PRICILLA FRINKA WIDJAJA / 00000008148

RABIES PREVENTION

Transmission Portal of entry

Pathogen
Direct Scratches,
Rabies Virus transmission by abrasions, open
Order: Portal of exit Transdermal wounds, or
Reservoir
Mononegavirales Saliva, or bite and mucous Establishment
Dogs, Cats, of infection in
Genus: infectious Rare: infectious membranes
Racoons, new host
Lyssavirus materials [brain material from a contaminated
Skunks, Foxes,
Ephemerovirus tissue] from rabid animal with saliva or Humans
Bats
Vesiculovirus rabid animals [saliva] gets other
into eyes, nose, potentially
Family: infectious
Rhabdoviridae mouth, or a
wound material

Primary Prevention Secondary Prevention Tertiary Prevention

Early diagnosis and Disability limitation

Health promotion Specific protection
Education to avoid Vaccinate your pet and you
contact with stray and (V-RG vaccine  inserting
wild animals the glycoprotein gene from
rabies into a vaccinia virus)
Maintain control of your Visit your veterinarian with
pets to reduce their your pet on a regular basis
exposure to wildlife and keep rabies
vaccinations up-to-date
Report any stray or ill Pre-exposure rabies
animals to animal immunization for people at
control increased risk of
Never adopt wild contracting rabies
animals or bring them (veterinarians and staffs,
Rehabilitation
prompt treatment
If your pet is bitten by Unclosed wound is immediately None [fatal disease]
a wild animal, seek and thoroughly cleaned After infection, the
veterinary assistance incubation period is
for the animal variable, but clinical
immediately illness most commonly
Surveillance by animal [Category III, Non Immunized] develops in several
control team Human rabies immunoglobulin weeks to several
(hRIG) is infiltrated into the months after
wounds without primary closure. exposure. The disease
The full dose should be given into progresses rapidly
the wound and surrounding area from a nonspecific,
if anatomically feasible. If this is prodromal phase with
not possible, any remaining hRIG fever and vague
should be given intramuscularly. symptoms to an acute,
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into your home. Do not animal handlers, workers in The site used to give progressive
try to nurse sick animals rabies laboratories, wildlife intramuscular hRIG must be encephalitis. The
to health. Do not handle, personnel, spelunkers, remote from the site used to give neurologic phase may
feed, or unintentionally hikers) the vaccine. be characterized by
attract wild animals with anxiety, paresis,
open garbage cans or paralysis, and other
litter. signs of encephalitis;
Prevent bats from [Category II, Non Immunized] A spasms of swallowing
entering living quarters rabies vaccine is given. Based on muscles can be
or occupied spaces in WHO, vaccines are given stimulated by the
homes, churches, intradermally using a 2-site or 8- sight, sound, or
schools, and other site protocol. In the US, the perception of water
similar areas, where they vaccine is given intramuscularly; (hydrophobia); and
might come in contact in adults, this is the deltoid area. delirium and
with people and pets. In children, the anterolateral convulsions can
aspect of the thigh. The gluteal develop, followed
area must never be used. The rapidly by coma and
first dose is given as soon as death. Once clinical
possible after the exposure. signs manifest,
Further doses are given 3, 7, and patients die quickly,
14 days after the initial dose. but with intensive
[Category II/III, Immunized] The supportive care may
wound is cleansed and a 2-dose succumb in 7–14 days.
immunization regimen is given
consisting of an immediate dose
and a second dose 3 days later.
hRIG is not required.
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Recommended PEP
Depending on the severity of the contact administering with the suspected rabid animal, administration of PEP is recommended as follows
(see table):

Table: Categories of contact and recommended post-exposure prophylaxis

(PEP)

Categories of contact with suspect rabid Post-exposure prophylaxis

animal measures
Category I – touching or feeding animals,
licks on intact skin None
Category II – nibbling of uncovered skin,
minor scratches or abrasions without Immediate vaccination and local
bleeding treatment of the wound
Category III – single or multiple
transdermal bites or scratches, licks on Immediate vaccination and
broken skin; contamination of mucous administration of rabies
membrane with saliva from licks, contacts immunoglobulin; local
with bats. treatment of the wound

All category II and III exposures assessed as carrying a risk of developing rabies require PEP. This risk is increased if:
 the biting mammal is a known rabies reservoir or vector species;
 the animal looks sick or displays an abnormal behaviour;
 a wound or mucous membrane was contaminated by the animal’s saliva;
 the bite was unprovoked; and
 the animal has not been vaccinated.