Rabies Prophylaxis

Introduction

* What is rabies?* A very rare and aggressive encephalitis* Global impact with exception of UK/Australia* Animals whose bites/scratches may require prophylaxis* Bats* Dogs, Cats, Ferrits* Other carnivorous animals* Foxes, Coyotes, Skunks, Raccoons* Post exposure prophylaxis* Both Rabies vaccine and immunoglobulin

When Do You Give Rabies Prophylaxis?

* Step 1: Bitten or scratched by domesticated pet?* Immunization status of pet does not matter* Animal must be monitored* Give prophylaxis if animal develops encephalitis* Step 2: Bitten or scratched by wild animal? * If animal is captured it can be sacrificed and tested* Give prophylaxis the animal is not captured and is a potential carrier* Step 3: Possible bat scratch/bite?* Give prophylaxis if the patient (or baby) cannot confidently say “NO, I DID NOT GET BITTEN OR SCRATCHED BY THE BAT”* Step 4: Do NOT give prophylaxis if the animal is not a carrier of rabies (check local guidance)* Reptiles* Birds* Small rodents* Rabbits/Hares* Livestock* Step 5: How to give prophylaxis* Only contraindication is severe egg allergy* Can be given to babies/pregnant women/etc* Rabies immunoglobulin* Give ONCE in the department* Inject as much as possible around wound* Rabies vaccine* Give first day* Have patient come back for more doses on day 3, 7, 14 (and SOMETIMES 28)

Pearls

* It doesn’t matter if the bite/scratch was provoked or unprovoked* It doesn’t matter where on the body the patient received the bite/scratch* It’s a universally fatal disease* No rabies in small rodents, reptiles, birds, squirrels, hamsters, rats, or rabits* The NNT is >300,000 (but we still do it)

Additional Reading

* Rabies Guidelines (CDC)