The Australian Immunisation Handbook 10th Edition 2013

• the rabies VNAb level is checked 14 to 21 days following completion of the
pre-exposure course of ID vaccine (see ‘Serological testing following rabies
vaccination’ below)
• it is only used for PreP for classical rabies exposures (there are no data on the
protection provided by ID rabies vaccination for the prevention of infection
with other lyssaviruses, including ABLV).
Post-exposure prophylaxis for rabies virus and other lyssavirus (including ABLV)
exposures
PEP for rabies virus and other lyssavirus exposures consists of prompt wound
management, vaccine and HRIG administration. The appropriate combination
of these components depends on the extent of the exposure, the animal source
of the exposure, the person’s immune status and their previous vaccination
history. The different PEP pathways are described in more detail below and PEP
management algorithms are outlined in Figures 4.16.1 and 4.16.2.
Types of potential rabies virus and other lyssavirus (including ABLV) exposures
Three different categories of lyssavirus exposure are outlined in Table 4.16.1,
based on those already described by the WHO. 22 The appropriate PEP pathway
following each of the different exposure categories varies depending on
whether the source of exposure was a terrestrial animal or a bat. Different
PEP management pathways following potential bat exposures compared with
terrestrial animal exposures are required because the risk from wounds from
bats is often difficult to determine due to the limited injury inflicted and there
is evidence that superficial bat exposures are more likely to result in human
infection. 31
An algorithm detailing the appropriate PEP pathway following potential classical
rabies virus exposure from a terrestrial animal is provided in Figure 4.16.1; an
algorithm for use following potential lyssavirus exposure from a bat is provided
in Figure 4.16.2.
Table 4.16.1: Lyssavirus exposure categories, to be used in conjunction with
Figure 4.16.1 or 4.16.2 to determine appropriate post-exposure
prophylaxis
Type of exposure Description
Category I Touching or feeding animals, licks on intact skin, as well
as exposure to blood, urine or faeces or to an animal that
has been dead for more than 4 hours
Category II Nibbling of uncovered skin, minor scratches or abrasions
without bleeding
Category III Single or multiple transdermal bites or scratches,
contamination of mucous membrane with saliva from
licks, licks on broken skin
Source: Modified from WHO 2010 22
360 The Australian Immunisation Handbook 10th edition