Rabies
Revision as of 18:14, 16 September 2014 by Ostermayer (talk | contribs)
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)
^Call CDC if questions
Workup
Was animal captured?
- Yes
- Is animal dog or cat?
- Yes: Observe 10 days, if abnormal, sacrifice and treat with vacc and RIG
- discontinue if animal negative path for rabies
- No: Sacrifice animal and begin RIG and vaccine
- discontinue if animal negative path for rabies
- Yes: Observe 10 days, if abnormal, sacrifice and treat with vacc and RIG
- Is animal dog or cat?
- No
- 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
- Is Animal dog or cat?
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[2]
- 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
Sources
- ↑ Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies. http://www.cdc.gov/rabies/resources/acip_recommendations.html
- ↑ Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies. http://www.cdc.gov/rabies/resources/acip_recommendations.html