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Viral disease transmitted by the bite or contact on wounded skin with saliva of infected animals.
The clinical course is very serious with encephalopathy, coma and habitual death, which is only preventable if post-exposure prophylaxis is administered early, during the incubation period, which is usually long (1 to 3 months; occasionally a few days), before becoming ill. (Red Book 2018 p673).
Lawrence 2016 p 452 and 786:
- Although the virus is found in the saliva and tears of sick people, human-to-human transmission has not been reported. The disease is not transmitted through breast milk.
- Post-exposure prophylaxis (PEP) consists in the administration of specific rabies immunoglobulin and rabies vaccine (live attenuated virus) as soon as possible after exposure. Both immunoglobulin and vaccine are compatible with breastfeeding.
- If the mother has been exposed (bitten by a suspicious or sick animal) and still has no symptoms, she should receive PEP and breastfeeding does not need to be interrupted.
- If both mother and baby have been exposed at the same time, both should receive PPE and breastfeeding can continue.
- If the mother has symptoms of rabies, direct breastfeeding should be stopped, the baby should be separated from the mother and given PEP and placed under close clinical monitoring. Expressed breast milk can be given, but expressing should take place avoiding possible contamination from the mother’s saliva or tears.
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