Rabies Post-Exposure Prophylaxis

Rabies is an almost universally fatal infection of the central nervous system caused by viruses in the Lyssavirus genus. Virus in saliva or neural tissue can enter through a bite, a tooth scratch, an open wound, or a mucous membrane. It can replicate near the entry site and then travel through peripheral nerves to the central nervous system. Prevention must occur before symptoms begin because established clinical rabies has no reliable curative treatment. Early illness may include fever, headache, fatigue, and pain or unusual tingling, prickling, or burning at the exposure site. Neurologic disease can then appear as agitation, confusion, difficulty swallowing, hydrophobia, aerophobia, seizures, progressive weakness, or paralysis. Once clinical disease develops, deterioration is rapid and death is the usual outcome. Post-exposure prophylaxis (PEP) interrupts infection before the virus enters the nervous system. Thorough cleansing mechanically reduces contamination. Rabies immunoglobulin (RabIg) supplies immediate passive antibody at the wound, while vaccine stimulates active immunity. PEP prevents disease; it does not replace emergency assessment when neurologic symptoms are already present. The practical nurse does not independently decide whether PEP is indicated...