RABIES: MANAGEMENT AND PREVENTION
Prophylaxis:
Pre-exposure prophylaxis - Vaccine may be administered to persons at increased risk of being exposed to rabies.
Post-exposure prophylaxis - In cases of animal bites, dogs and cats in a rabies endemic area should be held for 10 days for observation. If signs develop, they should be killed and their tissue send for examination.
The essential components of post-exposure prophylaxis are the local treatment of wounds and active and passive immunization.
Once rabies is established, there is nothing much that could be done except intensive supportive care. To date, only 2 persons with proven rabies have survived.
POST EXPOSURE PROPHYLAXIS
Wound treatment - Removing the rabies virus at the site of the infection by chemical or physical means is an effective means of protection.
Recommended first-aid procedures include immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.
Do not apply dressing & do not get the wound stitched.
TOP 10 GENERAL CONSIDERATIONS IN RABIES PEP (WHO)
1. Wounds must be immediately washed/flushed for 15 minutes and disinfected.
2. Rabies PEP should be instituted immediately. PEP consists of a course of potent, effective rabies vaccine that meets WHO recommendations and administration of rabies immunoglobulin.
3. PEP must be applied using vaccine regimens and administration routes that have been proven to be safe and effective.
4. PEP does not have contraindications if purified rabies immunoglobulin and vaccine are used. Pregnancy and infancy are not contraindications to PEP.
5. If rabies immunoglobulin is not available on first visit, use can be delayed by up to 7 days from the date of the first vaccine dose.
6. Initiation of PEP should not await the results of laboratory diagnosis or be delayed by dog observation when rabies is suspected.
7. When suspect rabid animal contacts (excluding bats) occur in areas free of carnivore-mediated rabies and where there is adequate surveillance in place, PEP may not be required. The decision must be based on expert risk assessment.
8. Patients presenting for rabies PEP even months after having been bitten should be treated as if the contact had recently occurred.
9. PEP should be administered even if the suspect animal is not available for testing or observation. However, vaccine and immunoglobulin administration may be discontinued if the animal involved: is a vaccinated dog (cat or ferret) that following observation for 10 days, remains healthy or is humanely killed and declared negative for rabies by a WHO prescribed laboratory test.
10. In areas enzootic for (canine and wildlife) rabies, PEP should be instituted immediately unless adequate laboratory surveillance and data indicates that the species involved is not a vector of rabies.
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