Overview, prevention, and treatment of rabies

Rabies is a uniformly fatal viral encephalitis that causes 30,000 to 70,000 deaths worldwide each year. Prevention is the primary approach to the disease. In the United States, 25,000 to 40,000 people are treated annually for exposure to rabid or potentially rabid animals at a per-patient cost exceeding $1000. Rabies is transmitted usually by saliva from infected animal bites. However, recent findings that rabies can be transmitted from bats to humans by relatively casual contact has resulted in dramatic changes in guidelines from the Centers for Disease Control and Prevention for postexposure prophylaxis. We review the 5 clinical stages of rabies, current methods of diagnosis, and prevention in animal reservoirs and in humans. We also discuss the use of rabies immune globulin and active and passive vaccinations for preexposure prophylaxis and postexposure treatment of rabies. Human exposure to rabies will always be a possibility, but methods to prevent the disease both before and after exposure to the virus are safe and readily available.