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- What is rabies?
- A very rare and aggressive encephalitis
- Global impact with exception of UK/Australia
- Animals whose bites/scratches may require prophylaxis
- Dogs, Cats, Ferrits
- Other carnivorous animals
- Foxes, Coyotes, Skunks, Raccoons
- Post exposure prophylaxis
- Both Rabies vaccine and immunoglobulin
When Do You Give Rabies Prophylaxis?
- Step 1: Bitten or scratched by domesticated pet?
- Immunization status of pet does not matter
- Animal must be monitored
- Give prophylaxis if animal develops encephalitis
- Step 2: Bitten or scratched by wild animal?
- If animal is captured it can be sacrificed and tested
- Give prophylaxis the animal is not captured and is a potential carrier
- Step 3: Possible bat scratch/bite?
- Give prophylaxis if the patient (or baby) cannot confidently say “NO, I DID NOT GET BITTEN OR SCRATCHED BY THE BAT”
- Step 4: Do NOT give prophylaxis if the animal is not a carrier of rabies (check local guidance)
- Small rodents
- Step 5: How to give prophylaxis
- Only contraindication is severe egg allergy
- Can be given to babies/pregnant women/etc
- Rabies immunoglobulin
- Give ONCE in the department
- Inject as much as possible around wound
- Rabies vaccine
- Give first day
- Have patient come back for more doses on day 3, 7, 14 (and SOMETIMES 28)
- It doesn’t matter if the bite/scratch was provoked or unprovoked
- It doesn’t matter where on the body the patient received the bite/scratch
- It’s a universally fatal disease
- No rabies in small rodents, reptiles, birds, squirrels, hamsters, rats, or rabits
- The NNT is >300,000 (but we still do it)
- Rabies Guidelines (CDC)