Rabies FAQ : Prevention, Part 3

by CDC

(Page 6 of 7)

What are some circumstances in healthcare settings in which rabies exposure may have occurred?

Healthcare workers who had an open wound, non-intact skin, or mucous membrane contact with a patient's saliva, or other potentially infectious material (such as neural tissue and other innervated tissue) , and health care workers who experienced an injury with a contaminated needle or other sharp device related to patient care should receive rabies PEP. Specific examples where PEP would be recommended include the following:

Needlestick, because it may have passed through innervated tissue (No virus has been detected in the blood of infected patients).

Cut or puncture of skin involving potentially contaminated tissues (e.g. scalpel injury during an invasive procedure or cut from bone fragment that penetrates glove and skin).

Cut or puncture with a solid sharp (e.g., scalpel injury during surgery or autopsy or cut from bone fragment that penetrates glove and skin).

Mucous membrane contamination with saliva (e.g., spray, splash, or hand-to-eye or hand-to-mouth contact of saliva to mucous membranes in the absence of personal protection).

Suctioning of respiratory secretions without respiratory protection.

Why is a needlestick injury considered a rabies exposure if the virus is not present in the blood?

PEP is recommended following a needlestick injury because infectious nerve material could be contained in the bore of the needle following tissue penetration in a rabies patient. Thus, the recommendation is related to the possibility of nerve tissue exposure rather than blood exposure.

What are some circumstances in healthcare settings that are not a risk for rabies exposure?

Exposure to feces, urine, blood, or other body fluids is not considered a risk for rabies transmission. The rabies virus cannot survive on surfaces in the environment for any substantial period of time. Specific examples of healthcare settings where PEP is not recommended include the following:

• Touching a patient (unless an open wound, nonintact skin, or mucous membrane was contaminated with saliva or central nervous system (CNS) material)
• Changing a patient's bed linens
• Taking a patient's blood pressure
• Serving or cleaning up a patient's meals, including handling of used dishes and utensils
• Phlebotomy (unless a needlestick injury occurs)
• Handling patient specimens (i.e., blood, csf, urine) in the laboratory
• Presence near the operating or autopsy table during routine procedures
• Observing or assisting with routine procedures

How does one determine the first date of onset of clinical signs in a patient with rabies?

The clinical presentation of rabies varies, and not all persons will develop the same clinical signs. The infection typically manifests as a viral prodrome, with any or all of the following symptoms: fever, myalgias, paresthesias, or other, flu-like symptoms. However, rabies patients usually progress to have defined CNS disturbances within 1 week of illness onset. Therefore, the patient's medical history should be carefully reviewed, and the earliest report/awareness of illness within 1 week of recognition of full CNS dysfunction should be considered the date of illness onset.

Prevention: Organ Transplants

How are potential donors screened to help ensure that their organs don't present a risk to transplant recipients?

All potential organ donors in the United States are screened and tested to identify if they might present an infection risk. Eligibility is determined through a series of questions posed to family and contacts, through physical examination, and by blood testing for evidence of organ dysfunction and selected bloodborne viral pathogens and syphilis. Organ donors with evidence active infection are deferred. The lifesaving potential from transplanted organs currently far outweighs their risk of transmitting infectious diseases.

I am an organ transplant recipient - am I at risk for rabies?

The risk for acquiring rabies from a transplant is extremely low. No human rabies cases associated with solid organ transplants have previously been reported, despite over 20,000 transplants being performed every year. Human rabies is uncommon in the United States , and on average, only 1 to 3 cases are reported each year.

I am a family member or close contact of the donor or one of the transplant recipients who died of rabies - am I at risk for rabies?

Transmission of rabies from an infected person is exceedingly rare, even in situations where there is extremely close interaction. Rabies can be transmitted when infectious material, such as saliva, enters a wound, a break in the skin, or a mucous membrane (such as the eyes, nose, or mouth). Persons who may have had this type of exposure in the 14 days before or anytime after the first signs of illness in the patient should receive rabies treatment as advised by their local health authorities.

Rabies Exposure from Unpasteurized Milk

How do people become infected with rabies?

The most common way for people to become infected with rabies is from the bite of a rabies-infected (rabid) animal. It is also possible, but extremely rare, for people to develop rabies if infectious material (such as saliva) from a rabid animal gets directly into their eyes, nose, mouth, or an open wound. Once clinical signs of rabies develop, the viral infection causes a rapidly fatal encephalitis (inflammation of the brain).

Can rabies virus be transmitted in any way other than by an animal bite?

Human cases due to non-bite exposures to rabies virus are rare. Such exposures include the contamination of scratches, abrasions, open wounds, and mucous membranes with saliva or other potentially infectious material (such as brain tissue) from a rabid animal. Occasionally, reports of non-bite exposures are such that treatment is given to the patient as a preventive measure against possible disease and death. This is called post-exposure prophylactic treatment.

Inhalation of aerosolized rabies virus is also a potential non-bite route of exposure. However, people other than laboratory workers are unlikely to encounter an aerosol of rabies virus.

Other contact, such as petting a rabid animal or contact with the blood, urine, or feces (including guano used as fertilizer) of a rabid animal, is not considered an exposure and does not require prophylactic treatment.

About the Author

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The Centers for Disease Control and Prevention (CDC) is one of the 13 major operating components of the Department of Health and Human Services (HHS), which is the principal agency in the United States government for protecting the health and safety of all Americans and for providing essential human services, especially for those people who are least able to help themselves.