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Human Rabies Prevention

(Advisory Committee on Immunization Practices [ACIP] 1999 Guidelines)

 Pre-exposure rabies vaccination and serological testing

  • For persons in the frequent risk category (includes veterinarians and staff in areas enzootic for rabies), the ACIP guidelines recommend only serological testing every 2 years and administration of a booster vaccine if the antibody level is below that considered protective
  • For persons in the infrequent risk category (includes veterinarians in areas of low rabies enzooticity; veterinary students), the ACIP guidelines recommend the primary series and no serological testing or booster vaccination
  • Post exposure rabies prophylaxis procedures (contact with potential or confirmed rabies case)

 Employees and students involved in a clinical teaching related incident

Definition of exposure

  • Rabies is transmitted only when the virus is introduced into bite wounds or open cuts in the skin or onto mucous membranes
  • Other contact by itself, such as petting a rabid animal and contact with blood, urine, or feces of a rabid animal, does nor constitute an exposure and is NOT an indication for prophylaxis

NC State Students

  • Student Health Service: vaccine series, titer, or rabies immune globulin (if non-vaccinated). Payment will be required
  • Contract students Ross University, St George’s University) 
  • Rx Urgent Care, Blue Ridge Road, or Rex Hospital: vaccine series, titer, or rabies immune globulin (if non-vaccinated)
  • Payment will be required at the time of service

Employees

  • NC State University Worker’s Compensation 
  • Outside remit Student Health Service
  • Rx Urgent Care, Blue Ridge Road, or Rex Hospital: rabies vaccine series, titer, or rabies immune globulin (need to provide a completed WC form signed by the supervisor) and any follow up

Rabies in North Carolina

Rabies Vaccine Information for Medical Professionals

  • NC Division of Public health
  • http://www.epi.state.nc.us/epi/rabies/vaccine.html
  • Source: Human Rabies Prevention - United States, 1999: Recommendations of the Advisory Committee on Immunization Practices (ACIP).
  • MMWR 1999: Vol. 48, No. RR-1. Centers for Disease Control and Prevention.
  • http://www.epi.stste.nc.us/epi/rabies/pdf/ACIP99.pdf

Summary - Post-exposure Rabies Prophylaxis

  • Person has NOT had prior rabies vaccination with a diploid cell vaccine -Human Diploid Cell Vaccine (HDCV), Rabies Vaccine Adsorbed (RVA), Purified Chick Embryo Cell (PCEC).
  • Give Rabies Vaccine, either RVA, HDVC, or PCEC (RabAvert) 1.0 ml IM deltoid on days 0, 3, 7, 14, 28 (all days relative to day 0)  
  • Give Rabies Immune Globulin (RIG), 20 IU per kg of body weight, as much of the material as possible should be infiltrated into and around the site of the wound; the remainder should be given IM in the gluteals. It is only given once; on day 0. If it is not given immediately, it may be given up until 7 days after the initial rabies vaccination (day 0). After that time, immune response to vaccination is presumed to have started and subsequent administration of RIG is contraindicated.
  • Person HAS had prior rabies vaccination with a diploid cell vaccine (HDCV, RVA, PCEC)
  • Give Rabies Vaccine either RVA, HDCV, or PCEC 1.0 ml IM deltoid on days 0, 3*
  • Rabies Immune Globulin
        1. NOT Indicated
  • For more information, contact the State Health Department at 919-733-3410

 Other Agencies to be Informed at the Time

  • State Division of Public Health – diagnostic procedure performed at the laboratory
  • State Department of Agriculture – confirmation of rabies positive case