Postexposure prophylaxis pep from the 2010 recommendations of the advisory committee on immunization practices acip what is rabies pep. Intradermal rabies vaccination idrv for postexposure prophylaxis was approved by who as early as in 1992 and has now been extensively used in india since 2006. Who guide for rabies pre and post exposure prophylaxis in. Rabies postexposure prophylaxis and animal bite reporting. Evaluation of clinicians management of human cases potentially exposed to rabies could contribute to improving pep prescribing practices to both reduce unnecessary costs associated with pep and reach the target of zero human deaths due to. Groups of persons at high risk of exposure to live rabies virus laboratory staff, veterinarians, animal handlers and wildlife. Post exposure prophylaxis pep from the 2010 recommendations of the advisory committee on immunization practices acip what is rabies pep. Mdss reporting jurisdictions may utilize the rabies. Arkansas department of health procedures for postexposure. If available, a virucidal agent such as providoneiodine solution should be used to irrigate wounds. Rabies is endemic in southern bhutan, associated with 12 human deaths and high post exposure prophylaxis pep costs annually.
It transmits through infected saliva via bites or scratches from rabid animals in particular dogs. If the patient can provide adequate history that no direct exposure occurred, then no treatment is necessary, if the patient is an unobserved. Rabies postexposure prophylaxis healthy, immunocompetent persons. Rabies postexposure prophylaxis pep protocol below you will find a rabies treatment algorithm that will assist you in identifying those highrisk animal bites for which post exposure prophylaxis pep should be initiated. Deaths from rabies can be prevented if postexposure prophylaxis pep is initiated soon after exposure and prior to symptom onset. Rabies postexposure prophylaxis regimen, animal bites and. Human exposure to rabies often results from the bite of a rabid animal. Although human rabies encephalitis remains untreatable, the infection is entirely preventable, both by post exposure prophylaxis pep of bite victims, and by populationlevel vaccination of the zoonotic reservoir, which across most of africa and asia is the domestic. Use of a reduced 4dose vaccine schedule for postexposure prophylaxis to prevent human rabies summary. Deaths from rabies can be prevented if post exposure prophylaxis pep is initiated soon after exposure and prior to symptom onset. An epidemiological study of suspected rabies exposures and.
Clinicians should be advised that, aside from concern about rabies, prophylaxis against tetanus or bacterial infection might be. Who guide for rabies pre and post exposure prophylaxis in humans. Summary of rabies postexposure prophylaxis pep recommendations march 20 page 1 wound cleansing all pep should begin with immediate thorough cleansing of all wounds with soap and water. Each of these cases involves a decision whether to start post exposure rabies prevention measures post exposure prophylaxis or pep. Rabies post exposure prophylaxis pep basics this online course is designed to educate healthcare providers and public health professionals about rabies, the approach used in evaluating patients for rabies virus exposure, and the administration of rabies post exposure prophylaxis pep as recommended by the advisory committee on. Exposure and post exposure treatment investigation. Therefore, rabies post exposure prophylaxis can be abridged to a threesession on days 0, 3, and 7, 1week institut pasteur du cambodge regimen to improve vaccine coverage at no risk to patients. The bite may be reported online or by faxing a completed animal bite. If you have any questions, ask your health care provider.
Protocol for rabies postexposure prophylaxis rpep after. The new jersey department of agriculture should be notified of livestock animals that may have exposed people to rabies. Rabies virus is present in the saliva and central nervous system cns tissue of rabid mammals. Fox or coyote postexposure prophylaxis against rabies epi. Administer the rabies vaccine in the deltoid muscle of adults and older children. Postexposure prophylaxis against rabies institute of tropical. This report summarizes new recommendation and updates previous recommendations of the advisory committee on immunization practices acip for postexposure prophylaxis pep to prevent human rabies cdc. Rabies post exposure prophylaxis modalities wound treatment bleeding at any wound site indicates potentially severe exposure and must be infiltrated with either human or equine rabies immunoglobulin.
Rabies postexposure prophylaxis pep administration guidance and schedule for healthcare providers all rabies pep should begin with immediate thorough cleansing of all wounds with soap and water. Choice of rabies pep schedule for a patient lacking preexposure vaccination. Postexposure prophylaxis for prevention of rabies in dogs. Rabies postexposure treatment pet algorithm, december 2000. Cost effectiveness of rabies post exposure prophylaxis in. Prevention of rabies in humans rabies is 100% fatal but also 100% preventable with prompt and complete postexposure prophylaxis pep. Administration of rabies postexposure prophylaxis is a medical urgency, not a medical emergency. Other treatments include administration of antibiotics and tetanus prophylaxis updated 20.
Health statistics and informatics general considerations in rabies postexposure prophylaxis pep who strongly recommends discontinuation of the nerve. Introduction rabies is an acute viral encephalomyelitis caused by several members of the rhabdoviridae family. Pdf evaluating new rabies postexposure prophylaxis pep. Although human rabies encephalitis remains untreatable, the infection is entirely preventable, both by postexposure prophylaxis pep of bite victims, and by populationlevel vaccination of the zoonotic reservoir, which across most of africa and asia is the. This algorithm only addresses rabies postexposure prophylaxis. Rabies post exposure prophylaxis guide was patient exposed to one of the following high risk animals. All animal bites, scratches and licks must be assessed for potential rabies virus exposure.
Pdf rabies is a fatal zoonotic disease preventable through timely and adequate postexposure prophylaxis pep to potentially exposed. In addition, new guidance on prudent use of rabies immunoglobulins rig is provided. Determining the need for rabies post exposure prophylaxis pep with human rabies immune globulin rig and rabies vaccine. Contact the health department at 7032466004 or 571. Jul 18, 2018 a detailed discussion of the regimens used for postexposure prophylaxis is found elsewhere. Postexposure prophylaxis pep consists of a dose of human rabies immune globulin hrig and rabies vaccine given on the day of the rabies exposure, and then a dose of vaccine given again on days 3, 7, and 14. Hpa guidelines on managing rabies postexposure prophylaxis. Evaluation of the risk of rabies in the animal 3 1. Management of potential rabies exposures guideline. Rabies exposures, postexposure prophylaxis and deaths in. Prior to july 2009, the standard rabies postexposure prophylaxis pep regimen for previously unvaccinated persons included human rabies immune globulin hrig given on a per weight basis on day 0, and five doses of human rabies vaccine given on days 0, 3, 7, 14, and 28.
Bite woundbroken skin any direct contact with bat saliva in open wound. Important information about postexposure pep rabies prophylaxis please read and be sure you understand and sign this form before beginning your postexposure rabies vaccination series. Department of health njdoh estimates that approximately 2,500 people in the state receive rabies post exposure prophylaxis pep annually, due to exposure to known or suspect rabid animals. For persons never vaccinated for rabies, treatment includes 1 human rabies immune globulin. A series of rabies vaccinations for persons who have. These updated recommendations are based on new evidence and directed by public health needs that are cost, dose and timesparing, while assuring safety and clinical effectiveness. Rabies exposure risk assessment requires balancing a number of criteria. A rabies vector species bat, raccoon, skunk that is unavailable for testing the first day of the pep treatment regimen is designated as day 0. After exposure, human rabies is preventable by prompt application of postexposure prophylaxis. Fox, cow, raccoon, skunk, bat, horse, goat, coyote, ferret, cat, dog, wild animal, or unknown animal. Human rabies vaccine should never be given in the gluteal area as studies have shown this may result in lower neutralizing antibody titers. Preexposure rabies prophylaxis prep prep is recommended for anyone who is at continual, frequent or increased risk for exposure to the rabies virus, as a result of their occupation or residence such as. Individuals with a history of prior rabies vaccination should receive two doses of vaccine day 0 and day 3 and hrig should not be administered.
Once people develop symptoms of rabies, treatment is almost never successful, and death ensues. Medical care for rabies exposure includes wound care and postexposure vaccinations. Should be immediate is essential even if the person presents long after exposure consists of. Who guide for rabies pre and post exposure prophylaxis in humans updated 2014. These findings contributed to the change in 2018 who recommendations for rabies postexposure prophylaxis. Treatment regimen these regimens are applicable for all age groups, including children. Prior to providing pep, a risk assessment should be performed to ensure pep is indicated.
Rabies postexposure prophylaxis immunocompromised persons pdf. This updates hpa guidelines on managing rabies postexposure prophylaxis january 20. Cost effectiveness of rabies post exposure prophylaxis. Rabies postexposure prophylaxis pep medical care rabies. In this paper we have estimated the cost effectiveness of rabies pep. Rabies postexposure prophylaxis pep basics this online course is designed to educate healthcare providers and public health professionals about rabies, the approach used in evaluating patients for rabies virus exposure, and the administration of rabies postexposure prophylaxis pep as recommended by the advisory committee on. Rabies vaccines and immunoglobulins world health organization. Rabies virus is most often transmitted through a bite or contact with saliva from a rabid animal. Rabies is a fatal neurologic illness transmitted to people by direct contact with the saliva of a rabid animal. A detailed discussion of the regimens used for postexposure prophylaxis is found elsewhere. Rabies is an acute viral infection which causes horrifying neurological symptoms that inevitably result in death.
Rabies is a viral disease that attacks the nervous system. Evaluation of the risk of exposure to rabies by the attending physician 3 1. These findings contributed to the change in 2018 who recommendations for rabies post exposure prophylaxis. An additional fifth dose of rabies vaccine is given on day 28 to immunocompromised patients table 4. Rabies vaccine must not be given in the gluteals due to the possibility of poor absorption from that site and lower neutralizing antibody titers. Rabies postexposure prophylaxis modalities wound treatment. Rabies postexposure prophylaxis pep protocol1 all potential rabies exposures must be reported to animal control. Prevention of rabies in humans rabies is 100% fatal but also 100% preventable with prompt and complete post exposure prophylaxis pep. There is growing concern in the united states about the excessive use of rabies post exposure prophylaxis pep treatment. Idrv is found to be equally effective as intramuscular rabies vaccination and at the same time reduces cost of pep by 6070%. Decisions about rabies pep are the purview of the clinician attending the patient. If the animal exhibits clinical signs compatible with rabies e. Proforma for management of animal bite case at an antirabies centreclinic arc. The epidemiology of human rabies postexposure prophylaxis pep in 4 upstate new york counties was described from data obtained from 2,216 incidences of pep recorded by local health departments from 1995 to 2000.
This algorithm only addresses rabies post exposure prophylaxis. Overall annual incidence for the study period was 27 cases per 100,000 persons. If available, a viricidal agent such as a povidoneiodine solution should be used to irrigate the wounds. For persons never vaccinated for rabies, treatment includes.
Patients presenting for rabies pep even months after having been. After exposure, human rabies is preventable by prompt application of post exposure prophylaxis. For people who have never been vaccinated against rabies previously, postexposure prophylaxis pep should always include administration of both hrig and rabies vaccine. Therefore, rabies postexposure prophylaxis can be abridged to a threesession on days 0, 3, and 7, 1week institut pasteur du cambodge regimen to improve vaccine coverage at no risk to patients. Rabies virus causes a fatal encephalitis in mammals. Evaluation of postexposure prophylaxis practices to. Evaluation of postexposure prophylaxis practices to improve. Because pep can cause adverse reactions, when possible, alternative measures, such as animal quarantine or. Assessment algorithm was the patient bitten or was there saliva contact from the animal to an open wound or mucous membrane of the patient. Determining the need for rabies postexposure prophylaxis pep with human rabies immune globulin rig and rabies vaccine. Rpep generally not indicated6 discuss indications for rpep on a casebycase basis bnormal ormal e e e e e ee e e no s no s no s animal healthy for entire 10 days animal appears sick or develops signs of rabies during 10 days rabies post exposure prophylaxis rpep1 algorithm 1. If a person has been exposed or reasonably presumed to have been exposed to a rabid or potentially rabid animal, then rabies post.
Oklahoma state department of health acute disease service public health fact sheet rabies postexposure prophylaxis pep administration. Rabies post exposure treatment pet algorithm, december 2000. Immediate washing and flushing wound for 15 minutes with soap and water, or water alone disinfection with detergent, ethanol 700mll, iodine tincture. Hpa guidelines on managing rabies post exposure prophylaxis. Mean annual pep incidence rates were highest in rural counties and during the summer months. Cost effectiveness of rabies post exposure prophylaxis in the. Rabies post exposure prophylaxis pep administration guidance and schedule for healthcare providers all rabies pep should begin with immediate thorough cleansing of all wounds with soap and water. Pdf the development of human rabies vaccines has evolved dramatically from the first crude nerve tissue vaccine produced then. Oklahoma state department of health 012018 revised rabies pre and postexposure prophylaxis 3 2. Rabies post exposure prophylaxis guide san antonio. Management of patients with suspected rabies exposure. Already received a complete preexposure prophylaxis prep in the past.
Rabies postexposure prophylaxis guide rabies postexposure prophylaxis, or pep, is recommended if a person was bitten by or had a highrisk exposure to. Evaluation of clinicians management of human cases potentially exposed to rabies could contribute to improving pep prescribing practices to both reduce unnecessary costs associated with pep and reach the target of zero human deaths due to rabies by 2023. A 1week intradermal dosesparing regimen for rabies post. Rabies exposures, postexposure prophylaxis and deaths in a. Rabies postexposure prophylaxis, new york, 19952000. Health statistics and informatics general considerations in rabies post exposure prophylaxis pep who strongly recommends discontinuation of the nerve. Indications to prevent rabies infection, postexposure prophylaxis should be administered to all patients who have had a known or likely exposure to rabies. Rabies postexposure prophylaxis pep administration.
For people who have never been vaccinated against rabies previously, postexposure prophylaxis pep should always include administration. Intradermal rabies vaccination idrv for post exposure prophylaxis was approved by who as early as in 1992 and has now been extensively used in india since 2006. Jan 29, 2019 an additional fifth dose of rabies vaccine is given on day 28 to immunocompromised patients table 4. Historically, the total number of rabies vaccine doses administered during human prophylaxis has.
1597 251 792 457 1274 1152 923 913 216 220 1412 1158 142 1053 430 585 1382 1180 884 480 607 395 1101 326 458 191 1306 982 1478 288 1069 1382 1385