RABIES - Medicine for Mountaineering and Other Wilderness Activities - page 488

the anterior thigh for small children. Rabies has developed following gluteal (buttock) in-
jections of vaccine.
The WHO has approved three rabies vaccines:
◆ Human Diploid Cell Vaccine—Rabivac®, Imovax®
◆ Purified Chick Embryo Cell Vaccine—Rabipur®, RabAvert®
◆ Purified Vero Cell Vaccine—Verorab®, Imovax®, Rabies Vero®, TRC Verorab®
Only the first two are available in the United States and Canada.
Because a few cases of human rabies develop following prolonged incubation peri-
ods—at least two were six years—postexposure therapy should be administered regardless
of the time that has elapsed since the bite.
BAT EXPOSURES
Because the manner in which rabies is transmitted by bats is uncertain, the following four
measures have been recommended:
◆ Dwellings should be bat-proofed by carefully covering all possible entrances, particu-
larly roof ventilation openings, with wire screens. Protection from bats in unscreened
dwellings or when sleeping outdoors can be achieved with mosquito netting.
◆ Contact with bats should be assiduously avoided, particularly bats that are behaving
unusually. Bats are nocturnal, and any activity during daylight hours should be con-
sidered abnormal. Diseased bats often are unable to fly. Bats should be caught with
nets; disabled bats should be scooped into a container. These animals must never be
picked up or handled with unprotected hands.
◆ Anyone who has contact with a bat, regardless of whether a bite is thought to have
been inflicted, should receive postexposure rabies therapy unlessthebatcanbecaught
and tested for rabies.
◆ Anyone, particularly a child, who awakens from sleep and finds a bat in the room
should receive postexposure prophylaxis unless the bat can be caught and tested for
rabies. A number of U.S. rabies infections in children have followed this type of ex-
posure. (A tennis racket may be useful for capturing a bat. Injuring the animal is not a
consideration because it must be killed to examine its brain for rabies.)
The problem of rabies transmission by bats is best addressed through education. Redu-
cing the bat population is not an acceptable approach, is probably impossible, and would
almostcertainlybeanecologicaldisasterbecausebatsplaysuchamajorroleininsectcon-
trol.
RABIES IN DEVELOPING COUNTRIES
Any bite or contact with saliva from any animal in a developing country should be con-
sidered an exposure to rabies, regardless of the animal's vaccination history. The vast ma-
jority of such exposures are to dogs, although in Nepal monkeys are responsible for ap-