Rabies Postexposure Prophylaxis

Rabies Postexposure Prophylaxis is a topic covered in the Washington Manual of Medical Therapeutics.

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  • For all suspected rabies exposures, consultation with local or state health officials is recommended. Contact information can be found at http://www.cdc.gov/rabies/resources/contacts.html.
  • Postexposure prophylaxis is generally indicated only for bite wounds from mammals.1
    • Bites from bats, skunks, raccoons, foxes, and most other carnivores warrant immediate prophylaxis unless the animal is confirmed to be rabies negative by laboratory testing. Animals should not be held for observation but euthanized as soon as possible.
    • Bites from dogs, cats, and ferrets that are rabid or suspected to be rabid also warrant immediate prophylaxis. If the animal is healthy and can be observed for 10 days, do not begin prophylaxis but observe. If signs or symptoms of rabies develop in the animal, prophylaxis should begin immediately. For bites where the status of the animal is unknown, consult with public health officials.
    • Bites from all other sources (e.g., rodents, hares, livestock) should be considered on an individual basis and prophylaxis initiated only in consultation with public health officials.
  • Postexposure prophylaxis consists of wound care, vaccination, and in certain situations, administration of human rabies immune globulin (HRIG) (Table A.4).2
    • All wounds should be cleaned thoroughly with soap and water and irrigated with a virucidal solution such as povidone-iodine.
      Table A.4: Rabies Postexposure Prophylaxis Recommendations

      Therapy
      Vaccination StatusVaccineHRIG
      Not previously vaccinatedYes, on days 0, 3, 7, and 14Yes, once on day 0
      Previously vaccinatedYes, on days 0 and 3No

      HRIG, human rabies immune globulin.

    • Human diploid cell vaccine or purified chick embryo cell vaccine, 1 mL IM, should be administered in the deltoid region, the only acceptable site for vaccination in adults.
    • If HRIG is indicated, give 20 IU/kg IM once. Do not administer in the same syringe as the vaccine. When possible, infiltrate as much of the product around and into the wound(s). The remaining volume can be administered intramuscularly at any site anatomically distant from the site of vaccination. Subsequent vaccine doses at later dates can be given at the same site as previous HRIG.

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  • For all suspected rabies exposures, consultation with local or state health officials is recommended. Contact information can be found at http://www.cdc.gov/rabies/resources/contacts.html.
  • Postexposure prophylaxis is generally indicated only for bite wounds from mammals.1
    • Bites from bats, skunks, raccoons, foxes, and most other carnivores warrant immediate prophylaxis unless the animal is confirmed to be rabies negative by laboratory testing. Animals should not be held for observation but euthanized as soon as possible.
    • Bites from dogs, cats, and ferrets that are rabid or suspected to be rabid also warrant immediate prophylaxis. If the animal is healthy and can be observed for 10 days, do not begin prophylaxis but observe. If signs or symptoms of rabies develop in the animal, prophylaxis should begin immediately. For bites where the status of the animal is unknown, consult with public health officials.
    • Bites from all other sources (e.g., rodents, hares, livestock) should be considered on an individual basis and prophylaxis initiated only in consultation with public health officials.
  • Postexposure prophylaxis consists of wound care, vaccination, and in certain situations, administration of human rabies immune globulin (HRIG) (Table A.4).2
    • All wounds should be cleaned thoroughly with soap and water and irrigated with a virucidal solution such as povidone-iodine.
      Table A.4: Rabies Postexposure Prophylaxis Recommendations

      Therapy
      Vaccination StatusVaccineHRIG
      Not previously vaccinatedYes, on days 0, 3, 7, and 14Yes, once on day 0
      Previously vaccinatedYes, on days 0 and 3No

      HRIG, human rabies immune globulin.

    • Human diploid cell vaccine or purified chick embryo cell vaccine, 1 mL IM, should be administered in the deltoid region, the only acceptable site for vaccination in adults.
    • If HRIG is indicated, give 20 IU/kg IM once. Do not administer in the same syringe as the vaccine. When possible, infiltrate as much of the product around and into the wound(s). The remaining volume can be administered intramuscularly at any site anatomically distant from the site of vaccination. Subsequent vaccine doses at later dates can be given at the same site as previous HRIG.

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