Rabies Post-Exposure Prophylaxis

Rabies post-exposure prophylaxis (PEP) prevents infection after a potentially infectious exposure; it does not treat established clinical rabies. The virus is usually introduced through infected saliva, then travels from peripheral tissue along nerves toward the central nervous system. Wound cleansing reduces the amount of virus at the entry site, rabies immune globulin (RIG) provides immediate passive antibody locally, and the vaccine stimulates the patient’s own antibody response before the virus reaches the nervous system. PEP is indicated after a bite, scratch, or saliva exposure to mucous membranes or nonintact skin from a confirmed or suspected rabid mammal. Bat contact deserves particular caution: a bite may be so small that the person never notices it, so contact with a bat can require assessment even when the skin appears intact. The decision is based on the exposure history and public-health risk assessment, not on whether the patient has fever, pain, or neurological findings. An experienced nurse does not use wound size to estimate rabies risk. A tiny puncture can be more significant than a large superficial abrasion if saliva entered the tissue....