Rabies

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)

^Call CDC if questions

Workup

Was animal captured?

1. Yes
   1. Is animal dog or cat?
      1. Yes: Observe 10 days, if abnormal, sacrifice and treat with vacc and RIG
         1. discontinue if animal negative path for rabies
      2. No: Sacrifice animal and begin RIG and vaccine
         1. discontinue if animal negative path for rabies
2. No
   1. Is Animal dog or cat?
      1. Yes: Give vacc and RIG only if rabies risk for species in area
      2. No: Treat with full course vacc and RIG

Treatment

1. Clean wound
2. Rabies vaccine: human diploid cell vaccine (HDCV): 1ml IM* Day 0, 3, 7, 14,and 28
   1. Give in deltoid not buttock (since Ab not created in fat cells)
   2. If previously immunized: HDCV on day 0, 3; no RIG
3. RIG (rabies immune globulin): 20 IU/kg (infiltrated SC around wound) if possible
   1. place remainder opposite arm of vaccine
   2. can administer up to 7 days after the first vaccine dose