Favipiravir: broad-spectrum RNA polymerase inhibitor studied in animal models
Intrathecal passive immunization: bypasses BBB; limited human data
Patient Discharge Instructions
copy discharge instructions
Rabies post-exposure prophylaxis instructions
You received the first dose of rabies vaccine and rabies immune globulin today
This treatment is highly effective at preventing rabies if started promptly after exposure
You must return for your remaining vaccine doses on the scheduled dates
Your vaccine schedule
Day 3 appointment
Day 7 appointment
Day 14 appointment
Missing a dose reduces protection — contact your doctor immediately if you cannot attend
Wound care at home
Keep the bite wound clean and dry
Wash the area gently with soap and water twice daily
Watch for signs of infection: increasing redness, warmth, swelling, pus
Return to the emergency department immediately if you develop
Numbness, tingling, or pain at the bite site
Weakness in any limb
Difficulty swallowing or breathing
Fever above 38.5 degrees C
Behavioral changes, confusion, or agitation
Difficulty drinking water or abnormal fear of water
Animal reporting
If the animal is a pet, ensure it is quarantined and observed for 10 days
If it is a wild animal or stray, report to animal control immediately
Do not handle or kill the animal yourself; capture if safe and report to authorities
Important information about rabies
Rabies is preventable with the vaccine series if treatment starts before symptoms develop
Once symptoms appear, rabies becomes nearly always fatal — this is why completing PEP is critical
The vaccine series takes about 2 weeks to complete and must not be missed
Vaccination site reactions
Pain, redness, or swelling at the injection site is common and expected
Mild fever or headache may occur after vaccine doses
Serious allergic reactions are rare; seek immediate care for difficulty breathing or facial swelling
References
Guidelines and key sources
Primary clinical references
Hemachudha T, Ugolini G, Wacharapluesadee S, et al. Human Rabies: Neuropathogenesis, Diagnosis, and Management. Lancet Neurology. 2013. PMID 23602163
Definitive review of paralytic rabies clinical features, diagnosis, and outcomes
Source for 20-33% paralytic proportion and survival statistics
Jackson AC. Rabies: A Medical Perspective. Revue Scientifique et Technique. 2018. PMID 30747124
Comprehensive management perspective including PEP protocols
Hemachudha T, Laothamatas J, Rupprecht CE. Human Rabies: A Disease of Complex Neuropathogenetic Mechanisms and Diagnostic Challenges. Lancet Neurology. 2002. PMID 12849514
Foundational pathophysiology review
Epidemiology and vaccine guidelines
Rupprecht CE, Briggs D, Brown CM, et al. Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis. MMWR Recommendations and Reports. 2010. PMID 20300058
ACIP 4-dose PEP schedule recommendation source
Rao AK, Briggs D, Moore SM, et al. Use of a Modified Preexposure Prophylaxis Vaccination Schedule. MMWR. 2022. PMC 9098245
Updated pre-exposure prophylaxis schedule
Wallace RM, Shlim DR. Rabies. CDC Yellow Book. 2025
Current US travel medicine and exposure management guidance
Diagnostic and special studies
Gadre G, Satishchandra P, Mahadevan A, et al. Rabies Viral Encephalitis: Clinical Determinants in Diagnosis With Special Reference to Paralytic Form. JNNP. 2010. PMID 19965838
Clinical differentiation of paralytic rabies from GBS
Sheikh KA, Ramos-Alvarez M, Jackson AC, et al. Overlap of Pathology in Paralytic Rabies and Axonal Guillain-Barre Syndrome. Annals of Neurology. 2005. PMID 15852372
Shared immune-mediated axonal pathology in paralytic rabies and GBS
Miller JM, Binnicker MJ, Campbell S, et al. Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update. IDSA/ASM. Clinical Infectious Diseases. 2024
Laboratory test selection and interpretation guidance
Recent case reports and outbreak data
Blackburn D, Minhaj FS, Al Hammoud R, et al. Human Rabies - Texas, 2021. MMWR. 2022. PMID 36480462
Recent US domestic rabies case illustrating diagnostic challenges
Deschamps N, Mayence C, Parize P, et al. Paralytic Rabies Outbreak Mimicking Guillain-Barre Syndrome in French Amazonia. PLoS Neglected Tropical Diseases. 2026. PMID 41911281
Cluster demonstrating GBS mimicry and diagnostic pitfalls
Whitehouse ER, Mandra A, Bonwitt J, et al. Human Rabies Despite Post-Exposure Prophylaxis. Lancet Infectious Diseases. 2023. PMID 36535276
Systematic review of PEP failures and protocol deviations
Damodar T, Mani RS, Prathyusha PV. Utility of Rabies Neutralizing Antibody Detection in CSF and Serum. PLoS NTD. 2019. PMID 30695032
RFFIT diagnostic utility for ante-mortem diagnosis
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.