Travel Reference
In-Depth Information
vaccine injections (1.0 ml injected in the deltoid muscle) on day zero and day three after
exposure are required. The duration of therapy is much shorter, but at a time when rabies
immuneglobulinmaybedifficultorimpossibletofindinmanyareas,eliminatingtheneed
for immune globulin is a more significant consideration.
TheCentersforDiseaseControlandPrevention(CDC)dividesindividualsatriskofde-
veloping rabies into three groups. Group I has the highest risk and consists of rabies labor-
atory workers. Group II has a lower but significant risk and includes spelunkers, as well
as veterinarians, animal control workers, and fish and game wardens in areas of high ra-
bies incidence. For these individuals, CDC recommends vaccination and serologic testing
or boosters every two years.
Group III, which has a definite but still lower risk, includes travelers to areas with a
high incidence of rabies, veterinarians and animal control workers in areas of low rabies
incidence, and veterinary students. The Advisory Committee for Immunization Practices
recommends preexposure vaccination only for individuals who are planning to reside in
rabiesendemicareasforthirtydaysormore.However,CDCandmanyotherauthoritiesre-
commend such vaccination for anyone visiting remote areas from which they cannot reach
a center where appropriate therapy can be given in less than twenty-four hours. These au-
thoritiesalsorecommendpreexposurevaccination foryoungchildrenwhocannotberelied
on to stay away from dogs or to report any contact with dogs.
RELIABILITY OF RABIES POSTEXPOSURE THERAPY
In its 1992 Eighth Report, the World Health Organization Expert Committee on Rabies
made the remarkable statement, “Prompt and thorough cleansing of the wound, and ad-
ministration of purified equine or human rabies immunoglobulins and cell-culture rabies
vaccine immediately after exposure virtually guarantee complete protection.” They added,
“Pregnancy and infancy are never contraindications to post-exposure rabies vaccination.”
1
Since rabies is essentially always fatal, no contraindication can exist.
____________
REFERENCE
ation, 1992 (WHO Technical Report Series, No. 824).
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