Emergency Medicine (J.A.R.), Mayo Clinic Col-
lege of Medicine, Rochester, Minn.
A question-and-answer section appears at the end of this article.
Address reprint requests and correspondence to Daniel G. Hankins,
MD, Department of Emergency Medicine, Mayo Clinic College of
Medicine, 200 First St SW, Rochester, MN 55905 (e-mail: dhankins
@mayo.edu).
Mayo Clin Proc. 2004;79:671-676
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.
Overview, Prevention, and Treatment of Rabies 671
prevention in animal reservoirs and in humans. We also
discuss the use of rabies immune globulin and active and
passive vaccinations for preexposure prophylaxis and
postexposure treatment of rabies. Human exposure to ra-
bies will always be a possibility, but methods to prevent the
disease both before and after exposure to the virus are safe
and readily available.
Mayo Clin Proc. 2004;79:671-676
CDC = Centers for Disease Control and Prevention; CNS =
central nervous system; RIG = rabies immune globulin;
RPEP = rabies postexposure prophylaxis
sible for all rabies. The discovery of rabies-related viruses
such as Lagos bat virus, Mokola virus, Duvenhage virus,
and European and Australian bat viruses, also in the genus
Lyssavirus, seriously challenged this view. Modern tech-
niques of antigen detection have shown that several viruses
and at least 6 serotypes in this genus cause diseases clini-
cally related to rabies. Also, it is possible to tell by genetic
sequencing that an infected human case originated, for
example, from a silver-haired bat or a raccoon.2-5
PATHOGENESIS
Generally, rabies is transmitted by saliva from infected
animal bites but may also be transmitted by scratches,
secretions that contaminate mucus membranes, aerosolized
virus that enters the respiratory tract, and corneal trans-
plants. Since 1980, most human cases in the United States
have not involved obvious bite wounds, but rather, less
direct mechanisms of transmission. Guidelines from the
Centers for Disease Control and Prevention (CDC) for
postexposure rabies prophylaxis for humans who have had
contact with a bat (see “Prevention” section) have changed
dramatically in the past few years, after it became obvious
that rabies could be transmitted from bats to humans by
relatively casual contact.6
The rabies virus has a predilection for nerve tissue and
spreads along peripheral nerves and possibly muscle fibers7
from the contact site to the central nervous system (CNS),
causing encephalomyelitis. Initial symptoms are typical of
a nonspecific viral syndrome, with fever, malaise, and
headache, which progress to anxiety, agitation, and de-
lirium. One clue for the clinician is tingling at the site of the
bite during the first few days after contact, a consistent
671 © 2004 Mayo Foundation for Medical Education and Research
672 Overview, Prevention, and Treatment of Rabies
symptom of a rabid bite. The virus then spreads from the
CNS throughout the peripheral nervous system, especially
to highly innervated areas such as salivary glands. This
causes hypersalivation—“frothing at the mouth”—and
spasm of the pharyngeal muscles at the sound, sight, or
taste of water leading to hydrophobia. The disease
progresses inexorably to generalized nervous system fail-
ure and death.
CLINICAL FEATURES
Rabies is a uniformly fatal disease once clinical symptoms
manifest. Only 6 documented cases exist of survival after
onset of clinical rabies; all these patients had received
either preexposure prophylaxis or expeditious postex-
posure prophylaxis after the rabid contact and before the
patients had established clinical disease. Obviously, to con-
sider the possibility of rabies at this stage requires a high
index of suspicion and a thorough patient history. The
remarkable bat-associated cases reported by the CDC dur-
ing the past few years have shown that often a bat contact
was missed because it was considered inconsequential by
family or friends.2-4
Rabies presents with 1 of 2 clinical features. Encepha-
litic (furious) rabies (80%-85% of cases) has the classic
presentation with hydrophobia, pharyngeal spasms, and
hyperactivity leading to paralysis, coma, and death. The
paralytic form is much less common.
Rabies progresses through 5 clinical stages with much
variability, depending on extent of bites, amount of secre-
tion encountered, and proximity to the CNS, ie, disease
transmitted through bites close to the brain will progress
faster than disease transmitted through bites on the lower
extremities.
Incubation—ranges from 10 days to 1 year (average, 20-
60 days).
Prodrome—occurs 2 to 10 days postexposure and lasts
1 day to 2 weeks. This stage is characterized by non-
specific flulike symptoms, including malaise, anorexia,
irritability, low-grade fever, headache, nausea, vomiting;
paresthesia, pain, or numbness may be present at the bite
site.
Acute neurologic syndrome—occurs 2 to 7 days after
onset of prodrome. This syndrome includes dysarthria, dys-
phagia, excessive salivation, diplopia, vertigo, nystagmus,
restlessness, agitation, visual or auditory hallucinations,
manic behavior alternating with lethargy, hydrophobia sec-
ondary to painful contractions of pharyngeal muscles, poly-
neuritis; hyperactive deep tendon reflexes with positive
Babinski signs and nuchal rigidity often are present.
Coma—occurs 7 to 10 days after onset of acute neuro-
logic syndrome. This stage is characterized by hydropho-
bia, prolonged apnea, and generalized flaccid paralysis that
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.
Mayo Clin Proc, May 2004, Vol 79
can intensify as in Guillain-Barré syndrome, seizures, and
coma with ultimate respiratory and vascular collapse.
Death—may follow 2 to 3 days after onset of paralysis
but may be delayed by life-support equipment. Recovery is
rare.
Rabies can be diagnosed in humans before death by
observation of virus-specific fluorescent material in skin
biopsy specimens, isolation of the virus from patient saliva,
or by the presence of antirabies antibodies in the serum or
cerebrospinal fluid of patients who have not been immu-
nized. Unfortunately, once the patient is symptomatic, use
of antirabies vaccine or rabies immune globulin (RIG) does
not improve prognosis, and treatment consists entirely of
supportive care.
ANIMAL RESERVOIRS
Rabies is found throughout the United States except for the
islands of Hawaii. Several countries, most of which are
islands, are rabies free, including the British Isles, New
Zealand, Japan, Taiwan, many of the Caribbean islands,
Sweden, Norway, and Spain. The fact that these countries
remain free of rabies is a tribute to the stringency of their
quarantine laws for imported animals. Australia was at one
time believed to be rabies free, but bat-transmitted rabies is
now endemic there.
In developed countries, the pattern of animal transmis-
sion has dramatically changed during the past 50 years.
Domesticated animals that transmit rabies (dogs, cats,
cattle) account for only 10% of human exposures, whereas
wild animals account for the other 90%, with skunks,
foxes, raccoons, and bats being the most prominent. Dogs
are the primary agent in nondeveloped countries.
It should be assumed that almost any warm-blooded
animal might be carrying rabies. However, small rodents
(gerbils, chipmunks, guinea pigs, squirrels, rats, and mice)
and lagomorphs (rabbits and hares) in general do not carry
rabies because they usually cannot survive an initial attack
by a rabid animal. No documented case of human rabies
has ever been traced to one of these animals in the United
States; however, there are anecdotal reports of rabies trans-
mitted by rats in Thailand8 and by bandicoots in Sri Lanka.
Woodchucks (groundhogs), which are large rodents, can
carry rabies. Beavers also have been reported to carry
rabies.5
Animal carriers may vary by region or state. If there is a
question, the state health department should be contacted.
Also, animal carriers vary around the world; mongooses
and antelope are common sources in Africa, for instance.
The rabies endemic to the United States results in
25,000 to 40,000 people being treated annually for expo-
sure to rabid or potentially rabid animals, especially ones
that escape after biting (usually dogs). The CDC estimates
Mayo Clin Proc, May 2004, Vol 79
that a course of RIG and 5 doses of vaccine given during a
4-week period typically exceeds $1000. The vaccine
course cost per human life saved from rabies ranges from
approximately $10,000 to $100 million, depending on the
nature of the exposure and the probability of rabies in a
region.9
PREVENTION
Rabies cannot be treated; therefore, efforts must be focused
on preventing the disease. Disease-prevention measures
are aimed at the animals that can transmit rabies or can
include postexposure treatment of a person.
The incidence of rabies in humans in the United States
has decreased dramatically with the introduction of
communitywide rabies immunization for domestic ani-
mals. Although most domestic animals in urban areas are
immunized repeatedly, this is not always the case for all
farm animals or for feral animals living on the fringes of
domestic society.10
Rabies-prevention measures are the responsibility of
animal owners. Maintaining immunizations for domestic
pets not only protects the pet but also provides some pro-
tection for pet owners and wild animals. Pets should be
supervised so that they do not come into contact with wild
animals. Communities maintain animal-control agencies
to remove stray or wild animals to decrease the risk of
disease.
Rabies continues to be found in wild animals in North
America. Education about avoiding contact with wild ani-
mals is an important public health measure in reducing risk
of rabies exposure. Raccoons, skunks, foxes, and coyotes
can be enjoyed from a distance, but they should not be
attracted intentionally or adopted. The first recorded hu-
man death from genetically sequenced raccoon rabies was
reported recently. Aerial vaccination programs have re-
duced the incidence of rabies in coyotes in southern Texas
and raccoons in the Atlantic states; however, any person
who is bitten by a wild animal anywhere in North Amer-
ica should be considered at extremely high risk of rabies
infection.11-15
Bats are the major source of human rabies in the United
States.16 For many patients in whom nucleotide analysis
shows that the rabies virus strain is of bat origin, no history
of an actual bat bite can be obtained. This may be because
the bat bite is extremely small, the patient does not report a
bite to anyone and can no longer give the history, or the
virus is spread through aerosol transmission.17,18
Preventing rabies transmission by bats needs to be ad-
dressed through education about bat behavior. Homes
should be bat-proofed by covering ventilation openings
with screens. Because bats are nocturnal, any daytime bat
activity should be considered extremely suspicious. Direct
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.
Overview, Prevention, and Treatment of Rabies 673
contact with bats should be avoided. The CDC recom-
mends postexposure rabies prophylaxis for anyone who
has contact with a bat, even if there has been no bite. Any
person who awakens from sleep and finds a bat in the room
should be immunized. Some may consider such immuniza-
tion to be overtreatment; however, rabies is uniformly fatal,
and effective treatment is available. Treatment is costly,
but no rabies-exposed patient wants to wait to see whether
clinical disease develops before being treated.
PREEXPOSURE PROPHYLAXIS
Preexposure prophylactic immunization is recommended
for people who are likely to be exposed to rabid animals.
Veterinarians, animal handlers, and laboratory personnel
should consider routine immunization. Also, people travel-
ing to areas where dog rabies is endemic and who will not
have easy access to medical care should consider immuni-
zation before traveling.19
A person who was previously immunized and who has
had a potential rabies exposure should receive 2 intramus-
cular doses of vaccine, the first dose as soon as possible
after exposure and the other 3 days later. “Previously im-
munized” persons include those who received 1 of the
vaccines according to recommended US schedules or those
who had a documented adequate rabies antibody titer after
other vaccination administration. RIG is unnecessary be-
cause of the anamnestic response in previously vaccinated
persons. Routine serologic testing after booster vaccination
is not recommended because of the uniformity of an anti-
body response.
POSTEXPOSURE TREATMENT
Wound Care
After an animal has bitten a person, the bite should be
cleaned extensively with soap and water to help reduce the
risk of bacterial infection. Povidone solutions or 70% alco-
hol may reduce viral transmission from a bite. Cosmetic
repair of a bite wound should be assessed; however, closing
a wound may increase the risk of bacterial infection.20
Immunization against rabies should be based on assess-
ment of the rabies risk in the animal that caused the bite
(Table 121).
In general, a bite from a domestic animal that has been
reliably immunized does not represent a high risk of rabies
and does not necessitate rabies treatment unless the ani-
mal’s behavior is unusual. Animals that are at low risk for
rabies can be observed for signs of behavioral abnormali-
ties for a 10-day period. If the animal shows abnormal
behavior, its saliva would be infectious, and killing the
animal is warranted.
In developing countries, immunization of domestic ani-
mals may not be current. Therefore, all bites should be
674 Overview, Prevention, and Treatment of Rabies Mayo Clin Proc, May 2004, Vol 79

Table 1. Indications for Rabies Immunization*

Evaluation and disposition Postexposure prophylaxis
Animal type of animal and recommendations
Dog, cat, ferret Healthy and available for 10-day Use prophylaxis only if animal
observation develops signs of rabies†
Rabid or suspected of being rabid Treat immediately with rabies
vaccine and RIG
Unknown or escaped Consult public health officials
Bat, skunk, raccoon, fox, and Regard as rabid unless geographic Treat immediately with rabies
most other carnivores; area is known to be rabies free or vaccine and RIG
woodchuck until animal is proved rabies free
by laboratory tests‡
Livestock, rodents, lagomorphs
(rabbits and hares) Consider individually Consult public health officials
*RIG = rabies immune globulin.
†During the 10-day observation period, at the first sign of rabies in the biting animal, treatment with RIG and
rabies vaccine should be initiated. The suspected animal should be killed and tested.
‡The animal should be killed and tested as soon as possible. Holding for observation is not recommended.
Immunization can be discontinued if immunofluorescent test results of the animal are negative.21

considered potentially rabid, and treatment should be
started immediately after any dog bite, whether the animal
is domestic or wild.
If a person is bitten by a wild or unimmunized animal
and the animal can be killed and examined for possible
rabies, the patient should be immunized immediately and
then treatment continued on the basis of test results. Unfor-
tunately, the animal is unavailable in many cases, and every
bite by a wild animal must be considered rabid.
Immunoprophylaxis
Administration of rabies postexposure prophylaxis
(RPEP) is a medical urgency but not a medical emergency.
The need for rabies prevention should be evaluated care-
fully. Regional public health officials are helpful in mak-
ing the decision to initiate prophylaxis. The Advisory
Committee on Immunization Practices has comprehensive
guidelines for RPEP. A review of actual RPEP practice
in urban emergency departments found that RPEP was
initiated inappropriately in many cases but was withheld
inappropriately in even more cases that met criteria for
immunization.22,23
When RPEP is indicated, both passive and active vacci-
nation always should be given. The combination of rabies
immunoglobulin and rabies vaccine should be used for
both saliva-contaminated bites and for nonbite exposures.
The incubation period in humans from virus exposure to
onset of clinical disease is believed to average from 4 to 6
weeks but has been reported to range from 5 days to more
than 1 year. Immunization should be initiated as quickly as
possible after potential rabies exposure.21
Passive Vaccination.—RIG is a solution of globulins
dried from the plasma or serum of selected adult human
donors who have been immunized with rabies vaccine and
have developed high titers of rabies antibody. RIG gener-
ally contains 10% to 18% protein of which 80% or more is
monomeric immunoglobulin G. RIG is administered to
previously unimmunized people so that passive antibodies
are present until the person begins making active antibod-
ies to the vaccine. RIG should not be given more than 7
days after initiation of the vaccine because RIG may de-
crease a person’s own antibody response.
RIG is given in a single dose of 20 IU/kg body weight.
This dose should not be exceeded because higher doses
may decrease antibody response to the vaccine.
If there is a bite wound and it is in an anatomical
location that allows infiltration of the wound, the full RIG
dose should be injected directly into and around the wound.
If the exposure is a nonbite event or if the bite is too small
or on an area such as a fingertip where infiltration is unfea-
sible, the entire RIG dose can be given intramuscularly,
usually in the buttocks.
The most common complications of RIG are pain and
soreness at the injection site. Caution must be taken to
avoid intravenous administration because anaphylaxis can
occur. If the patient had a previous reaction to any human
immunoglobulin, the patient’s history must be reviewed
carefully before RIG is given. If the patient has received
any other live virus vaccines, immune response may be
blunted by RIG.
Active Vaccination.—Three rabies vaccines are cur-
rently available in the United States: rabies vaccine ad-
sorbed, human diploid cell rabies vaccine, and purified
chick embryo cell vaccine; all 3 are inactivated virus vac-
cines. The production of specific antibodies against rabies
virus requires about 7 to 10 days to develop. The vaccina-
tion series needed to achieve protective levels of antibody
against rabies consists of five 1-mL doses given in the

For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.
Mayo Clin Proc, May 2004, Vol 79
deltoid area. After the initial vaccine is given, the 4 subse-
quent doses should be given on days 3, 7, 14, and 28.23
Vaccine failures have occurred when there was devia-
tion from the vaccination schedule, when the vaccine was
administered in the gluteal area, or when RIG was not
injected into and around the wound site.
There are few adverse reactions to human diploid cell
rabies vaccine because the vaccine contains fewer foreign
proteins. Local pain and swelling have been reported in
about one half of recipients. Immune complex reactions
and illness resembling Guillain-Barré syndrome have been
noted. These reactions seem to be less likely in people who
are receiving the vaccine for the first time.
Patients who are taking corticosteroids or are immuno-
suppressed may not develop active immunity with the vac-
cine. Antibody titers may need to be monitored for these
individuals to ensure that they have developed antibody
levels that will protect them from rabies.24
No evidence has shown that RIG or the rabies vaccine
causes fetal abnormalities; therefore, pregnancy is not a
contraindication to appropriate rabies prophylaxis. RIG
and the rabies vaccine have been used without problems in
infants.
SUMMARY
Unfortunately, rabies virus is present in the wild animal
population of the continental United States, and human
exposure to this fatal disease cannot be eradicated. Current
methods for preventing rabies both before and after poten-
tial rabies virus exposure are safe and readily available.
Public health officials maintain up-to-date information
about exposure risks and appropriate therapeutic measures.
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2. Centers for Disease Control and Prevention. Human rabies—Iowa,
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4. Centers for Disease Control and Prevention. Human rabies—Cali-
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6. Centers for Disease Control and Prevention. Human rabies preven-
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2000;49:737]. MMWR Morb Mortal Wkly Rep. 1999;48(RR-1):1-
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7. Jackson AC. Rabies. Curr Treatment Options Infect Dis. 2003;5:
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8. Dutta DJ. Treatment after rodent exposure necessary to avoid death
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/introduction/intro.htm. Accessibility verified April 5, 2004.
10. National Association of State Public Health Veterinarians, Inc.
Compendium of Animal Rabies Prevention and Control, 2001.
MMWR Recomm Rep. 2001;50(RR-8):1-9.
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associated with raccoon rabies—Virginia, 2003. MMWR Morb
Mortal Wkly Rep. 2003;52:1102-1103.
12. Rupprecht CE, Hanlon CA, Hemachudha T. Rabies re-examined.
Lancet Infect Dis. 2002;2:327-343.
13. Jackson AC. Update on rabies. Curr Opin Neurol. 2002;15:327-
331.
14. Finnegan CJ, Brookes SM, Johnson N, et al. Rabies in North
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16. Krebs JW, Noll HR, Rupprecht CE, Childs JE. Rabies surveillance
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17. Gibbons RV. Cryptogenic rabies, bats, and the question of aerosol
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18. Moran GJ. Dogs, cats, raccoons, and bats: where is the real risk for
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24. Hay E, Derazon H, Bukish N, Scharf S, Rishpon S. Postexposure
rabies prophylaxis in a patient with lymphoma. JAMA. 2001;285:
166-167.
Questions About Rabies
1. A farmer presents after 2 days of malaise, fever, and
lethargy. A thorough patient history is taken, during
which the farmer states that a calf had been choking
10 days previously and that he had reached into its
mouth with an ungloved arm to try to relieve an
airway obstruction but was unsuccessful; the calf
died. Which one of the following would be the best
action to take?
a. Send the calf’s brain to the state medical laboratory
for rabies analysis
b. Assume that the calf story is a red herring and
perform a sepsis evaluation
c. Treat the patient for influenza pneumonia
d. Begin treatment for rabies with RIG and rabies
vaccine
e. Do not begin rabies treatment because the sick
animal was domesticated and therefore the risk of
rabies is low
676 Overview, Prevention, and Treatment of Rabies
2. A 30-year-old woman living in an older rental home
with 3 young cats found 1 of the cats in her bedroom
playing with a dead bat. The woman found a second
bat in the bedroom closet. Which one of the
following actions is recommended?
a. The bat was dead and the woman had no direct
contact with it; therefore, no treatment is
necessary for the woman or her cat
b. The woman has been sleeping in a room where bats
have been present; therefore, she should receive
standard RIG and the rabies vaccination series
c. The woman has been sleeping in a room where bats
have been present, but she has had no direct
contact with the bats; therefore, she needs only
the rabies vaccination series
d. Because the cat was playing with the dead bat, the
cat should be killed and its brain examined for
possible rabies
e. The cat should be treated with rabies
immunoglobulin for rabies exposure
3. A 5-year-old girl ran home and told her mother that a
cat had bitten her hand when she tried to pet it. She
does not know the color of the cat or where it lives.
Her mother thinks some stray cats are living in the
area. The girl has 2 deep puncture wounds on her
right thumb. Which one of the following actions is
recommended?
a. The neighborhood should be searched for stray
cats; any cats found should be killed and sent to
the state medical laboratory for analysis of brain
tissue. The girl should not receive prophylatic
treatment until results are available
b. The wound should be cleaned with soap and water,
and antibiotics should be started to prevent
bacterial infection. No rabies prophylaxis is
needed because cats are unlikely to spread this
viral disease
c. The girl should begin the rabies vaccination series,
but she does not need RIG because the wounds
are too small to be injected
d. The girl should receive RIG at a dose of 20 IU/kg
divided between injection into the wound sites
and intramuscularly in the buttocks; also, she
should begin the rabies vaccination series
e. The girl should receive RIG at a dose of 20 IU/kg
injected into the wound sites only; the rabies
vaccination series is not needed
For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.
Mayo Clin Proc, May 2004, Vol 79
4. At a family reunion, a horse was bridled with a mouth
bit and ridden by several children. The next day, the
horse was found dead. Veterinary and laboratory test
results were positive for rabies. Which one of the
following treatments is indicated?
a. Everyone who bridled or petted the horse and was
exposed to the horse’s saliva should receive RIG
and the rabies vaccination series
b. Everyone who attended the reunion and was in the
vicinity of the horse should receive RIG and the
rabies vaccination series
c. Everyone who touched or rode the horse should
receive RIG and the rabies vaccination series
d. Only people who were bitten by the horse should
receive RIG and the rabies vaccination series
e. Everyone who was bitten by the horse or otherwise
exposed to the horse’s saliva should begin the
rabies vaccination series; however, RIG is not
needed if the exposure was a nonbite event or
the bite was on an area where infiltration is
unfeasible
5. A 24-year-old medical student is planning a trek in
Nepal. She plans to be away from Katmandu and
other medical treatment centers. She is concerned
about exposure to rabid dogs, which are endemic in
the trek area. Which one of the following
precautions is recommended?
a. She should carry a first-aid kit that includes
povidone-iodine and 70% alcohol to clean
contaminated wounds; she should be concerned
about rabies only if bitten by a dog that was
acting strangely
b. She should return immediately to Katmandu for
proper treatment within a week of a bite
c. She should carry RIG and rabies vaccine with her
to start treatment if she is bitten
d. She should be immunized with the rabies vaccine
before going into an endemic area
e. She should use simple avoidance measures to keep
all dogs away from her during the trek
Correct answers:
1. d, 2. b, 3. d, 4. a, 5. d