years 4 , we can move to a more advanced risk assessment . Make sure the bite is reported to ADH or the county health unit . Does this patient need post-exposure prophylaxis ? Is further consultation with the Arkansas Department of Health necessary ? Following consultation with ADH , we elect to start PEP . See Table 1 .
Upon completion of your patient ’ s post-exposure prophylaxis , what practical information could you share to decrease the potential exposure again :
1 . Vaccinate your dogs and cats . The Rabies Control Act requires all dogs and cats to be vaccinated by 4 months of age by a licensed veterinarian 8 , 9 .
2 . Educate your patients , family , and friends ( especially children and grandchildren ) to avoid wild animals , especially if there is a behavioral change , e . g . a skunk being out during the day .
3 . Avoid bats , especially those lying on the ground .
4 . Exercise extreme caution around dogs when traveling outside of the U . S . ( the U . S . has eliminated the rabies-canine variant , but it is prevalent in other countries ; this is why there is increased risk in dogs outside the U . S ., e . g . a dog imported from Egypt )
5
. Use caution with skunks , raccoons , fox , wood chucks , beavers , coyotes , bobcats , mountain lions , wolves , and bears .
5 . Generally , there is no indication to test or prophylaxis for the following : squirrels , chipmunks , rats , hamsters , gerbils , guinea pigs , mice , or rabbits .
6 . There is no known transfer from infected patient to health care provider and no apparent fomite transfer 6 . There has been transmission via multi-organ transplant infection from an undetected rabies-infected donor .
6 , 10
7 . Exercise good hygiene , hand washing , and wound cleansing .
8 . Utilize the available resources at the Arkansas Department of Health , including the county health units ; do not carry biologics for PEP .
Table I Vaccination Status Intervention Regimen *
Not previously vaccinated
Wound cleansing
Human rabies immune globulin ( HRIG )
9 . State Public Health Veterinarian – Laura Rothfeldt , D . V . M ., Phone : 501- 280-4136
10 . Emergency Communication Center ( available 24 / 7 ), Phone : 1-800-633- 1735
11 . Ask permission before approaching anyone ’ s pet .
12 . Exercise caution but get outside and
All PEP should begin with immediate , thorough cleansing of all wounds with soap and water . If available , a virucidal agent ( e . g ., povidine-iodine solution ) should be used to irrigate the wounds .
Administer 20 IU / kg body weight . If anatomically feasible , the full dose should be infiltrated around and into the wound ( s ), and any remaining volume should be administered at an anatomical site ( intramuscular [ IM ]) distant from vaccine administration . Also , HRIG should not be administered in the same syringe as vaccine . Because RIG might partially suppress active production of rabies virus antibody , no more than the recommended dose should be administered .
Vaccine Human diploid cell vaccine ( HDCV ) or purified chick embryo cell vaccine ( PCECV ) 1.0 mL , IM ( deltoid area ) 1 each on days O §, 3 , 7 and 14 . ¶
Previously vaccinated ** |
Wound cleansing |
All PEP should begin with immediate , thorough cleansing of all wounds with soap and water . If available , a virucidal agent such as povidine-iodine solution should be used to irrigate the wounds . |
HRIG HRIG should not be administered . Vaccine
HDCV or PCECV 1.0 mL , IM ( deltoid area ). 1 each on days O § and 3 .
* These regimens are applicable for persons in all age groups , including children .
The deltoid area is the only acceptable site of vaccination for adults and older children . For younger children , the outer aspect of the thigh may be used . Vaccine should never be administered in the gluteal area .
§ Day 0 is the day dose 1 of vaccine is administered .
¶ For persons with immunosuppression , rabies PEP should be administered using all 5 doses of vaccine on days 0 , 3 , 7 , 14 , and 28 .
** Any person with a history of pre-exposure vaccination with HDCV , PCECV , or rabies vaccine adsorbed ( RVA ); prior PEP with HDCV , PCECV , or rabies vaccine adsorbed ( RVA ); prior PEP with HDCV , PCECV or RVA ; or previous vaccination with any other type of rabies vaccine and a documented history of antibody response to the prior vaccination . exercise while enjoying our beautiful ate , pets , wildlife , and outdoors .
References
For a complete list of references , email ams @ arkmed . org .
Volume 117 • Number 8 FEBRUARY 2021 • 175