Rabies: Difference between revisions
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==Background== | ==Background== | ||
Indication for Prophylaxis | Indication for Prophylaxis | ||
* Bite or salivary exposure from bat, or mammalian carnivore | *Bite or salivary exposure from bat, or mammalian carnivore | ||
* Inhalation counts (e.g. dead bat in room) | *Inhalation counts (e.g. dead bat in room) | ||
;Not needed if non-salivary exposure, or if bird, reptile, or rodent (rare cases) | ;Not needed if non-salivary exposure, or if bird, reptile, or rodent (rare cases) | ||
| Line 24: | Line 24: | ||
==Management== | ==Management== | ||
===Immunocompetent + NOT Vaccinated=== | ===Immunocompetent + NOT Vaccinated=== | ||
* Clean wound | *Clean wound | ||
*Rabies vaccine (human diploid cell vaccine) | *Rabies vaccine (human diploid cell vaccine) | ||
**1mL IM on days: 0, 3, 7, 14<ref name="4 dose">Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies. http://www.cdc.gov/rabies/resources/acip_recommendations.html</ref> | **1mL IM on days: 0, 3, 7, 14<ref name="4 dose">Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies. http://www.cdc.gov/rabies/resources/acip_recommendations.html</ref> | ||
| Line 35: | Line 35: | ||
===Immunocompetent + Vaccinated=== | ===Immunocompetent + Vaccinated=== | ||
* Clean wound | *Clean wound | ||
*Rabies vaccine (human diploid cell vaccine) | *Rabies vaccine (human diploid cell vaccine) | ||
**1mL IM on days: 0 and 3 | **1mL IM on days: 0 and 3 | ||
| Line 42: | Line 42: | ||
===Immuno-compromised=== | ===Immuno-compromised=== | ||
* Clean wound | *Clean wound | ||
*Rabies vaccine (human diploid cell vaccine) | *Rabies vaccine (human diploid cell vaccine) | ||
**1mL IM on days: 0, 3, 7, 14, and 28<ref name="4 dose"></ref> | **1mL IM on days: 0, 3, 7, 14, and 28<ref name="4 dose"></ref> | ||
Revision as of 11:16, 10 July 2016
Background
Indication for Prophylaxis
- Bite or salivary exposure from bat, or mammalian carnivore
- Inhalation counts (e.g. dead bat in room)
- Not needed if non-salivary exposure, or if bird, reptile, or rodent (rare cases)
Clinical Features
Differential Diagnosis
Jaw Spasms
- Acute tetanus
- Akathisia
- Conversion disorder
- Drug toxicity (anticholinergic, phenytoin, valproate, carbamazepine)
- Dystonic reaction
- Electrolyte abnormality
- Hypocalcemic tetany
- Magnesium
- Mandible dislocation
- Meningitis
- Peritonsillar abscess
- Rabies
- Seizure
- Strychnine poisoning
- Stroke
- Temporomandibular disorder
- Torticollis
Diagnosis
Algorithm for Prophylaxis
Animal was captured
Is animal dog or cat?
- Yes: Observe 10 days, if abnormal, sacrifice and treat patient with the vacc and RIG. Then patient treatment can be discontinued if the animal pathology is negative for rabies
- No: Sacrifice animal and begin RIG and vaccine. Discontinue if animal negative path for rabies
Animal was not captured
Is Animal dog or cat?
- Yes: Give vacc and RIG only if rabies risk for species in area
- No: Treat with full course vacc and RIG
Management
Immunocompetent + NOT Vaccinated
- Clean wound
- Rabies vaccine (human diploid cell vaccine)
- 1mL IM on days: 0, 3, 7, 14[1]
- Give in deltoid (not buttock), since Ab not created in fat cells
- AND, Rabies immune globulin
- 20 IU/kg subcutaneous
- Infiltrate around wound if possible
- place remainder opposite arm of vaccine
- can administer up to 7 days after the first vaccine dose
Immunocompetent + Vaccinated
- Clean wound
- Rabies vaccine (human diploid cell vaccine)
- 1mL IM on days: 0 and 3
- Give in deltoid (not buttock), since Ab not created in fat cells
- NO rabies immune globulin
Immuno-compromised
- Clean wound
- Rabies vaccine (human diploid cell vaccine)
- 1mL IM on days: 0, 3, 7, 14, and 28[1]
- Give in deltoid (not buttock), since Ab not created in fat cells
- AND, Rabies immune globulin
- 20 IU/kg subcutaneous
- Infiltrate around wound if possible
- place remainder opposite arm of vaccine
- can administer up to 7 days after the first vaccine dose
References
- ↑ 1.0 1.1 Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies. http://www.cdc.gov/rabies/resources/acip_recommendations.html