Rabies Guide 2010.pdf - the South African Veterinary Council

Appendix 2
1. Assess the risk of transmission (page 36) and category of exposure (see B below)
2. Record full details and history of the incident
3. If risk of rabies is considered, proceed as indicated in the flow chart
Animal not
available for
assessment
Administer
PEP (see B, C
and D below)
Administer PEP (see
B, C and D below)
Animal available for assessment
AND
Animal assessment by State Veterinarian/
Veterinarian or dead animal sent to
testing centres
Animal healthy and alive after 10
days of observation
OR
Laboratory testing at
ARC-OVI or APVL
Discontinue PEP
Negative rabies test
OR
Positive rabies test
A. Animal Assessment
The following aspects must be considered:
1. Vaccination: tangible proof of current rabies vaccination
status (dog or cat) must be obtained. See constraints on
page 36
2. Behavioural changes: all aspects must be considered
3. Possible exposure: any known incident during the
previous few months
4. Rabies endemicity: entire RSA is rabies endemic but
current incidence and prevalence are important
5. Provocation: was the animal’s reaction due to
provocation?
6. Stray (unsupervised animals): this history may be
unreliable
B. Categories of rabies exposure
Risk
Cat.
Type of
exposure
1 Touching/
feeding animal
Licking of intact
skin
2 Nibbling of
uncovered skin
Superficial
scratch without
bleeding
3 Bites/scratches
which penetrate
the skin and
draw blood
Licking of
mucous
membranes or
broken skin
Action to be taken
None if case history is reliable
If history is not reliable, treat
as for category 2
Apply wound treatment
Administer vaccine
Do not administer antirabies
immunoglobulin
Stop vaccination if animal is
rabies negative on laboratory
test, or remains healthy after
10 days observation
Apply wound treatment
Administer vaccine
Administer antirabies
immunoglobulin
Stop vaccination if animal is
rabies negative on laboratory
test, or remains healthy after
10 days observation
C. Wound treatment
1. Flush well with soap and water or water alone for at least 5
minutes and apply disinfectant eg. 70% alcohol or iodine
solution (eg. Betadine)
2. Avoid suturing or use of compressive bandages
3. Administer anti-tetanus treatment and antibiotics if
indicated
D. PEP schedules
No previous immunization
Category 2: Inject single dose vaccine into deltoid muscle
(NEVER in gluteus) or antero-lateral thigh in children
on days 0, 3, 7, 14 and 28
Category 3: Infiltrate immunoglobulin (20 IU/kg) on day 0
into and around wound, with remainder into deltoid of
opposite arm to vaccine. Inject vaccine as for category
2. Rabies immunoglobulin if not immediately available
can be given up to 7 days of the first vaccine dose, but
never after 7 days
Previously immunized
Category 2 and 3 exposures: Inject single dose vaccine
into deltoid muscle on days 0 and 3. No rabies
immunoglobulin should be given
Special considerations
Late presentation: Treat without delay as if the contact
occurred recently, following the guidelines for wound
treatment (where possible), and administration of
immunoglobulin and vaccine. Deviation from the
suggested doses/regimens is not advised.
Immunosuppressed patient: Emphasize thorough
wound cleaning and ALWAYS administer antirabies
immunoglobulin in both category 2 and 3 exposures in
addition to the vaccine. Deviation from the number of
doses and prescribed regimens is not advised.
Bat exposures: PEP provides variable protection against
rabies-related viruses. The categories of exposure do not
apply to bats, as transmission can occur with very minor
or even inapparent contact. Any close contact with bats
is considered as a category 3 exposure.
Fig. 7: Actions following a human exposure to a suspected rabid animal
Continue PEP
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