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Rabies Nursing Management

October 26, 2024 Modified date: October 26, 2024

Rabies is a viral disease primarily affecting the central nervous system, which is 100% fatal once symptoms appear but is entirely preventable through vaccination. Dogs are responsible for nearly 99% of human rabies cases, with children aged 5 to 14 being especially vulnerable. The disease, classified as neglected, does not lead in mortality and morbidity statistics but is nonetheless a significant public health problem due to its acute fatality rate. In the Philippines alone, rabies causes the death of approximately 200-300 Filipinos each year, underscoring the need for increased awareness and prevention efforts. According to the WHO (2024), rabies can infect various mammals, including domestic pets like dogs and cats, livestock, and wildlife.

Rabies transmission to humans and animals occurs via saliva, typically through transdermal bites or scratches, and occasionally through contact with mucous membranes such as the eyes, mouth, or open wounds. Rare cases of rabies transmission have occurred through inhalation of virus-containing spray or organ transplants. The global economic impact of rabies is estimated at about US$8.6 billion annually, considering the costs of lost lives and livelihoods, medical expenses, and other related factors (WHO, 2024).

Nurses play a critical role in managing potential rabies cases and are often at the frontline of healthcare delivery. Their responsibilities include assessing patients for potential exposure to rabies by gathering detailed histories of any animal interactions, especially bites or scratches. Understanding the circumstances of these injuries is essential to determining the need for post-exposure prophylaxis (PEP). Additionally, nurses execute proper wound management to prevent infection, ensuring that any bite or scratch is thoroughly cleaned and assessed for further treatment, such as vaccinations.

Lastly, nurses also educate patients about the risks associated with animal bites and scratches, emphasizing the importance of seeking immediate medical attention following any potential rabies exposure.

Mode of transmission

The rabies virus is most commonly transmitted via the saliva of infected mammals, particularly through bites. When an infected animal bites another animal or a human, the virus-laden saliva enters through broken skin or mucous membranes. In rare cases, transmission can also occur through scratches or open wounds that come into contact with infected saliva.

Once inside the body, the virus binds to specific receptors on host cells, particularly muscle cells and nerve cells. It can replicate in muscle tissue near the entry site before moving into the nervous system. The virus does not penetrate intact skin, making direct contact with broken skin or mucous membranes essential for transmission.

The rabies virus is neurotropic, meaning it has a strong affinity for nerve cells. After initial replication, it travels centripetally (toward the center) along peripheral nerves to the central nervous system (CNS) using retrograde axonal transport mechanisms. This transport occurs rapidly, allowing the virus to evade the immune response during its early stages.

Upon reaching the CNS, the virus undergoes significant replication, leading to neurological symptoms as it disrupts normal nerve function. This phase marks a critical point where clinical symptoms begin to manifest.

Following replication in the CNS, the virus spreads away from the center to various tissues and organs throughout the body, including salivary glands, corneal epithelial cells, and other secretory tissues.

One notable aspect of rabies is its effect on animal behavior; infected animals may exhibit aggression or increased biting tendencies, facilitating further transmission of the virus. This behavior enhances the likelihood of encounters with other animals or humans

Sign and Symptoms

Animals	Human
may appear sick, crazed, or vicious (“mad dog”)	pain, tingling, and/or itching at bite site.
may also appear overly friendly, docile or confused	– nonspecific – fever, chills, fatigue, muscle aches
nocturnal animals alert during the day	later – high fever, agitation, confusion
	extreme hydrophobia and aerophobia
	death during later stages

Incubation period

The usual incubation period is 2 to 8 weeks. However, It can also belong for a year it depends on the severity of the wounds and the resistance of the host.

Period of communicability
The patient is communicable 3 to 10 days before the onset of symptoms until the entire course of illness.

Diagnosis

No tests are available to diagnose rabies infection in humans before the onset of clinical disease, and unless the rabies-specific signs of hydrophobia or aerophobia are present, the clinical diagnosis may be difficult. Post mortem, the standard diagnostic technique is to detect rabies virus antigen in brain tissue by fluorescent antibody test.

Treatment

Once symptoms for rabies appear, there is no treatment. However, a vaccine can be administered after an exposure (postexposure prophylaxis). The indication of vaccination depends on type of contact with the rabid animal.

Category of exposure to suspect rabid animal	Post-exposure measures
Category I -touching or feeding animals, licks on intact skin	None
CategoryII -nibbling of uncovered skin, minor scratches or abrasions without bleeding	Immediate vaccination and local treatment of the wound
Category III- single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks, exposures to bats.	Immediate vaccination and administration of rabies immunoglobulin; local treatment of the wound

Recommended Postexposure Prophylaxis Administration
A patient who is exposed and has never been vaccinated against rabies should give Intramuscular (IM) of rabies immune globulin (RIG) on day 0, give 1 mL of rabies vaccine on days 0, 3, 7, 14, and 28. If the patient has previously vaccinated with a cell culture vaccine and previously demonstrated rabies antibody he/she should receive 2 IM doses of 1 ml each, one immediately and one 3 days later.RIG should not be given.
Note: Administer IM in the deltoid area in older children, adults, and in the mid-lateral aspect of the thigh in young children. Never administer rabies vaccine in the gluteal area this may result in an inadequate immune response. Post-exposure prophylaxis dose must be given as soon as possible.