Editing Rabies (section)

===After exposure===
[[postexposure prophylaxis|Treatment after exposure]] can prevent the disease if given within 10 days. The rabies vaccine is 100% effective if given early, and still has a chance of success if delivery is delayed.<ref name=Sherris/><ref name="CDC_Rabies_PEP"/><ref name="Lite2009">{{cite magazine|url=http://www.scientificamerican.com/article.cfm?id=jeanna-giese-rabies-survivor |title=Medical Mystery: Only One Person Has Survived Rabies without Vaccine—But How? |magazine=[[Scientific American]] | first = Jordan | last = Lite | name-list-style = vanc |date=8 October 2008 |access-date=2010-01-30 |url-status=live |archive-url= https://web.archive.org/web/20091105091606/http://www.scientificamerican.com/article.cfm?id=jeanna-giese-rabies-survivor |archive-date=5 November 2009 }}</ref> Every year, more than 15&nbsp;million people get vaccinated after potential exposure. While this works well, the cost is significant.<ref>{{Cite web|url=https://www.who.int/neglected_diseases/news/human_rabies_better_coordination_and_emerging_technology/en/ |title=Human rabies: better coordination and emerging technology to improve access to vaccines |website=World Health Organization |language=en-GB |access-date=2017-02-23 |url-status=live |archive-url=https://web.archive.org/web/20170224131644/http://www.who.int/neglected_diseases/news/human_rabies_better_coordination_and_emerging_technology/en/ |archive-date=24 February 2017 }}</ref> In the US it is recommended people receive one dose of human rabies [[immunoglobulin]] (HRIG) and four doses of rabies vaccine over a 14-day period.<ref>[https://www.cdc.gov/mmwr/pdf/rr/rr5902.pdf "Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies"] {{webarchive|url=https://web.archive.org/web/20110725112251/http://www.cdc.gov/mmwr/PDF/rr/rr5902.pdf |date=25 July 2011 }}. [[Centers for Disease Control and Prevention]] (CDC).</ref> HRIG is expensive and makes up most of the cost of post exposure treatment, ranging as high as several thousand dollars.<ref>{{cite web|url=https://www.cdc.gov/rabies/location/usa/cost.html |title=Cost of Rabies Prevention |url-status=live |archive-url=https://web.archive.org/web/20160329143011/http://www.cdc.gov/rabies/location/usa/cost.html |archive-date=29 March 2016 |date=11 June 2019 }}</ref> As much as possible of this dose should be injected around the bites, with the remainder being given by deep intramuscular injection at a site distant from the vaccination site.<ref name="CDC_Rabies_PEP">{{cite web |url=https://www.cdc.gov/rabies/exposure/postexposure.html |title=Rabies Post-Exposure Prophylaxis |publisher=[[Centers for Disease Control and Prevention]] (CDC) |date=23 December 2009 |access-date=2010-01-30 |url-status=dead |archive-url=https://web.archive.org/web/20100201085054/http://www.cdc.gov/rabies/exposure/postexposure.html |archive-date=1 February 2010 }}</ref>

People who have previously been vaccinated against rabies do not need to receive the immunoglobulin, only the postexposure vaccinations on days 0 and 3.<ref>Park's textbook of Community medicine, 22nd edition, 2013, p 254.</ref> The side effects of modern [[cell-based vaccine]]s are similar to the side effects of flu shots. The old nerve-tissue-based vaccination required multiple injections into the abdomen with a large needle but is inexpensive.<ref name="Ly2009"/> It is being phased out and replaced by affordable World Health Organization intradermal-vaccination regimens.<ref name="Ly2009"/> Intramuscular vaccination should be given into the [[deltoid muscle|deltoid]], not the [[gluteal muscles|gluteal area]], which has been associated with vaccination failure{{Citation needed|date=May 2020}} due to injection into fat rather than muscle. In children less than a year old, the lateral thigh is recommended.<ref>{{cite web|url=https://www.who.int/ith/vaccines/rabies/en/ |title=Rabies |website=www.who.int |publisher=[[World Health Organization]] |access-date=1 February 2015 |url-status=live |archive-url=https://web.archive.org/web/20150215014809/http://www.who.int/ith/vaccines/rabies/en/ |archive-date=15 February 2015 }}</ref> Thoroughly washing the wound as soon as possible with soap and water for approximately five minutes is effective in reducing the number of viral particles.<ref>{{cite web |url=http://www.health.vic.gov.au/ideas/bluebook/rabies_info |title=Rabies & Australian bat lyssavirus information sheet |publisher=Health.vic.gov.au |access-date=2012-01-30 |url-status=dead |archive-url=https://web.archive.org/web/20110818081218/http://www.health.vic.gov.au/ideas/bluebook/rabies_info |archive-date=18 August 2011 }}</ref> [[Povidone-iodine]] or alcohol is then recommended to reduce the virus further.<ref>{{cite web |author1=National Center for Disease Control |title=National Guidelines on Rabies Prophylaxis |url=http://nicd.nic.in/Rabies_guidelines2014.pdf |access-date=5 September 2014 |year=2014 |url-status=dead |archive-url=https://web.archive.org/web/20140905235321/http://nicd.nic.in/Rabies_guidelines2014.pdf |archive-date=5 September 2014 }}</ref>

Awakening to find a bat in the room, or finding a bat in the room of a previously unattended child or mentally disabled or intoxicated person, is an indication for [[post-exposure prophylaxis]] (PEP). The recommendation for the precautionary use of PEP in bat encounters where no contact is recognized has been questioned in the medical [[literature]], based on a [[cost–benefit analysis]].<ref>{{cite journal | vauthors = De Serres G, Skowronski DM, Mimault P, Ouakki M, Maranda-Aubut R, Duval B | title = Bats in the bedroom, bats in the belfry: reanalysis of the rationale for rabies postexposure prophylaxis | journal = Clinical Infectious Diseases | volume = 48 | issue = 11 | pages = 1493–9 | date = June 2009 | pmid = 19400689 | doi = 10.1086/598998 | doi-access = free }}</ref> However, a 2002 study has supported the protocol of precautionary administering of PEP where a child or mentally compromised individual has been alone with a bat, especially in sleep areas, where a bite or exposure may occur with the victim being unaware.<ref>{{cite journal | vauthors = Despond O, Tucci M, Decaluwe H, Grégoire MC, S Teitelbaum J, Turgeon N | title = Rabies in a nine-year-old child: The myth of the bite | journal = The Canadian Journal of Infectious Diseases | volume = 13 | issue = 2 | pages = 121–5 | date = March 2002 | pmid = 18159381 | pmc = 2094861 | doi = 10.1155/2002/475909 }}</ref>

{{anchor|Jeanna Giese}}