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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