Revised Guidelines on the Management of Animal Bite Patients

Administrative Order No. 164 DOH , 2002

Management of Potential Rabies Exposure 

Category 1
a. feeding/touching an animal b. licking of intact skin (w/ reliable history and thorough PE 

Management > Wash exposed skin immediately w/ soap and water. > No vaccine or RIG needed

Animal is rabid. Minor scratches/abrasions without bleeding c. If animal under observation died within 14 days and was FAT positive or no FAT testing was done or had signs of rabies . Complete vaccination regimen until day 90 if: a.Category II a. died or unavailable for 14-day observation or examination b. killed. Licks on broken skin Management:  Start vaccine immediately  Condition of the animal: 1. Nibbling of uncovered skin b.

Complete vaccination regimen until day 30 if: a.2. was FAT-negative and without any signs of rabies Category III a. with saliva Exposure to a rabies patient Handling of infected carcass or ingestion of raw infected meat e. if animal under observation died within 14 days . All Category II exposures on head & neck area . Single or multiple transdermal bites or scratches Contamination of mucous memb. d. c. b. if animal is alive and remains healthy after 14-day observation period b.

Complete vaccination regimen until day 30 if: a. Complete vaccination regimen until day 90 if: a. Animal is rabid.Management of Category III Exposures  Start vaccine and RIG immediately  Condition of the animal: 1. If animal under observation died within 14 days and was FAT-negative & w/o any signs of rabies . Animal is alive and remains healthy after 14-day observation period b. died or unavailable for 14-day observation or examination b. If animal under observation died w/in 14 days and was FAT-positive or no FAT testing was done or had signs of rabies 2. killed.

Purified Verocell Rabies Vaccine (PVRV) . Purified Chick Embryo Cell Vaccine (PCECV) 1.: a.0 ml / vial .Active Immunization It induces an active immune response in 7-10 days 7after vaccination and may persist for 1 year or more Types of vaccines available in the Phil.5ml/vial b. Purified Duck Embryo Vaccine (PDEV) 1 ml/ vial c.

RIG is of two types: 1. BW ( 200 IU/ml ) . Equine Rabies Immunoglobulin (ERIG) dose: 40 IU per kg.Passive Immunization   Rabies Immune Globulin (RIG) is given together with anti-rabies vaccine to provide immediate antiprotection to patients with Category III exposure. BW ( 150 IU/ml ) 2. Human Rabies Immunoglobulin (HRIG) dose: 20 IU per kg.

Any remaining RIG should be administered IM at the site distant from the site of vaccine injection A skin test must be performed prior to ERIG administration. A positive skin test is based on an induration of 6 mm or more .Passive Immunization    RIG should be given as single dose for all Category III exposures RIG should be infiltrated around and into the wound .

tincture of iodine or any antiseptic > Suturing of wounds should be avoided > Anti-tetanus immunization and anti-microbial Antiantimaybe given if indicated .Post-Exposure Treatment  Local Wound Treatment > Wash & flush wounds with soap and water preferably for 10 minutes > Apply alcohol.

Treatment Regimen  2-Site Intradermal Schedule ( 2-2-2-0-1-1) 2One dose of ID administration is equivalent to 0.2 ml for PDEV/PCECV One dose should be given at 2 sites on Days 0.1 ml for PVRV & 0. 7 and one site on Days 30 and 90 Injections should be given on the deltoid area of each upper arm in adults and on the anterolateral aspect of the thigh in infants The schedule should be strictly followed to avoid treatment failure . 3.

2-Site Intradermal Schedule 2.1 ml. 0. 0.2.2 ml.1 ml.1 ml. 0.2 ml.2 ml.2. 0. None None 0.0-1-1 Day of Immunization Day 0 Day 3 Day 7 Day 14 Day 30 Day 90 PVRV PDEV/ Site of Injection PCECV 0.2 ml. 0.1 ml. 0. Left & right deltoids Left & right deltoids None One deltoid One deltoid . 0. Left & right deltoids 0.1 ml.2 ml.

Treatment Regimen  2 ±1 ±1 Intramuscular Schedule One dose is equivalent to 1 vial of 0. of PDEV/PCECV Should be used in combination with RIG for Category III exposure 2 doses are given IM on day 0 and 1 dose on days 7 & 21 If the dog is alive & healthy after the 14-day observation period. discontinue the last dose .5 ml of PVRV or 1 ml.

1 ml.5 ml 1 ml. 1 ml.5 ml.2-1-1 Intramuscular schedule Day of PVRV Immunization Day 0 Day 7 Day 21 PDEV/ Site of Injection PCECV Left and Right 0. One deltoid One deltoid .5 ml. deltoids 0. 0.

1 ml. 1 ml. 0.5 ml. 0.5 ml.5 ml.5 ml. 1 ml.5 ml. 1 ml. 0.Standard Intramuscular Schedule Day of Immunization PVRV PDEV/ PCECV Site of Injection One deltoid One deltoid One deltoid One deltoid One deltoid Day 0 Day 3 Day 7 Day 14 Day 28 0. . 1 ml. 0.

1 ml. of Immunization doses Site of Injection Deltoid (2). 8 Day 7 Day 30 Day 90 0.1 ml. anterolateral thigh (2) Deltoid (1) Deltoid (1) Day 0 0. suprascapular region (2) Deltoid (2). 0.8-Site Intradermal Schedule Day of PCECV No. 4 1 1 . anterolateral thigh (2). lower quadrant of abdomen (2).1 ml. 0.1 ml.

rabbits and domestic animals other than dogs & cats do not require post-exposure treatment unless postthe animal is proven rabid Patients bitten by wild animals should be managed similarly as patients bitten by dogs and cats . systemic steroids antiand heavy alcohol consumption Immuno compromised individuals should be given vaccine using standard IM regimen and RIG for both Category II and III exposures Bites by rodents. anti-epileptic drugs.Post-Exposure Treatment under Special Conditions      Pregnancy & infancy are not contraindications to treatment with purified cell culture vaccines Avoid Chloroquine .

Post-Exposure Treatment of Previously Immunized Animal Bite Patients Local wound treatment should always be done Persons with a second exposure after having previously received complete pre-exposure preprophylaxis & PET with tissue culture vaccine: a) < than 1 month : no booster dose b) > 1 month ± 3 years : 2 booster doses (D0.2 ml for PDEV/PCECV or IM at 1 vial of PVRV.D3) c) > than 3 years : another full course of vaccine Booster doses maybe given ID at 0. PDEV or PCECV.1 ml. No need to give RIG . for PVRV or 0.

7 and 21 or 28 One booster dose should be given every 2-3 2years depending on the risk of work-related workexposure .Pre-Exposure Prophylaxis Recommended to individuals at high risk of exposure to rabies Initial Pre-exposure prophylaxis consist of Pregiving 1 dose of vaccine on Days 0.

1 ml 0.1 ml 0.Pre-Exposure Prophylaxis Schedule PVRV D0 D7 D 21/28 PDEV/PCEC D0 D7 D 21/28 IntraIntradermal 0.1 ml 0.5 ml 0.1 ml ml 1.1 0.1 ml 1.0 ml ml IntraIntra0.0 1.5 muscular ml .0 ml 0.5 ml 0.

the patient shall be provided the required dose of RIG. if available. EIG is the first RIG of choice .Dispensing of Human Anti-Rabies Immunizing agents     Patients needing Post-exposure treatment shall be referred Postto the Animal Bite Treatment Centers where free human antianti-rabies immunizing agents are administered In Category II and III exposures. complete course of immunization is given free If indicated. the patient shall be provided the initial 2 doses of tissue culture vaccine for the 2-1-1 schedule If intradermal regimen is used .

Individuals exposed to human rabies patients thru bite/non-bite exposure 4. Patients bitten by animals found positive for ³negri bodies´ 2. Patients bitten by animals that are not available for observation ( stray or slaughtered) 5. Patients with Category II exposure .Provisions of Free Anti-Rabies Immunizing Agents The following shall be the program¶s order of priority for free vaccine assistance: 1. Patients with Category III exposure 3.

collation. & private hospitals. clinics & health centers shall be directed to notify gov¶t.Rabies Surveillance System (RSS) Entails systematic collection of pertinent data on Rabies. interpretation and dissemination of information to appropriate user groups Goal : To obtain a comprehensive view of the epidemiologic situation of rabies in the community so that appropriate preventive measures maybe instituted All gov¶t. health officers or rabies field coordinators of any human rabies case .

Specific Uses of RSS To assess the magnitude & geographical distribution of rabies To monitor the trends of rabies in the community To evaluate the impact of instituted intervention To furnish public information of the risk of rabies exposure in an area To provide indicators for decision on future health care needs .

Constraints 1. 2. Local ordinances that enforce compulsory dog immunization and RPO are either not enacted or weakly enforced by the LGUs The Rabies control program has not been integrated among the regular health services provided by local health facilities .

Sign up to vote on this title
UsefulNot useful