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Rabies virus and other lyssavirus exposures for health professionals

Post exposure prophylaxis

All cases requiring post exposure prophylaxis (PEP) need to be reported to SA Health’s Communicable Disease Control Branch (CDCB) on 1300 232 272 (24 hours/7 days).

People who come into contact with any bat in Australia or overseas, and people who come into contact with any mammal (especially dogs, cats and monkeys) in a country where there is a rabies virus risk, are at increased risk of rabies. Rabies virus and Australian bat lyssavirus (ABL) belong to a group of viruses which cause rabies. Rabies affects the central nervous system and is usually fatal.

Around 60% of human rabies immunoglobulin in Australia is used for PEP of monkey bites acquired in Bali. Doctors providing travel advice to people visiting all rabies-endemic areas should stress the importance of avoiding situations where mammalian bites may occur.

The rabies incubation period is usually three to eight weeks but may be as short as one week. The risk of dying from rabies after an untreated bite from a rabid animal is estimated to be 15 to 80%. Scratches are associated with a risk of dying of rabies of 2 to 5%. Animal behaviour is an unreliable method of determining whether or not a mammal is rabid. If potentially exposed to rabies or ABL virus, it is extremely important that appropriate treatment commences immediately. Incorrect or incomplete treatment can be fatal.

Management of potential rabies or ABL exposures

Immediate first aid measures, rabies vaccine and, where appropriate, human rabies immunoglobulin (HRIG) decrease the risk of rabies after mammalian bites and scratches.

First aid measures include thorough washing of all bite wounds and scratches with soap and water for about 5 minutes, and then the application of a virucidal preparation such as povidone-iodine solution. Between 2 and 5 rabies vaccinations may be required depending on the person’s current health status and vaccination history. HRIG provides localised anti-rabies antibody protection while the patient responds to the rabies vaccine (usually 14 to 21 days).

Consider whether tetanus vaccination (and immunoglobulin) is required.

When is rabies post exposure prophylaxis required?

Classify the wound using the World Health Organization system

  • Category I exposures (touching or feeding animals, licks on intact skin, as well as exposure to blood, urine or faeces or to an animal that has been dead for more than 4 hours).
  • Category II exposures (nibbling of uncovered skin, minor scratches or abrasions without bleeding).
  • Category III exposures (single or multiple transdermal bites or scratches, contamination of mucous membranes with saliva from licks, licks on broken skin).

PEP for mammalian bites (excluding bats) occurring outside Australia

  • Category I exposures-  HRIG and vaccine are not recommended.
  • Category II exposures - Rabies vaccine is recommended but not HRIG.
  • Category III exposures - Both HRIG and rabies vaccine are recommended.

PEP for bat exposure (any geographical location)

The risk of lyssavirus infection in wounds from bats is more difficult to determine.

  • Category I exposures-  HRIG and vaccine are not recommended.
  • Category II exposures - Both HRIG and rabies vaccine are recommended.
  • Category III exposures - Both HRIG and rabies vaccine are recommended

How to obtain rabies post exposure prophylaxis?

Reporting of post exposure treatment for rabies or ABL virus and to obtain rabies vaccine and, if required, HRIG, phone SA Health Communicable Disease Control Branch 1300 232 272 (24 hours /7 days). For more information see the Reporting of post exposure treatment for rabies or Australian bat lyssavirus page.

For details on how to administer rabies vaccination and how to infiltrate a wound with rabies immunoglobulin please refer to Australian Immunisation Handbook 10th Edition 2013 - Chapter 4.16 Rabies and other lyssaviruses (including Australian bat lyssavirus).

See the 'Rabies Shot' YouTube video shows how to infiltrate a wound with rabies immunoglobulin.

Rabies immunoglobulin

Imogam® Rabies Pasteurized (Human Rabies Immunoglobulin), which is the only HRIG registered with the Therapeutic Goods Administration (TGA), is only intermittently available in Australia.

The Australian Government has sourced an alternate HRIG product (KamRAB® Rabies Immune Globulin (Human)) which is not yet licensed in Australia. KamRAB will be used when Imogam is unavailable.

Donors of blood used for the production of KamRAB HRIG are screened and the products are treated to minimise the risk of KamRAB HRIG containing human immunodeficiency virus (HIV), hepatitis A, hepatitis B or hepatitis C viruses, or parvovirus. However as the product is not registered by TGA, it is necessary to go through the following procedures to obtain it. Complete a:

Further information on KamRAB

For further information on KamRAB see the following fact sheets:

Patient information

 

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