Materiały źródłowe

• #1 Rabies Prevention | doh

  https://dchealth.dc.gov/service/rabies-prevention

  Rabies is a fatal disease transmitted from animals to humans, caused by a virus that attacks the central nervous system, causing convulsions, paralysis and finally death. The virus is present in the saliva of a rabid animal and is transmitted primarily by animal bites and rarely by contamination of open wounds, fresh abrasions or mucous membranes. […] Rabies can be prevented if early treatment is administered. If in contact with an animal with possible rabies, you must contact the health department or a medical facility for advice on rabies prevention treatment. […] Treatment includes a first dose of vaccine and another protective injection. Then 4 more doses of vaccine are administered over 28 days. […] Vaccinate dogs and cats against rabies as required by law. All dogs and cats more than four months of age must be vaccinated against rabies. Keep vaccinations current at all times.

• #2 Indications for post-exposure rabies prophylaxis – UpToDate

  https://www.uptodate.com/contents/indications-for-post-exposure-rabies-prophylaxis

  Indications for post-exposure rabies prophylaxis […] Rabies is a viral disease primarily acquired from the bite of a rabid animal. There is no known effective treatment for rabies, and virtually all cases are fatal. Although the prognosis is poor in patients who develop rabies, the disease is usually preventable with proper wound care and post-exposure prophylaxis, which was first pioneered by Louis Pasteur in 1885. Survival following development of disease remains a rare and largely inexplicable phenomenon but is often associated with severe neurologic sequelae. This topic will discuss when to use rabies prophylaxis. […] The decision to initiate rabies post-exposure prophylaxis after a potential exposure should be made following a thorough risk assessment. Post-exposure prophylaxis includes rabies vaccine with or without rabies immune globulin. The specific regimen depends upon the patient’s prior rabies vaccine history and other factors. […] To prevent rabies infection, post-exposure prophylaxis should be administered to all patients who have had a known or likely exposure to rabies, including those who received prior pre-exposure prophylaxis.

• #3 Rabies Pre-Exposure Prophylaxis Regimen Animal Bites and Rabies Risk: A Guide for Health Professionals – MN Dept. of Health

  https://www.health.state.mn.us/diseases/rabies/risk/preexposure.html

  Pre-exposure vaccination against rabies simplifies the rabies post-exposure treatment, and it may protect in cases of unrecognized rabies exposure or when post-exposure treatment is delayed. It does not eliminate the need for appropriate treatment following a known rabies virus exposure. […] A 2-dose PrEV schedule has replaced the 3-dose PrEV schedule. The primary vaccination series is now two doses on Days 0 and 7 and then depending on the persons risk category they may require nothing additional, or they may require a 1-time booster, a 1-time titer check, or serial titer checks. […] The ACIP recommends that a single booster rabies vaccination be given when the titer falls below 0.5 IU/mL by the rapid fluorescent focus inhibition test (RFFIT), a virus neutralization test.

• #4 Rabies Pre-exposure Prophylaxis | Rabies | CDC

  https://www.cdc.gov/rabies/hcp/prevention-recommendations/pre-exposure-prophylaxis.html

  Pre-exposure vaccination is recommended for persons who work directly with animals that could have rabies. […] Also, those who travel to parts of the world where rabies is common and access to medical care is limited. […] These people should receive rabies pre-exposure prophylaxis (PrEP), a series of rabies vaccine doses given before exposure to the rabies virus. […] A 2-dose PrEP schedule has replaced the 3-dose PrEP schedule to protect people from rabies for up to 3 years. […] Clinical guidance for administering PrEP to people with weakened immune systems has been outlined and includes recommendations to confirm that the vaccine was effective. […] 2 doses, days 0 and 7. […] 2 doses, days 0 and 7. […] 2 doses, days 0 and 7, plus: Either a one-time titer check after 1 year and up to 3 years following the first 2-dose vaccination. […] 1-dose booster between 3 weeks and 3 years following the first vaccine in the 2-dose vaccination. […] 2 doses, days 0 and 7. […] None. […] Rabies is a preventable viral disease of mammals usually transmitted through the bite of an infected animal.

• #5 Rabies prevention | Rabies – Bulletin – Europe

  https://www.who-rabies-bulletin.org/site-page/rabies-prevention

  Because of the high fatality rate, the prevention of rabies infection is of utmost importance. Please visit the WHO site for the latest recommendations on rabies prophylaxis. […] WHO strongly recommends discontinuation of the nerve tissue vaccine, and replacement with modern concentrated and purified cell culture derived vaccines (CCDV) and embryonated egg-based rabies vaccines. These vaccines must comply with WHO criteria for potency and innocuity following satisfactory assessment in humans during well-designed field trials. […] Generally, pre-exposure vaccination should is recommended to anyone at continual, frequent or increased risk for exposure to the rabies virus such as those working in rabies diagnostic or research laboratories, veterinarians, animal handlers (including bat handlers), animal rehabilitators and wildlife officers, as well as other people (especially children) living in or travelling to high-risk areas.

• #5 Rabies prevention | Rabies – Bulletin – Europe

  https://www.who-rabies-bulletin.org/site-page/rabies-prevention

  After exposure, prevention of infection is virtually assured by post-exposure prophylaxis consisting of local treatment of the wound, initiated as soon as possible after an exposure, followed by the administration of a potent and effective rabies vaccine that meets WHO criteria and a passive immunization, if indicated (category III). […] Any bite wound or scratches that might be contaminated with rabies virus should immediately be flushed with rinsing water as first-aid procedure! Thorough washing for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances of proven lethal effect on rabies virus or other detergents should follow. […] For detailed information on vaccination regimens ask your national health authorities or see WHO-pages on rabies: www.who.int/rabies. […] Still the best possible way to prevent rabies is to keep away from rabies suspect animals.

• #6 Rabies pre-exposure vaccination and titers for the veterinary team | American Veterinary Medical Associationmultiple-users-1addaddaddaddadd

  https://www.avma.org/resources-tools/one-health/rabies/rabies-pre-exposure-vaccination-and-titers-veterinarians

  Rabies exposure is an occupational hazard for veterinary professionals, and preventive measures are necessary to protect veterinary teams. […] Pre-exposure rabies vaccination (also known as pre-exposure prophylaxis or PrEP) is an important part of this protection, as is a rabies antibody titer check, when recommended. […] PrEP doesn’t eliminate the need for additional treatment after rabies exposure. What it does eliminate is the need for post-exposure rabies immunoglobulin administration. It also decreases the number of post-exposure doses of vaccine needed. […] In May 2022, the ACIP redefined its categories for people at risk of rabies, and revised its recommendations concerning rabies PrEP. Veterinarians, credentialed veterinary technicians, and veterinary assistants (including non-credentialed staff working as technicians) are now considered to be in risk category 3 of 5, and are recommended to get a primary PrEP series with two doses of rabies vaccine, seven days apart, to provide protection for up to three years.

• #7 Preventing Rabies | Bavarian Nordic

  https://bnvaccines.com/disease-area/about-rabies/preventing-rabies

  In the United States, deaths associated with rabies occur in people who fail to seek timely postexposure prophylaxis (PEP) usually because they are unaware of their exposure. […] The CDC advises that people should consider pre-exposure vaccination if they are in frequent contact with the rabies virus or rabid animals, such as on the job, or if they’re active outdoors and could encounter animals with rabies in the wild. […] Pre-exposure rabies vaccination also makes sense for travelers likely to come in contact with animals in parts of the world where rabies is common and immediate access to appropriate care is limited. […] Pre-exposure vaccination is not recommended for all travelers. […] PrEP is appropriate for persons in high-risk groups, including international travelers visiting areas where rabies is enzootic and immediate access to appropriate medical care, including biologics, may be limited.

• #7 Preventing Rabies | Bavarian Nordic

  https://bnvaccines.com/disease-area/about-rabies/preventing-rabies

  Although PrEP does not eliminate the need for medical care following possible rabies exposure, PrEP: […] Offers a level of protection, particularly to unrecognized exposures, through the presence of rabies antibodies in the weeks following vaccination […] Primes the immune response so that treatment after exposure (PEP), can be effective more quickly […] Simplifies treatment: […] Eliminates the need for human rabies immune globulin (HRIG), which may not be readily available and […] Decreases the number of vaccine doses needed after suspected exposure. […] May also provide partial immunity for individuals whose PEP may be delayed or who are at continual, frequent or increased risk of unapparent or unrecognized exposure to the rabies virus due to their location or occupation. […] HRIG is a medication administered to previously unvaccinated persons to provide immediate access to neutralizing antibodies until the patient’s immune system can respond to the vaccine and actively produce antibodies of its own.

• #7 Preventing Rabies | Bavarian Nordic

  https://bnvaccines.com/disease-area/about-rabies/preventing-rabies

  HRIG is administered only once, preferably at the initiation of PEP or within 7 days after the first dose of rabies vaccine. […] HRIG is infiltrated into and around any detectable wounds or administered intramuscularly when a bite site is unknown or indeterminate. […] Because HRIG can be difficult to obtain in some countries, access to appropriate care may be delayed. This, along with the level of exposure risk in a travel location, should be considered when recommending whether pre-exposure vaccination is appropriate. […] If a wound is present, immediately wash it for at least 15 minutes using soap and water. […] Wound washing helps to reduce rabies virus infection by eliminating or inactivating rabies virus particles that may have infiltrated the wound.

• #8 Preventing Rabies | Bavarian Nordic

  https://www.bnvaccines.com/disease-area/about-rabies/preventing-rabies

  Although PrEP does not eliminate the need for medical care following possible rabies exposure, PrEP: Offers a level of protection, particularly to unrecognized exposures, through the presence of rabies antibodies in the weeks following vaccination […] Primes the immune response so that treatment after exposure (PEP), can be effective more quickly […] Simplifies treatment: Eliminates the need for human rabies immune globulin (HRIG), which may not be readily available and decreases the number of vaccine doses needed after suspected exposure. […] May also provide partial immunity for individuals whose PEP may be delayed or who are at continual, frequent or increased risk of unapparent or unrecognized exposure to the rabies virus due to their location or occupation. […] HRIG is a medication administered to previously unvaccinated persons to provide immediate access to neutralizing antibodies until the patient’s immune system can respond to the vaccine and actively produce antibodies of its own. […] HRIG is administered only once, preferably at the initiation of PEP or within 7 days after the first dose of rabies vaccine. […] Wound washing helps to reduce rabies virus infection by eliminating or inactivating rabies virus particles that may have infiltrated the wound.

• #8 Preventing Rabies | Bavarian Nordic

  https://www.bnvaccines.com/disease-area/about-rabies/preventing-rabies

  In the United States, deaths associated with rabies occur in people who fail to seek timely postexposure prophylaxis (PEP) usually because they are unaware of their exposure. […] The CDC advises that people should consider pre-exposure vaccination if they are in frequent contact with the rabies virus or rabid animals, such as on the job, or if they’re active outdoors and could encounter animals with rabies in the wild. […] Pre-exposure rabies vaccination also makes sense for travelers likely to come in contact with animals in parts of the world where rabies is common and immediate access to appropriate care is limited. […] Pre-exposure vaccination is not recommended for all travelers. […] PrEP is appropriate for persons in high-risk groups, including international travelers visiting areas where rabies is enzootic and immediate access to appropriate medical care, including biologics, may be limited.

• #9 What is the Treatment for a Rabies Exposure? | Rabies Watch?

  https://www.rabieswatch.com/en/families/what-is-the-treatment-for-rabies-exposure

  Theres no cure for rabies. But when you are exposed to the rabies virus, there is a rabies treatment for preventing the virus from spreading. […] Protective measures, known as postexposure prophylaxis or PEP, are the only proven way to avoid the onset of rabies. There are 3 parts to this process. All of them are necessary. […] This important step needs to be administered quickly before the rabies virus can take hold. […] An HRIG like HyperRAB (rabies immune globulin [human]) provides critical, immediate protection. Its given to individuals who have not been previously vaccinated. […] The HRIG is usually administered at the same time as the first dose of the vaccine but can be given up to 7 days later. […] In addition to the HRIG, which provides immediate protection, a vaccine is administered to build active, long-lasting immunity. The rabies vaccine is usually given as a series of 4 shots.

• #10 Rabies Post-exposure Prophylaxis | Rabies | CDC

  https://www.cdc.gov/rabies/hcp/prevention-recommendations/post-exposure-prophylaxis.html

  Rabies Post-exposure Prophylaxis (PEP) includes wound washing, human rabies immune globulin (HRIG), and a four-dose series of vaccines. […] Rabies PEP consists of wound washing, a dose of human rabies immune globulin (HRIG) and rabies vaccine given at the time of your first medical visit, and a dose of vaccine given again on days 3, 7, and 14 after the first dose. […] Wound cleansing is especially important in rabies prevention since, in animal studies, thorough wound cleansing alone without other medical treatments (e.g., PEP) has been shown to markedly reduce the likelihood of rabies. […] For people who have never been vaccinated against rabies, PEP should always include the administration of both HRIG and rabies vaccine. […] People who have been previously vaccinated or are receiving pre-exposure vaccination for rabies should not receive HRIG. PEP for persons who have previously been vaccinated against rabies consists of two doses of vaccine, 3 days apart.

• #10 Rabies Post-exposure Prophylaxis | Rabies | CDC

  https://www.cdc.gov/rabies/hcp/prevention-recommendations/post-exposure-prophylaxis.html

  HRIG is administered only once at the beginning of the PEP course, and only to previously unvaccinated persons. […] HRIG should never be administered in the same syringe or in the same anatomical site as the first vaccine dose. […] All PEP should begin with immediate thorough cleansing of all wounds with soap and water. […] A fifth dose on day 28 is recommended for persons with a confirmed or suspected immune disorder. […] RIG should NOT be administered. […] Although no PEP failures have occurred in the United States since cell culture vaccines have been routinely used, failures have occurred abroad when some deviation was made from the recommended PEP protocol or when less than the currently recommended amount of rabies immune globulin (RIG) was administered.

• #11 | Rabies Post-exposure Prophylaxis (PEP) I KEDRAB® Rabies Immune Globulin (Human)

  https://kedrab.com/rabies-disease-pep/

  Human Rabies Is Essentially 100% Preventable With Proper Post-exposure Prophylaxis (PEP)1 […] The 3 crucial components of PEP are highly effective in preventing human rabies in exposed patients who have not been previously vaccinated against the virus.2 […] Immediately cleanse all wounds thoroughly with soap and water, including a virucidal agent2 […] Administer a human rabies immune globulin (HRIG), such as KEDRAB, as soon as possible after exposure, but no later than 7 days after the first dose of the vaccine2,3 […] Vaccinate against the rabies virus to stimulate the patients immune system (virus neutralizing antibodies will appear approximately 7 to 10 days after initiation of the vaccine series)2 […] Effective PEP Requires Both Passive and Active Immunization2,3 […] HRIG provides immediate protection for passive immunization. It is administered only once, and to previously unvaccinated patients, to provide rabies virus-neutralizing antibody coverage until the patient responds to the rabies vaccine.2,3

• #11 | Rabies Post-exposure Prophylaxis (PEP) I KEDRAB® Rabies Immune Globulin (Human)

  https://kedrab.com/rabies-disease-pep/

  The rabies vaccine stimulates the patients immune system to produce virus-neutralizing antibodies for ongoing protection, known as active immunization. This occurs approximately 7 to 10 days after initiation of the vaccine series.2,3 […] If the 3 components of PEP are not followed promptly and properly, a patient may not be fully protected and may be at increased risk of death from the rabies virus. Specific to the administration of HRIG, there are several errors that can contribute to PEP failure2,4,5: […] NOTE: For persons with immunosuppression, rabies post-exposure prophylaxis should be administered using all 5 doses of vaccine on days 0, 3, 7, 14, and 28.2 […] Failure to infiltrate HRIG into and around eligible wounds was the largest area of non-adherence to guideline recommendations6.

• #12 Rabies Post-Exposure Prophylaxis Regimen Animal Bites and Rabies Risk: A Guide for Health Professionals – MN Dept. of Health

  https://www.health.state.mn.us/diseases/rabies/risk/postexposure.html

  Wound cleansing is especially important in rabies prevention. In animal studies, thorough wound cleansing alone without other medical treatments (e.g., PEP) has been shown to markedly reduce the likelihood of rabies. […] The rabies PEP regimen involves administration of human rabies immune globulin (HRIG), which is given only once, and a series of four 1 mL rabies vaccinations. […] HRIG must be infiltrated into and around the bite wound site(s), and provides immediate, passive immune protection until the patient produces antibodies through the PEP vaccine series. […] A 1 mL dose of rabies vaccine is given IM in the deltoid area of adults or the anterolateral thigh of young children on Days 0, 3, 7, and 14 of the rabies PEP regimen. […] Previously vaccinated individuals are those who have completed a pre-exposure or post-exposure regimen of human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCEC). […] Once the decision to initiate rabies PEP has been made, the PEP regimen should be started as soon as possible. […] In general, there is a very low frequency of serious adverse reactions to the rabies PEP regimen.

• #13 Rabies Postexposure Prophylaxis Guidelines | Rabies Watch

  https://www.rabieswatch.com/en/hcp/rabies-postexposure-prophylaxis-guidelines

  An HRIG like HyperRAB (rabies immune globulin [human]) provides critical, immediate protection. […] HyperRAB (rabies immune globulin [human]), in conjunction with a vaccine, is indicated for postexposure prophylaxis for both bite and nonbite exposures regardless of the time interval between exposure and initiation of PEP in previously unvaccinated persons. […] HyperRAB should be administered as promptly as possible after exposure, but must be administered within 7 days after the first dose of rabies vaccine. Beyond 7 days, HyperRAB is not indicated since an antibody response to vaccine is presumed to have occurred. […] All PEP should begin with immediate, thorough cleansing of all wounds with soap and water. If available, a virucidal agent (eg, povidine-iodine solution) should be used to irrigate the wounds.

• #13 Rabies Postexposure Prophylaxis Guidelines | Rabies Watch

  https://www.rabieswatch.com/en/hcp/rabies-postexposure-prophylaxis-guidelines

  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. […] HRIG should not be administered. […] HYPERRAB (rabies immune globulin [human]) is indicated for postexposure prophylaxis, along with rabies vaccine, for all persons suspected of exposure to rabies. […] For unvaccinated persons, the combination of HYPERRAB and vaccine is recommended for both bite and nonbite exposures regardless of the time interval between exposure and initiation of postexposure prophylaxis. Beyond 7 days (after the first vaccine dose), HYPERRAB is not indicated since an antibody response to vaccine is presumed to have occurred.

• #14 Post-Exposure Prophylaxis Protocol – Cook County Department of Public Health

  https://cookcountypublichealth.org/communicable-diseases/rabies/post-exposure-prophylaxis-protocol/

  Rabies Post-Exposure Prophylaxis Protocol […] If a person that has not been vaccinated is exposed to a rabid animal, the following is required for post exposure prophylaxis: Human Rabies Immune-Globulin (HRIG) on day 0, plus a series of Human Rabies Vaccines (HRV) on days 0, 3, 7, and 14 (immunocompromised patients should receive a 5th dose on day 28 and subsequent titer check). […] Persons with previous rabies vaccination [i.e., those who completed the series of the three vaccine pre exposure prophylaxis or the series of four/five vaccines and Human Rabies Immune Globulin post exposure prophylaxis (using Human Diploid Cell Vaccine, Rabies Vaccine Adsorbed, or Purified Chick Embryo Vaccines)], should receive two doses of rabies vaccine on days 0 and 3. The person does not need Human Rabies Immune Globulin.

• #15 Rabies Post-Exposure Prophylaxis | Wisconsin Department of Health Services

  https://www.dhs.wisconsin.gov/rabies/algorithm/post-exposure-prophylaxis.htm

  Rabies post-exposure prophylaxis (PEP) – Schedule1 […] All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent (e.g., povidone-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) distant from vaccine administration. […] Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL, intramuscular (deltoid area), 1 each on days 0, 3, 7, and 14. […] Both HRIG and vaccine should be used, regardless of how long ago the exposure occurred. […] 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. […] HDCV or PCECV 1.0 mL, intramuscular (deltoid area), 1 each on days 0, 3, and 7. […] HRIG should NOT be administered.

• #16 Patient education: Rabies (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/rabies-beyond-the-basics

  Everyone, including children and pregnant people, can and should receive post-exposure prophylaxis if an exposure to rabies virus has occurred. […] Certain information is needed to determine if post-exposure rabies prophylaxis is needed at all or if it can be delayed while the animal is observed or tested for rabies virus. […] Post-exposure prophylaxis should be given promptly in response to any severe exposure (eg, multiple bites or a bite on the head, neck, or trunk) from an animal likely to be rabid. […] If prophylaxis is recommended, one dose of RIG is given immediately. […] If post-exposure prophylaxis is needed and the person has not received a rabies vaccine series in the past, the rabies vaccine should also be given as soon as possible. […] State or local health departments should be consulted to help make decisions about whether rabies prophylaxis is needed and when treatment can be delayed during the animal observation period.

• #16 Patient education: Rabies (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/rabies-beyond-the-basics

  Post-exposure prophylaxis is recommended if a person has direct physical contact with a bat, unless the exposed individual is certain that there was no bite or scratch, or the bat was tested and found not to be rabid. […] Anyone who is bitten by, or has other saliva exposure to, a potentially rabid livestock species should be managed individually, in consultation with state or local public health authorities.

• #17 LA County Department of Public Health

  http://publichealth.lacounty.gov/vet/rabiesmanual/prevention.htm

  Immediate and extensive washing of all bite wounds, scratches, or other sites of potential exposure for 10 minutes with soap and water is arguably the most important measure for preventing rabies following an exposure to a rabid animal. […] Purified human anti-rabies immunoglobulin (HRIG) provides rapid protection against rabies for one to two weeks after exposure — while the more lasting vaccine-induced immune response is developing. […] Primary post-exposure immunization with HDCV, RVA, and PCECV is given intramuscularly (IM) in a regimen of five 1-ml doses. The first dose is given as soon after exposure as possible (day 0). The remaining four doses are given on days 3, 7, 14 and 28 following the first dose. […] The need for post-exposure treatment should be based on careful consideration of four basic areas: TYPE OF EXPOSURE, ANIMAL BEHAVIOR, ANIMAL SPECIES, and LABORATORY TEST RESULTS.

• #17 LA County Department of Public Health

  http://publichealth.lacounty.gov/vet/rabiesmanual/prevention.htm

  Local governments should initiate and maintain effective programs to ensure vaccination of all dogs, cats, and ferrets and to remove strays and unwanted animals. […] Rabies Vaccination of Dogs and Cats: All owners or harborers shall have their dog(s) currently vaccinated against rabies by a California licensed veterinarian. […] Pre-exposure vaccination should be offered to persons among high-risk groups, such as veterinarians, animal handlers, certain laboratory workers, and persons spending time (e.g., 1 month) in foreign countries where canine rabies is endemic. […] There are three components to PEP: 1) local treatment of wounds; 2) provision of passive immunity with purified specific immunoglobulin; and 3) the induction of active immunity with rabies vaccine. All three components are critical to the effective prevention of rabies.

• #18 Rabies vaccines: Canadian Immunization Guide – Canada.ca

  https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-18-rabies-vaccine.html

  Post-exposure prophylaxis of persons previously appropriately immunized with rabies vaccine consists of: local wound treatment and two 1.0 mL IM doses of rabies vaccine given on days 0 and 3. […] Rabies prophylaxis must be considered in every incident in which human exposure to potentially rabid animals has occurred, unless rabies is known to be absent from the local animal population. […] Post-exposure prophylaxis should begin immediately following exposure to a wild terrestrial carnivore (such as a fox, skunk or raccoon) in enzootic areas, unless the animal is available for rabies testing and rabies is not considered likely. […] Post-exposure rabies prophylaxis following bat exposure is recommended when there has been direct contact between a person and a bat, or, much less commonly, when saliva from the bat enters into an open wound or mucous membrane.

• #18 Rabies vaccines: Canadian Immunization Guide – Canada.ca

  https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-18-rabies-vaccine.html

  Rabies is a rare viral central nervous system infection most often transmitted to humans through the bite of an infected mammal. […] Pre-exposure immunization for high risk persons produces rabies neutralizing antibodies. […] Post-exposure prophylaxis is highly effective in preventing rabies. […] Evaluation of an individual’s need for post-exposure prophylaxis includes risk assessment related to the exposure to the potentially rabid animal. […] If indicated, initiate post-exposure prophylaxis as soon as possible but administer regardless of the time interval since exposure. […] Post-exposure prophylaxis of immunocompetent persons who have not been previously immunized with rabies vaccine consists of: local wound treatment; rabies immunoglobulin (20 IU/kg body weight) given on day 0 with as much as possible infiltrated into and around the wound; and four 1.0 mL IM doses of rabies vaccine given on days 0, 3, 7 and 14.

• #19 Anyone who has potentially been exposed to rabies virus or other lyssaviruses is recommended to receive post-exposure prophylaxis with rabies vaccine and, in some cases, rabies immunoglobulin | The Australian Immunisation Handbook

  https://immunisationhandbook.health.gov.au/recommendations/anyone-who-has-potentially-been-exposed-to-rabies-virus-or-other-lyssaviruses-is-recommended-to-receive-post-exposure-prophylaxis-with-rabies-vaccine-and-in-some-cases-rabies-immunoglobulin

  Make every effort to have the animal tested for lyssaviruses after a potential human exposure, to avoid unnecessary post-exposure prophylaxis. […] Give post-exposure prophylaxis that is appropriate for the category and source of exposure, even if there was a considerable delay in reporting the incident. […] A person does not need post-exposure prophylaxis if they present ≥15 days after being bitten or scratched by a domestic pet in a rabies-enzootic country and it is known that the animal is healthy ≥15 days after the exposure. […] After wound management, withhold giving HRIG and rabies vaccine if the bat’s ABLV status will be available within 48 hours of the exposure. If the bat’s ABLV status will not be available within 48 hours, start the appropriate post-exposure prophylaxis as soon as possible.

• #20

  https://www.who.int/teams/control-of-neglected-tropical-diseases/rabies/vaccinations-and-immunization

  Elimination of rabies virus at the site of the infection by chemical or physical means is an effective mechanism of protection. Local treatment of wounds involving possible exposure to rabies is recommended in all exposures. […] Recommendations for post-exposure depend on the type of contact with the suspected rabid animal. […] WHO strongly recommends the discontinuation of production and use of nerve tissue vaccine and their replacement by modern cell culture vaccines. Intradermal vaccination is recommended as an alternative to intramuscular vaccination as it is safe, immunogenic and dose and cost sparing. […] Prompt administration of rabies vaccine after exposure, combined with proper wound management and administration of rabies immunoglobulins where indicated, is almost invariably effective in preventing rabies, even after high-risk exposure.

• #21 Schedule Rabies Vaccine | Walgreens

  https://www.walgreens.com/topic/pharmacy/scheduler/rabies-vaccine.jsp

  People who are likely to come in contact with the rabies virus or with rabid animals […] Travelers who plan to spend time outdoors where rabies is common […] Veterinarians and animal control or wildlife workers […] Anyone with moderate or severe illness should wait until they recover to be vaccinated […] People who previously had a severe, life-threatening allergic reaction to the vaccine or any ingredient in the vaccine […] People with a weakened immune system should talk with a doctor before receiving the vaccine. […] Mild-to-moderate side effects: Soreness, redness or swelling at the injection site […] Headache, nausea, abdominal pain, muscle aches and dizziness […] Hives, pain in the joints and fever […] Severe side effects, although rare, may include serious allergic reactions. Symptoms include Deafness

• #22 Rabies Surveillance | Health & Senior Services

  https://health.mo.gov/living/healthcondiseases/communicable/rabies/index.php

  Rabies is a viral disease of mammals and is transmitted primarily through bites. […] Fortunately, human deaths in the United States have become relatively rare because: (1) effective vaccinations have been available for dogs and cats since the 1950s, (2) public health practices such as animal quarantine and testing are aggressively pursued, and (3) improved anti-rabies shots have been developed for persons exposed to rabies. […] Effective rabies vaccines are available for dogs, cats, ferrets, sheep, cattle, and horses. Vaccination of cats and dogs is crucial, since vaccinated pets are a protective barrier between the people who own and interact with them and rabid wild animals with which the pets might have contact. […] There is no postexposure treatment available for animals as there is for humans. Information pertaining to animal rabies vaccines as well as the prevention and control of rabies in animals is available in the Compendium of Animal Rabies Prevention and Control, 2008.

• #23

  https://dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/diseases/rabies.html

  People in high-risk occupations–for example, veterinarians, wildlife biologists, wildlife rehabilitators, animal control officers and taxidermists–should consider getting the rabies vaccine to protect themselves from exposures that could occur in their work. This type of vaccination (pre-exposure vaccination) consists of three rabies vaccine injections. These vaccinated persons should have their rabies titers tested every two years. If their titer falls below 1:5 they should receive a booster vaccination. A person already vaccinated and later exposed to rabies must receive two booster injections three days apart immediately after exposure. […] If your pet has been in a fight with another animal call your veterinarian. A vaccinated pet may need a booster dose of rabies vaccine as soon as possible. Unvaccinated animals exposed to a known rabid animal must be confined and professionally observed for six months or euthanized. […] Vaccinated pets serve as a buffer between rabid wildlife and humans, so be sure dogs and cats are up-to-date on their rabies vaccinations. Consult with your veterinarian about when your pet needs to be vaccinated. […] Report all animal bites to the local animal control.

• #24 Rabies – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rabies/symptoms-causes/syc-20351821

  Once a person begins showing signs and symptoms of rabies, the disease nearly always causes death. For this reason, anyone who may have a risk of contracting rabies should receive rabies vaccinations for protection. […] Seek immediate medical care if you’re bitten by any animal, or exposed to an animal suspected of having rabies. Based on your injuries and the situation in which the exposure happened, you and your doctor can decide whether you should receive treatment to prevent rabies. […] To reduce your risk of coming in contact with rabid animals: Vaccinate your pets. Cats, dogs and ferrets can be vaccinated against rabies. Ask your veterinarian how often your pets should be vaccinated. […] Consider the rabies vaccine if you’re traveling or often around animals that may have rabies. If you’re traveling to a country where rabies is common and you’ll be there for an extended period of time, ask your doctor whether you should receive the rabies vaccine. This includes traveling to remote areas where medical care is difficult to find. […] If you work as a veterinarian or work in a lab with the rabies virus, get the rabies vaccine.

• #25 Animal bites and rabies – King County, Washington

  https://kingcounty.gov/en/dept/dph/health-safety/disease-illness/health-advisories/animal-bites

  Animal bites are a public health concern because of the potential for transmission of rabies, a viral infection of the nervous system and brain of humans and other mammals that is almost always fatal. Infection can be prevented by administering rabies immune globulin and a series of rabies vaccine doses. […] If a person is exposed to rabies, an injection of immune globulin and a series of rabies vaccinations need to be given as soon as possible to prevent infection and death. […] Keep rabies vaccinations up-to-date for all dogs, cats, and ferrets. In King County, all dogs, cats and ferrets must be vaccinated for rabies by 4 months of age and receive booster vaccinations on schedule. […] Before traveling abroad, consult with a health care provider about rabies risk in the country you are going to. Pre-exposure rabies vaccines might be recommended.

• #26 About RabAvert | Rabavert

  https://rabavert.com/about-rabavert/

  RabAvert has been used for more than 35 years to protect humans from rabies infections. Your doctor will assess whether vaccination is appropriate for you. RabAvert (rabies vaccine) is for pre-exposure vaccination in both primary series and booster dose, and for post-exposure prophylaxis against rabies, in all age groups. If you are considered to be at high risk of exposure to rabies, RabAvert may be given as a preventative immunization. This is known as PrEP or pre-exposure prophylaxis. According to the FDA-approved prescribing information, RabAvert is administered intramuscularly in 3 doses on Day 0, Day 7, and Day 21 or 28. Periodic testing for antibodies after people have received rabies vaccination is sometimes recommended to ensure ongoing protection against infection, especially if you have frequent or continuous contact with potentially rabid animals, or to the live rabies virus itself. A rabies immunity level (or titer) test indicates the strength of someone’s immune response against rabies virus infection. A routine test that checks your titer can be performed to determine whether vaccine booster doses are needed to enhance the immune response. Pre-exposure vaccination does not eliminate the need for additional treatment after a known rabies exposure. If you might have been exposed to rabies (for example, from a bite from a potentially rabid bat), RabAvert may be given to prevent rabies from developing. This is known as PEP or post-exposure prophylaxis. PEP, if it is necessary, should begin as soon as possible after exposure and consists of extensive washing and local treatment of any wound as soon as possible after exposure, administration of human rabies immune globulin (HRIG) if you have not previously received rabies immunization, and a course of rabies vaccinations. According to the FDA-approved prescribing information, the HRIG injection is followed by a series of 5 individual injections of RabAvert® (1.0 mL each) given intramuscularly on days 0, 3, 7, 14, and 28. HRIG should not be administered to previously vaccinated patients. You should receive 2 doses of RabAvert – one on Day 0 and another on Day 3. Vaccination before a potential exposure (PrEP) to the rabies virus does not remove the need for additional therapy after a suspected or known rabies exposure. Seek the advice of a healthcare professional to help assess your specific level of risk if you are traveling to areas of high risk of rabies exposure; in frequent contact with the rabies virus or rabid animals, such as on the job; and/or are active outdoors and could encounter animals with rabies in the wild. If you are exposed to a potentially rabid animal, seek medical attention right away before you have symptoms. Once symptoms are present, the rabies infection has spread through the body and survival is unlikely.

• #27 Rabies: For health professionals – Canada.ca

  https://www.canada.ca/en/public-health/services/diseases/rabies/for-health-professionals.html

  Rabies in humans can be prevented through pre-exposure prophylaxis and prompt post-exposure prophylaxis combined with appropriate medical care. […] Rabies is a preventable disease. Pre-exposure and post-exposure prophylaxis is available. Additionally, proper wound care after an animal bite can significantly reduce the risk of rabies. […] Rabies pre-exposure prophylaxis consists of vaccination with rabies vaccine. In Canada, human diploid cell vaccine or purified chick embryo cell vaccine are given on days 0, 7 and any time between days 21 to 28. […] Rabies post-exposure prophylaxis (RPEP) is intended to neutralize any rabies virus that was introduced by the animal exposure before it can enter the nervous system. […] For people who have not been previously vaccinated against rabies, RPEP involves administering rabies immune globulin (RabIg) treatment and rabies vaccine.

• #28 Rabies – El Paso County Public Health

  https://www.elpasocountyhealth.org/rabies/

  Rabies is a fatal but preventable viral disease. It can spread to people and pets if they are bitten or scratched by a rabid animal. […] Rabies can be prevented by vaccinating pets, staying away from wildlife, and seeking medical care after potential exposures before symptoms start. […] In the United States, more than 90% of reported cases of rabies in animals occur in wildlife. […] There are several things you can do to protect your pet from rabies. These include making sure your pets get regular rabies vaccines, keeping pets away from wild animals, spaying or neutering pets, and calling animal control to remove stray animals from your neighborhood. […] If you are bitten, scratched, or unsure, talk to a healthcare provider about whether you need postexposure prophylaxis. Rabies in people is 100% preventable through prompt appropriate medical care.

• #29 Rabies infections and prevention | Cornell University College of Veterinary Medicine

  https://www.vet.cornell.edu/departments-centers-and-institutes/riney-canine-health-center/canine-health-information/rabies-infections-and-prevention

  Rabies is a viral disease that remains a significant public health concern. […] Vaccination is crucial for prevention since there is currently no effective treatment for rabies in any species. […] There is no treatment or cure for rabies, so prevention via vaccination and education are crucial. […] Rabies is a reportable disease, so veterinarians and physicians must notify the local or state regulatory authorities if a dog bites a person. […] Rabies is zoonotic, meaning that humans can become infected if they are bitten by a rabid animal. […] Because there is no effective treatment for rabies, prevention is the primary focus. Vaccinating dogs is the most critical step for rabies prevention in pets and in people. […] Rabies vaccines are incredibly effective. Puppies are generally vaccinated around 12 weeks of age, again when they are 1-year-old, and then every three years throughout their life. […] Other preventive measures include avoiding interactions with dogs when traveling to countries where canine rabies is prevalent, preventing contact with wildlife such as skunks, foxes, bats, and raccoons, and seeking immediate medical care if possible exposure or a bite occurs.

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