Rabies!

22 Jul

RAGING HYPOTHETICAL:

22 month old male presents to the ED with a CC of right forearm wound after being bitten by an unknown dog the previous day.

On physical exam the puncture wounds are non-draining and non-erythematous with no obvious bony deformity.

In addition to antibiotic and tetanus prophylaxis, should we vaccinate him against rabies?

 

EPIDEMIOLOGY

CDC epidemiological survey published in 2010

92.1% of all rabid animals were wild animals

                Raccoons, skunks, bats, foxes, and other mammals

7.9% of all rabid animals were domestic

                Cats > dogs

 rabiesmap

Map of rabid dogs and cats reported in 2010

 

All wild animals listed above are considered rabid unless they test negative in laboratory.

                Give RIG and vaccine and if negative discontinue

 

Domestic animals

Animal captured

-> normal behavior for 10 days -> no prophylaxis

->abnormal behavior when captured or after -> animal brain testing

Animal escaped

-> epidemiological absence of rabies in species -> no prophylaxis

-> epidemiological existence of rabies in species or data lacking -> prophylaxis

 

Submitted by Matthew Kongkatong. 

 

References: Blanton, J. D., Palmer, D., Dyer, J., & Rupprecht, C. E. Rabies surveillance in the United States during 2010. Journal of the American Veterinary Medical Association, 773-783.; Tintinalli, J. E. (2012). 152. Rabies. Tintinalli’s emergency medicine manual (7th ed., ). New York: McGraw-Hill Medical.; picture

 

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