d5

Rabies Immunization

It involves administration of (a) Anti-Rabies Vaccine and (b) Anti-Rabies Serum in severe of class III bites. Because of long and variable incubation period of rabies, immunization must be started at the earliest to ensure that the individual is immune before the rabies virus reaches the nervous system.

Indications For Anti-rabies Immunization

It should be started immediately when a person is bitten, scratched or licked under the following conditions:

1. The animal is stray and not available for observation (presumed rabies).

2. The animal shows clinical signs of rabies (suspect rabies ).

3. The animal is proved positive for rabies by laboratory examination (confirmed rabies).

Situations where anti-rabies immunization is
not indicated/required.

1. Drinking of boiled milk (even heated milk) of rabid animal.

2. Biting animal has remained healthy and alive for 10 days after the bite.

3. Mere touching of a rabid animal (no contact with saliva/urine)

4. A bite or scratch over clothing without tearing or piercing it and no sign of injury on skin at all.

5. Unprovoked and accidental bites by rodents, rats, mice, hares, rabbits, birds, bats and insects. In an endemic and enzootic country like India where every animal bite is considered a “risk” Immediate starting if vaccine in “low risk” exposures [class II of WHO classification] and serum and vaccine in “high risk” [class III of WHO classification] exposure is strongly recommended. Simultaneously the dog/cat is observed for 5 days. If the animal remains healthy upto 5 days, it may be assumed that it is not rabid and the treatment discontinued and the dog/cat further observed for 10 days. During this period if the dog/cat becomes sick and rabies is suspected/confirmed/dies (cause not known, then presumed rabies) or absconds and becomes unavailable for observation the treatment should be continued (not restarted afresh and completed as per original schedule.

WHO GUIDELINES FOR POST-EXPOSURE TREATMENT
[PET]

Category Type of contact with a suspect or
confirmed rabid domestic or wild ? animals or animal unavailable for observation.

Recommended treatment

I Touching or feeding of animals.
Licks on intact skin.
None , if reliable case history
is available.

II

Nibbling of uncovered skin.Minor
scratches or abrasions without bleeding. licks on broken skin.
Administer vaccine immediately .
Stop treatrment if animal remains healthy throughout an observation period of 10 days or
if animal? is euthanised and found to be negative for rabies by appropriate
laboratory techniques.

III

Single or multiple transdermal
bites or scratches .
Contamination of mucos membrane with saliva(i.e.,licks).
Administer rabies immunoglobulin
and vaccine immediately .
Stop treatement if animals remains? healthy throughout an observation period of 10
days or if animal? is euthanised and found to be negative for rabies by appropriate
laboratory techniques.

a. Exposure to rodents,rabbits and hares seldom , if ever requires specific anti-rabies treatment.

b. If an apparentely healthy dog or cat in or from a low risk area is placed under observation, the situation may warrant delaying initiation of treatment.

c. This observation period applies only to dogs and cats.Except in the case of threatened or endangered species, other domestic and wild animals suspected as rabid should be killed humanely and their tissues examined using appropriate laboratory techniques.

The above recommendations are to some extent flexible and can be modified under specific / peculiar/ rare case situations. However , though vaccination is recommended immediately? / as early as possible after the exposure , but it should not be denied to exposed persons whatever time interval has lapsed after exposure, if the history is reliable, vaccination may be deferred in individual cases as an exception.