Rabies Post Exposure Prophylaxis

For more detailed information please visit  http://www.cdc.gov/rabies.

Rabies is a viral disease transmitted by saliva, usually from a bite of an infected animal. Any mammals can get or transmit rabies.

Rabies is 100 percent preventable either by animal vaccination, or treatment following an exposure.

Rabies can be spread by non-domestic animals such as raccoons, fox, coyotes, skunks, and bats. It is usually not transmitted by domestic pets such as cats and dogs, but can be if they have not been properly vaccinated. Small rodents like squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, and rabbits are almost never found to be infected with rabies and have not been known to transmit rabies to humans.

Rabies is spread by saliva or exposure to brain/nervous system tissue from an infected mammal. Rabies is not spread by petting an animal or by exposure to animal blood, urine, or feces. Rabies is spread when there is saliva exposure to an open wound, or if there is a bite. Rabies virus does not survive once it is dry on a surface.

If someone is bit or has a possible rabies exposure, you should contain the animal if it is domestic for up to 10 days. If it is a non-domestic animal it should not be contained, but is usually euthanized if captured. The reason is that in non-domestic animals, the incubation period, the time the mammal has been exposed to the disease until the time when symptoms appear, is unknown. There is no need to quarantine the animal because potential rabies exposure is presumed.

After an exposure, you should thoroughly wash the wound or exposure site thoroughly with soap and water for at least 5 minutes.

A rabies exposure is a medical URGENCY. You should seek the guidance of your primary care provider. If they are unavailable, you should go to the emergency room. If there is a bite, wound treatment may consist of a tetanus shot, wound irrigation, closure if appropriate, possible antibiotic treatment, and discussion of rabies exposure. Your medical provider may consult with the local health department for recommendations regarding treatment and what to do with any contained animal.

Animal Type to Postexposure Prophylaxis
Animal Type	Evaluation and Disposition of Animal	Postexposure Prophylaxis Recommendations
Dogs, cats, and ferrets	Healthy and available for 10 day observation	Persons should not begin vaccination unless animal develops clinical signs of rabies
	Rabid or suspected rabid	Immediately vaccinate
	Unknown (escaped)	Consult public health officials
Raccoons, skunks, foxes, and most other carnivores; Bats	Regarded as rabid unless animal is proven negative by laboratory test	Consider immediate vaccination
Livestock, horses, rodents, rabbits and hares, and other mammals	Consider individually	Consult public health officials. Bites of squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, other small rodents, rabbits, and hares almost never require rabies postexposure prophylaxis.

  Treatment for rabies exposure is called Post Exposure Prophylaxis. During your first visit, rabies immune globulin (RIG) is administered regardless of the length of time from exposure. Rabies vaccine is also administered on that same day. Additional dosages of rabies vaccine are given on day 3, 7, and 14. It is important to follow the rabies vaccine schedule to ensure proper immunity and prevention of rabies. Rabies immune globulin is administered in the emergency room. Additional dosages of post-exposure rabies vaccine may have to be obtained through the emergency room, an infusion center, or at immunization clinics that offer rabies vaccine.

Adverse reactions to rabies vaccine is rare, but may include redness, soreness, or swelling at the injection site. Rarely, symptoms such as headache, nausea, abdominal pain, muscle aches, and dizziness have been reported. Local pain and low-grade fever may follow injection of rabies immune globulin.

It is important to keep documentation of rabies post-exposure treatment. Once you receive rabies vaccine, if there is another exposure to rabies, additional doses of rabies vaccine is administered on day 0 and 3. RIG is only administered if a patient has never had a rabies vaccine series. Testing for rabies antibodies takes up to 4-6 weeks and is not recommended prior to treatment after an exposure.

Individuals handling animals that may be at risk for rabies exposure should have pre-exposure rabies vaccine and have periodic blood work for rabies antibody testing.

Appointments for rabies vaccine can be scheduled at St. Luke's Travel Medicine and Immunization Clinic.