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Skidmore College
Comprehensive Emergency Management Plan (CEMP)
Rabies Treatment Algorithm
New York State Department of Health
Note: In New York State, excluding New York City, health care providers must consult with their local health authority before starting any rabies treatments, except in those cases where prior notification would compromise the health of the patient.
Notes
Comprehensive Emergency Management Plan (CEMP)
Rabies Treatment Algorithm
New York State Department of Health
Note: In New York State, excluding New York City, health care providers must consult with their local health authority before starting any rabies treatments, except in those cases where prior notification would compromise the health of the patient.
| Person bitten by a high rabies incidence wildlife species: raccoon, bat, skunk, or fox | Person bitten by a rabid-actinga dog, cat, ferret, or other domestic animalb |
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| Capture animal and submit it for emergency testing immediatelyd | |
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| If animal can be captured and tested within 24 hours, do not begin treatment | |
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| If animal is not captured, prompt testing is not possible, the specimen is untestable or is positive for rabies, begin treatment immediately | |
| Person otherwise exposedc to a raccoon, bat, skunk, or fox | Person otherwise exposedc to a rabid-acting dog, cat, ferret, or other domestic animalb | Person bitten or otherwise exposedc to other wild animals |
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| Capture animal and submit for routine testinge | ||
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| If animal can be captured and tested within three (3) days, do not begin treatment | ||
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| If animal is not captured, testing is not possible, the specimen is untestable or is positive for rabies, begin treatment | ||
| Person bitten by or otherwise exposed to a normal-acting dog, cat, ferret, or other domestic animalb |
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| Capture, confine, and observe animal for ten (10) daysg |
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| No rabies treatment should be provided unless animal develops rabies signs (then follow appropriate guidance for rabid-acting animals above) |
| Person bitten by or otherwise exposedc to small rodents or rabbitsh |  | No need to capture and test animal or provide treatment unless there are unusual circumstancesi |
Notes
- Rabid-acting: a combination of neurologic signs, best interpreted by a veterinarian, including a change in or unusual behavior, extreme aggressiveness, paralysis, convulsions, excess salivation, difficulty eating or drinking, unusual vocalizations
- Domestic animal: horses, cattle, sheep, goats, and swine
- Otherwise exposed: see NYSDOH's Guidance Regarding Human Rabies Exposure and Treatment Decisions (2/1/99) and Guidelines for Managing Bats and Risk of Rabies Transmission (2/1/99) for a more complete definition of exposure; includes scratches or other fresh wounds or mucous membranes contaminated with the animal's saliva; also includes a 'reasonable probability' of an undetected bite from a bat, as evidenced by direct skin contact with a bat, or a bat found in the room with a sleeping person, unattended child or person with mental impairment. [Guidelines available from local health authorities or here ].
- Emergency testing: requires phone consultation with NYSDOH Wadsworth Center Rabies Laboratory, 518-869-4527 during business hours, or off-hours 518-527-7369 or 518-527-7370; and requires driving specimen to the Rabies Laboratory at Griffin Laboratories, 5668 State Farm Rd. (Hwy 155 west of Rt. 20, Western Ave.), Guilderland, NY. For emergency non-workday tests, results will be available the same day, often as quickly as within several hours after the specimen is received at the lab.
- Routine testing: submission to NYSDOH Wadsworth Rabies Laboratory with appropriate lab submission form via overnight delivery service. See specimen submission guidelines at: www.wadsworth.org/rabies or call 518-869-4527. If specimen is at the laboratory in the morning, results will be available that afternoon. All efforts should be made for up to 3 days to capture and test animals when there has been a possibility of exposure, because most will be negative for rabies and will eliminate the need for rabies treatment. Consideration should be given to reliable identification of the exposing animal in making decisions about need for rabies treatment.
- Treatment: Except for those previously vaccinated, rabies treatments include (1) 1.0 ml doses of vaccine administered IM in the deltoid area on days 0, 3, 7, 14, and 28; and (2)rabies immune globulin (RIG). To avoid treatment failure, all the RIG must be infiltrated into and around the wounds [20 IU/kg body weight; calculation formula: #cc=(weight in lbs x 9.09)/150)]. If not feasible depending on the site, a mucous membrane exposure, or unidentified exposure site in "reasonable probability" bat exposures, administer RIG IM at a site distant from vaccine administration (e.g. deltoid of opposite arm from one receiving vaccine). Those with certain types of previous rabies immunization should receive treatment consisting only of vaccine on days 0 and 3. For details on appropriate treatment regimens see NYSDOH guidelines listed (in part c) above and the federal guidance document available from local health authorities or here.
- Capture, confine, and observe animal for 10 days: All efforts should be made for up to 3 days to get the animal under a 10-day confinement and observation for rabies signs. Rabies treatment should not be started during the period in which efforts are made to determine the rabies status of the animal. If the animal is observed to be symptom-free during this period, it did not have rabies virus in its saliva at the time of exposure, and no human rabies treatment is needed. Consideration should be given to requiring confinements in an official place (veterinary office, kennel, shelter) if the animal is not up-to-date on its rabies vaccinations. If the animal is periodically observed but not captured during the 10 days, and appears to be healthy, health care providers and local health authorities should review the circumstances and determine whether there is sufficient assurance the animal is not rabid and that rabies treatment is not necessary.
- Small rodents (mice, rats, hamsters, gerbils, squirrels, chipmunks, moles, voles) and wild rabbits have not been found rabid in NYS, so they should not be submitted for testing unless there are unusual circumstances and there is consultation with the Rabies Laboratory. Similarly, persons should not be provided rabies treatments for exposures unless there are unusual circumstances and there is consultation with the local health authority.
- Unusual circumstances: If there has been a bite from a small rodent or rabbit, the animal is available for testing, and there is considerable concern about the incident and/or the animal has been acting rabid, the animal may be submitted for routine rabies testing. Both in NY and elsewhere, pet rabbits caged outside have developed rabies (probably because the cage protected them from more serious wounds that would have led to their deaths). This information should be provided to the bite victims and considered when reaching a decision about testing the animal.
