The Fort Wayne Allen County Department of Health

Alerts and Advisories

09 Rabies

This year we have noted a significant increase in the number of bats that we have had tested for rabies that are positive. Last year we had 1 rabid bat and this year as of this date, we have had 5. We also had an opossum bite but results are pending. As some of you may be seeing patients with complaints of bat exposures, below you will find a quick update about a few issues around rabies post exposure treatment.

Exposure : (http://www.cdc.gov/RABIES/bats.html)

Most of the recent human rabies cases in the United States have been caused by rabies virus from bats. A few people die each year from rabies because they did not know they were bitten or did not seek treatment. People usually know when they have been bitten by a bat. However, because bats have small teeth which may leave marks that are not easily seen or quickly disappear, there are situations in which patients should be treated even in the absence of an obvious bite wound. For example, if they awaken and find a bat in their room, see a bat in the room of an unattended child, or see a bat near a mentally impaired or intoxicated person, the bat should be tested. Also, if infectious material from a bat gets into their eyes, nose, mouth, or a wound. However, contact such as petting or handling an animal, or contact with blood, urine or feces does not constitute an exposure, and therefore no postexposure prophylaxis is needed in these situations.

Animal Type to Postexposure Prophylaxis Table
Animal Type	Evaluation and Disposition of Animal	Postexposure Prophylaxis Recommendations
Dogs, cats, and ferrets	Healthy and available for 10 day observation	Persons should not begin vaccination unless animal develops clinical signs of rabies
	Rabid or suspected rabid	Immediately vaccinate
	Unknown (escaped)	Consult public health officials
Raccoons, skunks, foxes, and most other carnivores; Bats	Regarded as rabid unless animal is proven negative by laboratory test	Consider immediate vaccination
Livestock, horses, rodents, rabbits and hares, and other mammals	Consider individually	Consult public health officials. Bites of squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, other small rodents, rabbits, and hares almost never require rabies postexposure prophylaxis.

Treatment

Postexposure Prophylaxis for Non-immunized Individuals

Treatment	Regimen
Wound cleansing	All postexposure prophylaxis should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as povidine-iodine solution should be used to irrigate the wounds.
RIG	If possible, the full dose should be infiltrated around any wound(s) and any remaining volume should be administered IM at an anatomical site distant from vaccine administration. Also, RIG should not be administered in the same syringe as vaccine. Because RIG might partially suppress active production of antibody, no more than the recommended dose should be given.
Vaccine	HDCV or PCECV 1.0 mL, IM (deltoid area †), one each on days 0 §, 3, 7, 14, and 28.

To report animal bites, contact Fort Wayne Animal Care & Control at 449-1244 or fax the bite report to 427-5514.

For questions regarding rabies prophylaxis, contact the Community Health Nursing Division at 449-7514.

Thanks, Deb McMahan, MD

I WILL BE SENDING OUT SEASONAL AND H1N1 FLU VACCINE LATER THIS WK