II. Epidemiology
- Postexposure Rabies Prophylaxis is given to as many as 55,000 patients per year in United States
III. Approach
- Dog, cat, or ferret bite
- Worldwide, dogs are responsible for many of the 59,000 human deaths due to Rabies each year
- Rabies Prophylaxis is needed if Dog Bite occurs outside developed regions
- Healthy appearing animals
- Observe for 10 days and start Rabies Vaccine if Rabies clinical signs develop
- Do not euthanize any animal involved in a bite injury prior to completion of 10 day observation
- Start Vaccination immediately if
- Rabies suspected or
- Unknown status such as an escaped dog that cannot be observed (consult with public health first)
- Worldwide, dogs are responsible for many of the 59,000 human deaths due to Rabies each year
- Bat, raccoon, skunk, fox, coyote or other carnivorous mammal bite
- Assume rabid status unless Rabies test negative
- Vaccination may be delayed if Rabies testing of the animal is pending (consult with public health)
- Livestock and horse bite
- Livestock are typically fully vaccinated in the U.S.
- Consult public health
- Rabbit, hare, small rodent (squirrel, chipmunk, rat, mouse, hamster, gerbil, guinea pig) or other mammal bite
- Rarely requires Rabies Prophylaxis
- No known cases of these small rodents transmitting Rabies to humans
- Consult public health
- References
IV. Indications: Post-exposure Prophylaxis
- High risk exposures
- Lab workers
- Veterinarians
- Spelunkers
- International travelers to high risk areas, and unable to be medically evaluated within 24 hours
- High risk animal exposure
- See Approach above
- Dog or cat with unknown Vaccination status
- Animal cannot be quarantined for 10 days
- Rabies suspected or unprovoked attack
- Bite from bat, raccoon, skunk, fox or other carnivorous mammal bite
- Possible bat exposure (e.g. awakening in same room as bat)
V. Protocol: Post-exposure Prophylaxis
- See Animal Bite
- Wash wound with soap and water
- Also update Tetanus Vaccine
- Unvaccinated against Rabies: Administer both Immune globulin and Vaccine
- Human Rabies immune globulin 20 IU/kg
- Inject into and around all wound sites
- Intended to neutralize Rabies virus before it enters nerve
- Remote site injections are less likely to be of benefit (minimal distribution via systemic circulation)
- May be administered up to 7-10 days following bite
- However, administer immune globulin as soon as possible
- Rabies Vaccine (HDCV, RVA, PCEC)
- Consider Vaccination even if delayed presentation weeks after exposure
- Rabies incubation may be 1-3 months or even delayed for years (and is uniformly fatal)
- Administer 1 ml Vaccine IM in Deltoid
- Administer Vaccine on Days 0, 3, 7, 14
- Prior 5th dose on day 28 was eliminated in U.S. as of 2007-2009
- Consider Vaccination even if delayed presentation weeks after exposure
- Human Rabies immune globulin 20 IU/kg
- Vaccinated against Rabies
- Complete unvaccinated protocol unless can demonstrate Immunity
- Indications
- Protocol
- No immune globulin needed
- Give 2 Rabies Vaccine doses on Days 0 and 3
VI. Resources
- CDC Rabies Contact Information
VII. References
- Swaminathan and Hope in Herbert (2018) EM:Rap 18(12): 11-2
- Ellis (2014) Am Fam Physician 90(4):239-43 [PubMed]
- Wilde (2003) Clin Infect Dis 37:96-100 [PubMed]