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Rabies Post-Exposure Prophylaxis and Animal Bite Reporting: A Guide for Emergency Care Providers

Fort Wayne-Allen County Department of Health | Fort Wayne Animal Care & Control

Rabies Post-Exposure Prophylaxis (PEP) Protocol

Below you will find a Rabies Treatment Algorithm that will assist you in identifying those high-risk animal bites for which post -exposure prophylaxis (PEP) should be initiated. If you should have any questions, please do not hesitate to call the Department of Health at (260) 449-7556 during business hours or, if after hours, call dispatch at (260) 449-7661 and ask for a Department of Health representative.

PEP Treatment Guidelines

Resources for Bite Victims

• Novartis' Patient Assistance Program for RabAvert ® is managed through RX for Hope and can be accessed at www.rxhope.com or by calling 1-800-589-0837.

• Sanofi Patient Connection can be accessed at www.visitspconline.com/ or by calling 1-888-visitSPC (847-4877).

• CDC’s Rabies Awareness Page: www.cdc.gov/worldrabiesday/

Reporting Animal Bites

If you have a patient who has been bitten or scratched by an animal, domestic or wild, it is critical that you report the bite immediately to Fort Wayne Animal Care & Control, the agent for the Department of Health. You are obligated by law to do so. Timely reporting will increase the likelihood that Animal Control officers can secure the animal for quarantine purposes before the animal escapes or causes harm to others.

In Allen County, fax the completed Indiana Animal Bite Report to (260) 427-5514.

Vaccination Status

Intervention Regimen*

Not previously vaccinated

Wound cleansing All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent (e.g., providine-iodine solution) should be used to irrigate wounds.

Human Rabies Immune Globulin (HRIG)

Administer 20 IU/kg body weight. If anatomically feasible, the full dose should be infiltrated around and into the wound(s) and any remaining volume should be administered at an anatomical site (intramuscular [IM]) distant from vaccine administration. Also, HRIG should not be administered in the same syringe as vaccine. Because RIG might partially suppress active production of rabies virus antibody, no more than the recommended dose should be administered.

Vaccine Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL, IM (deltoid area), 1 each on days 0, 3, 7 and 14.*

Previously Vaccinated**

Wound cleansing All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent (e.g., providine-iodine solution) should be used to irrigate wounds.

HRIG HRIG should not be administered.

Vaccine HDCV or PCECV 1.0 mL, IM (deltoid area), 1 each on days 0 and 3.

Below you will find treatment recommendations when initiating PEP.

*For persons with altered immunocompetence, PEP should continue to comprise a 5-dose vaccination regimen with 1 dose of RIG.

**Any person with a history of pre-exposure vaccination with HDCV, PCECV, or rabies vaccine adsorbed (RVA); prior PEP with HDCV, PCECV or RVA; or previous vaccination with any other type of rabies vaccine and a documented history of antibody response to the prior vaccination.

Source: Use of a Reduced (4-Dose) Vaccine Schedule for Post-exposure Prophylaxis to Prevent Human Rabies, Recommendations of the Advisory Committee on Immunization Practices, MMWR, 2010; 59 (RR02); 1-9.