Rabies Exposure
Animal Bites?…What Now?
What Is Rabies?
Rabies is a viral disease most often transmitted through the bite of a rabid animal. The rabies virus attacks the central nervous system producing an acute illness with rapidly progressive signs and symptoms of anxiety, difficulty in swallowing, seizures and sometimes paralysis. Animals both wild and domestic are a potential source of transmission of the rabies virus.
If a person has had an exposure that may have potential for transmission of the rabies virus, there are several resources available to healthcare practitioners with regard to the management of a possible rabies exposure. Anyone having knowledge of an animal biting or scratching so as to break the skin is required by Texas State Law to report the incident to the local health authority. This may be done in San Antonio by calling Animal Care Services at 210-207-6668.
Important Information for Providers:
Administration of post-exposure prophylaxis (treatment) (PEP) is a medical urgency not a medical emergency. All bite wounds must first be provided with proper wound care and treatment in an acute care or primary care setting (ER or Primary Care Provider).
Anti-rabies biologicals may be administered to humans only by and under the supervision of a medical professional licensed to practice in Texas. “Prophylaxis should begin as soon as possible after exposure, ideally within 24 hours. However, a delay of several days or more may not compromise effectiveness, and prophylaxis should be initiated if indicated, regardless of the interval between exposure and initiation of therapy.”--Red Book, 2006 Report of the Committee on Infectious Diseases, 27th Ed.
The initial treatment consists of Human Rabies Immune Globulin (HRIG) given according to weight, and the first dose of rabies vaccine (day 0). Subsequent doses of PEP are to be administered by the Primary Care Physician (PCP) or a physician that will monitor the client and complete the rabies treatment on days 3, 7, and 14.
HRIG is given to provide immediate protection to the patient against the virus that causes rabies while the patient’s immune system works to build long-lasting protection with the help of the rabies vaccine.
A vaccine depot such as Metro Health is not under authorization by the state of Texas to administer the rabies vaccine, but rather to have the anti-rabies biologicals accessible to health care providers. Patients may obtain rabies vaccine from Metro Health to be administered in the PCP’s office. *Please contact the rabies surveillance nurse prior to your visit to Metro Health. It will take approximately 24 hours for vaccine delivery. The release of anti-rabies biologicals and/or rabies immune globulin will require a written prescription from the treating physician, physician’s assistant, or nurse practitioner. Prescriptions from anyone other than those listed above will not be accepted.
The State has the right to refuse to provide anti-rabies biologicals if the incident in question does not warrant rabies post-exposure prophylaxis. The guidelines established by the Advisory Committee on Immunization Practices (ACIP) are used to assess and determine a true rabies exposure. In the event that the incident in question does not warrant rabies PEP, the department will provide the name of a source from which anti-rabies biologicals may be purchased to the medical professional.
For further instructions on the process of obtaining vaccine, patients or providers may call the Rabies Surveillance Nurse at 210-207-2095. This call may help to facilitate a better understanding for completion of the patient’s treatment.
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