RABIES - Medicine for Mountaineering and Other Wilderness Activities - page 487

The behavior associated with rabies by animals other than dogs or cats is not well
known. Occasionally the only sign of rabies is the absence of fear of humans, which may
even appear to be a show of friendliness. Animals such as skunks, which usually scurry
away from any threatening situation, may actually pursue humans. Because rabid behavior
of such animals is unknown, quarantining for ten days is not a reliable way to determine
whether they are infected.
Theonlyexceptionstothiscaveatwouldbethosefewareaswhererabiesdoesnotoccur.
Hawaii, for example, is free of all forms of rabies. (To prevent the introduction of this in-
fection any mammal brought into the Islands is quarantined, unless the animal can be pos-
itivelyidentifiedbyanimplantedmicrochip,hasbeenvaccinatedforrabies,andlaboratory
studies have demonstrated that the vaccination was effective.)
Cleansing of the bite wound is just as vital as administration of immune globulin and
vaccineinthecareforpersonsexposedtorabies.Theseverityandspeedofonsetofanyin-
fection is dependent upon the number of viruses or bacteria introduced. Rinsing saliva out
of a bite wound reduces the number of rabies viruses that can enter the tissues and slows
the onset of infection, which allows time for vaccination to be effective.
Washing should be done with large quantities of soap and water—the WHO recom-
mends fifteen minutes of continuous washing—and the wound subsequently should be
flushed with a povidoneiodine preparation such as Betadine®. Washing is of such urgency
that it should be instituted without delay. If soap and water are not available, anything on
hand—even a favorite whiskey—should be used.
Immunotherapy for rabies consists of administering immune serum from an individual
or horse immune to rabies, followed by vaccine to build up immunity to the rabies virus.
The immune globulin provides passive immunization while the body is building active im-
munity in response to the vaccine. In the United States and Canada only immune globulin
of human origin is licensed. In developing nations, usually only equine (horse) globulin is
available.
Twenty international units per kilogram of body weight (20 IU/kg; 2.2 lb = 1 kg) of
rabies immune globulin of human origin or 40 IU/kg for equine globulin should be injec-
ted around the wound. If a single bite is on a finger or toe, as much globulin as possible
should be infiltrated immediately around the wound; the rest should be injected deeply in
the nearest large muscle. (Infiltration of large volumes of globulin into a finger is painful.)
If multiple wounds are present, the globulin can be diluted with saline and injected around
all the wounds. (Additional globulin should not be given because it interferes with active
immunization by vaccine.)
Following an exposure, one milliliter (1 ml) of rabies vaccine should be injected into
the deltoid muscle on the day of the bite (day zero) and on days three, seven, fourteen, and
twenty-eight.Theinjectionsmustbemadeintothedeltoid(shoulder)muscleforadultsand