Rabies

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Background

  • Indication for Prophylaxis
    • Bite or salivary exposure from bat, or mammalian carnivore
    • Close proximity with unknown salivary exposure (e.g. live/dead bat in room)
  • Prophylaxis not needed if non-salivary exposure, or if bird, reptile, or rodent (rare cases)

Clinical Features

Differential Diagnosis

Jaw Spasms

Evaluation

Algorithm for Prophylaxis

Animal was captured

Is animal dog or cat?

  • Yes: Observe 10 days, if abnormal, sacrifice and treat patient with the vacc and RIG. Then patient treatment can be discontinued if the animal pathology is negative for rabies
  • No: Sacrifice animal and begin RIG and vaccine. Discontinue if animal negative path for rabies
Animal was not captured

Is Animal dog or cat?

  • Yes: Give vacc and RIG only if rabies risk for species in area
  • No: Treat with full course vacc and RIG

Management

Immunocompetent + NOT Vaccinated

  • Clean the wound (e.g. copious irrigation)
  • Rabies vaccine (human diploid cell vaccine)
    • 1mL IM on days: 0, 3, 7, 14[1]
    • Give in deltoid (not buttock), since Ab not created in fat cells
  • AND, Rabies immune globulin
    • 20 IU/kg subcutaneous
    • Infiltrate around wound if possible
    • place remainder opposite arm of vaccine
    • can administer up to 7 days after the first vaccine dose

Immunocompetent + Vaccinated

  • Clean the wound (e.g. copious irrigation)
  • Rabies vaccine (human diploid cell vaccine)
    • 1mL IM on days: 0 and 3
    • Give in deltoid (not buttock), since Ab not created in fat cells
  • NO rabies immune globulin

Immuno-compromised

  • Clean the wound (e.g. copious irrigation)
  • Rabies vaccine (human diploid cell vaccine)
    • 1mL IM on days: 0, 3, 7, 14, and 28[1]
    • Give in deltoid (not buttock), since Ab not created in fat cells
  • AND, Rabies immune globulin
    • 20 IU/kg subcutaneous
    • Infiltrate around wound if possible
    • place remainder opposite arm of vaccine
    • can administer up to 7 days after the first vaccine dose

Disposition

See Also

References

  1. 1.0 1.1 Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies. http://www.cdc.gov/rabies/resources/acip_recommendations.html