The Australian Immunisation Handbook 10th Edition 2013

The relevant state/territory health authority should be contacted about any
potential exposure sustained from a terrestrial animal in a rabies-enzootic area, or
any potential exposure sustained from a bat anywhere in the world46 (see 4.16.12
Public health management of lyssavirus infections below). Dogs and monkeys are the
usual exposures in Asia, Africa and Central and South America, but exposures to
other terrestrial mammals and bats must also be assessed for potential classical
rabies virus transmission. If a traveller presents >10 days after being bitten or
scratched by either a domestic dog, cat or ferret in a rabies-enzootic country, and
it can be reliably ascertained that the animal has remained healthy (>10 days after
the exposure), PEP is not required. Otherwise, PEP appropriate for the category
and source of exposure (see Figure 4.16.1 or 4.16.2) should be administered, even
if there has been a considerable delay in reporting the incident.
The relevant state/territory veterinary or health authority should be contacted
regarding any potential exposure to Australian bats (for ABLV) (see 4.16.12 Public
health management of lyssavirus infections below). This includes situations where
the category of the exposure is unsure, for example, for a person or child who
has woken up with a bat present in a confined space but with no recollection of
contact. If possible, and without placing others at risk of exposure, the bat should
be kept and arrangements promptly made for testing the bat for ABLV. Following
wound management (see below), the administration of HRIG and rabies vaccine
can be withheld if the bat’s ABLV status will be available within 48 hours of
the exposure. If the result will not be available within 48 hours, the appropriate
post-exposure prophylaxis should begin as soon as is practicable, following the
bat exposure algorithm as outlined in Figure 4.16.2. Where a bat is tested at a
reference laboratory and later found to be negative for ABLV, then PEP for the
person exposed to that bat can be discontinued.
Wound management in post-exposure prophylaxis
One of the most vital steps following a potential rabies virus or other lyssavirus
exposure is wound management. Immediate and thorough washing of all bite
wounds and scratches with soap and water, and the application of a virucidal
preparation such as povidone-iodine solution after the washing, are important
measures in the prevention of rabies. Consideration should also be given to the
possibility of tetanus and other wound infections, and appropriate measures
taken. Primary suture of a bite from a potentially rabid animal should be
avoided. Bites should be cleaned, debrided and infiltrated well with HRIG, when
indicated (see Figure 4.16.1 or 4.16.2).
Post-exposure prophylaxis of persons who are previously unvaccinated
Vaccine
After performing wound management, rabies vaccine should be administered
with or without HRIG (see ‘Human rabies immunoglobulin’ below), depending
on the category and source of exposure, as outlined in Figure 4.16.1 or Figure
4.16.2, and described below.
PART 4 VACCINE-PREVENTABLE DISEASES 361
4.16 RABIES AND OTHER
LYSSAVIRUSES (INCLUDING
AUSTRALIAN BAT LYSSAVIRUS)