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Rabies Exposure Definition Suspected Rabid Animal Definition Find my Local Health Department

Person was exposed to:



Cat/Dog/Ferret
Bat

Livestock
Other Native Wildlife

Exotic Animal

Does the case fit the exposure definition?

Yes No

No further action required.

No need for postexposure prophylaxis.

Report the exposure to your local health department or animal control agency.

Is the animal available for testing or observation?

Yes No

Administer postexposure prophylaxis.

Has the patient ever received a series of rabies vaccines before?*

Yes No

*If the patient reports receiving the rabies vaccination series prior to 1980 in the US or in another country at any time, contact the local health department for guidance. A directory of local health departments is available at http://www.vdh.virginia.gov/LHD/index.htm.

Rabies PEP is an urgency, but not in most cases an emergency. If there are any questions or concerns, please contact your local health department for guidance before begining PEP.

  1. All PEP should begin with immediate, thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as povidone-iodine solution should be used to irrigate the wounds.
  2. Human Rabies Immune Globulin (HRIG) should not be administered.
  3. Administer HDCV or PCECV 1.0 mL, IM (deltoid area), 1 each on days 0 and 3.*

* If in the healthcare provider's opinion, the patient is immunosuppressed, the healthcare provider should contact the health department for guidance. A directory of local health departments is available at http://www.vdh.virginia.gov/LHD/index.htm.

If PEP has been initiated and appropriate laboratory diagnostic testing (i.e., the direct fluorescent antibody test) indicates that the animal that caused the exposure was not rabid, PEP may be discontinued.

Rabies PEP is an urgency, but not in most cases an emergency. If there are any questions or concerns, please contact your local health department for guidance before begining PEP.

  1. All PEP should begin with immediate, thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as povidone-iodine solution should be used to irrigate the wounds.
  2. Administer 20 IU/kg Human Rabies Immune Globulin (HRIG) body weight. If anatomically feasible, the full dose (HRIG) 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 HRIG might partially suppress active production of rabies virus antibody, no more than the recommended dose should be administered.
  3. Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL, IM (deltoid area), 1 each on days 0, 3, 7, 14.*

*If in the healthcare provider's opinion, the patient is immunosuppressed, the patient should receive an additional dose of vaccine on day 28 and a rabies virus-neutralizing antibody level by the rapid fluorescent focus inhibition test (RFFIT) should be assessed 1-2 weeks after the final dose. Information about the RFFIT is available via your local health department. A directory of local health departments is available at http://www.vdh.virginia.gov/LHD/index.htm.

If PEP has been initiated and appropriate laboratory diagnostic testing (i.e., the direct fluorescent antibody test) indicates that the animal that caused the exposure was not rabid, PEP may be discontinued.

Vaccine Brands

Two brands of rabies vaccine are available in the US: RabAvert (Novartis) and Imovax (Sanofi Pastuer). Rabavert is a purified chick embryo based vaccine (PCECV) and Imovax is a human diploid cell based vaccine (HDCV).

Rabies vaccine regimens are applicable for persons in all age groups, including children.

Administering PEP

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.

Definition of Days

Day 0 is the day the first dose of vaccine is administered. It is not the day the patient was potentially exposed.

If the animal is available for confinement, it is recommended to not start PEP unless the animal dies or appears ill during the confinement period, or unless positive test results are returned. (Typically available within 24-48 hours from submission.)

Your local health department or Animal Control Authority will coordinate testing or confinement, as well as communicate with the patient about confinement and/or test results and if further actions are required by the patient in regards to rabies.

Test the animal for rabies.

The test results were:

Positive Negative

Have the animal examined by a veterinarian to determine if the signs are compatible with rabies.

If the signs are compatible with rabies the animal must be euthanized.

Compatible with rabies. Not compatible with Rabies

Continue observation to the end of the 10-day period.

Return to confinement.

Does the case fit the exposure definition?

Yes No

Livestock such as cattle, horses, sheep, goats, and pig are not usually at high risk for transmitting rabies. Report the exposure your local health department or animal control authority for rabies exposure response assistance.

Is the animal available for testing or observation?

Yes No

Bats are considered high risk species for rabies. Due to the nature of bat bites (small, often unnoticed), evaluating exposure is different than it is with other animals.

If the patient meets any of the following criteria they should be consided exposed:

  1. Bitten by a bat and knows that he/she has been bitten.
  2. In direct, bare-skinned contact with a bat and cannot rule out that a bite has not occurred.
  3. In a room with a bat and is unable to tell or articulate whether an exposure took place (e.g., infant, senile or unconscious adult).

Particularly in situations involving mentally competent adults where the only evidence of potential exposure is scenario 3, further evaluation should be performed to ascertain the likelihood of being exposed without being aware of the exposure.

When possible, a bat that has potentially exposed a person to rabies should be tested. Rabies test results are typically available in 24-48 hours after laboratory submission. If a bat is available for testing, it is typically recommended that rabies post-exposure prophylaxis not be initiated unless test results indicate that it should.

Does the case fit the exposure definition described above?

Yes No

Questions about exposure and testing should be directed to your local health department. A directory of local health departments can be found at http://www.vdh.virginia.gov/LHD/index.htm

Does the case fit the exposure definition?

Yes No

Was the animal a high risk or low risk animal?

High Risk Low Risk

High Risk Wildlife

The highest risk for rabies is posed by bats, raccoons, skunks, and foxes. In Virginia, where raccoon rabies is established, other mammals such as opossums, groundhogs (woodchucks), and beavers are also considered high risk.

Low Risk Wildlife

Small rodents (including mice, rats, suirrels, chipmunks, moles, voles, guinea pigs, gerbils, and hamsters) and rabbits and hares are considered low risk species for rabies.

Report the exposure to your local health department.

Is the exposing animal available for testing?

Yes No

High risk animals, regardless of perceived health, and low risk animals that have been acting ill or abnormally should be euthanized and tested for rabies by the local health department or animal control authority.

Initiating rabies post-exposure prophylaxis is not recommended until test results are reported. (Typically 24-48 hours after submission.) The local health department will communicate test results to the patient and advise the patient if further action is necessary.

Was the animal acting ill or oddly at the time of the exposure?

Yes No

Is the animal available for testing?

Yes No

Exotic animal exposures are managed on a case by case basis. Contact your local health department for rabies exposure response assistance.

Definition

Any bite, scratch or other circumstance where saliva or CNS tissue from a laboratory confirmed rabid or suspected rabid animal (please review as this includes healthy animals to which an observation period may be applied) enters an open, fresh wound or comes in contact with a mucous membrane by entering the eye, mouth, or nose. Scratches should be evaluated like any other wound. The touching or handling of a suspected rabid animal or another animal or inanimate object that had contact with a rabid animal does not constitute an exposure unless wet saliva or CNS material from the potentially rabid animal entered a fresh, open wound or had contact with a mucous membrane.

Due to the nature of bat bites (small, often unnoticed), evaluating exposures to bats is different than evaluating exposures to terrestrial mammals. Therefore, anyone who:

  1. Has been bitten by a bat and knows he has been bitten, OR
  2. Has been in direct, bare-skinned contact with a bat and cannot rule out that a bite has not occurred OR
  3. Has been in a room with a bat and is unable to tell or articulate whether an exposure took place (e.g., infant, senile or unconscious adult) should be considered exposed.*

*Particularly in situations involving mentally competent adults where the only evidence of potential exposure is scenario #3 above, further evaluation should be performed to ascertain the likelihood of being exposed without being aware of the exposure.

Questions about exposure should be directed to your local health department. A directory of local health departments can be found at http://www.vdh.virginia.gov/LHD/index.htm.

Suspected Rabid Animal Definition

A suspected rabid animal is any animal that has not been tested for rabies and that VDH considers to be a species at high risk for acquiring or transmitting rabies. This is regardless as to whether or not the animal is exhibiting clinical signs of rabies.

Also, any animal VDH considers low risk for acquiring or transmitting rabies that is acting ill or abnormal at the time of the exposure.

At the discretion of the local health director, any animal to which an observation period will be applied that may have bitten a person should be considered a suspected rabid animal until the end of the observation period. The status of animals for which an observation period will not be applied and/or that VDH has not identified as either high or low risk for acquiring or transmitting rabies is at the discretion of the local health director.

Animals with Observation Periods

Otherwise healthy dogs, cats, and ferrets that bite people should be confined and observed for 10 days.

The local health department or animal control agency should be notified in order to assist with the confinement and animal health follow up.

Initiating rabies post-exposure prophylaxis is not recommended unless a dog, cat or ferret becomes ill within the observation period.

If a person is exposed to a known positive dog, cat or ferret or if a person is exposed to a dog, cat or ferret that is not available for testing or observation, rabies post-exposure vaccinations are recommended.

Domestic livestock such as cattle, horses, sheep, goats, and pigs are not usually at high risk for transmitting rabies.

Many factors should be considered prior to initiating rabies post-exposure prophylaxis after a person has been bitten by a domestic livestock species and in these instances the local health department may apply an observation time.

Healthcare providers should contact the local health department or animal control agency to report incidents associated with livestock bites for guidance about how to proceed.

A directory of local health departments can be found at http://www.vdh.virginia.gov/LHD/index.htm