Rabies: Difference between revisions
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====Animal was captured==== | ====Animal was captured==== | ||
''Is animal dog or cat?'' | ''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==== | ====Animal was not captured==== | ||
''Is Animal dog or cat?'' | ''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 | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 21: | Line 21: | ||
==Management== | ==Management== | ||
===Immunocompetent + NOT Vaccinated=== | ===Immunocompetent + NOT Vaccinated=== | ||
* Clean wound | |||
*Rabies vaccine (human diploid cell vaccine) | |||
**1mL IM on days: 0, 3, 7, 14<ref name="4 dose">Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies. http://www.cdc.gov/rabies/resources/acip_recommendations.html</ref> | |||
**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=== | ===Immunocompetent + Vaccinated=== | ||
* Clean wound | |||
*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=== | ===Immuno-compromised=== | ||
* Clean wound | |||
*Rabies vaccine (human diploid cell vaccine) | |||
**1mL IM on days: 0, 3, 7, 14, and 28<ref name="4 dose"></ref> | |||
**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 | |||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 20:37, 16 November 2015
Background
Indication for Prophylaxis
- Bite or salivary exposure from bat, or mammalian carnivore
- Inhalation counts (e.g. dead bat in room)
- Not needed if non-salivary exposure, or if bird, reptile, or rodent (rare cases)
Workup
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
Differential Diagnosis
Jaw Spasms
- Acute tetanus
- Akathisia
- Conversion disorder
- Drug toxicity (anticholinergic, phenytoin, valproate, carbamazepine)
- Dystonic reaction
- Electrolyte abnormality
- Hypocalcemic tetany
- Magnesium
- Mandible dislocation
- Meningitis
- Peritonsillar abscess
- Rabies
- Seizure
- Strychnine poisoning
- Stroke
- Temporomandibular disorder
- Torticollis
Management
Immunocompetent + NOT Vaccinated
- Clean wound
- 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 wound
- 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 wound
- 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
References
- ↑ 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