Human Rabies Prevention

(Advisory Committee on Immunization Practices [ACIP] 1999 Guidelines)

For persons in the frequent risk category (includes veterinarians and staff in areas enzootic for rabies), the ACIP guidelines recommend only serological testing every 2 years and administration of a booster vaccine if the antibody level is below that considered protective
For persons in the infrequent risk category (includes veterinarians in areas of low rabies enzooticity; veterinary students), the ACIP guidelines recommend the primary series and no serological testing or booster vaccination
Post exposure rabies prophylaxis procedures (contact with potential or confirmed rabies case)

Definition of exposure

Rabies is transmitted only when the virus is introduced into bite wounds or open cuts in the skin or onto mucous membranes
Other contact by itself, such as petting a rabid animal and contact with blood, urine, or feces of a rabid animal, does nor constitute an exposure and is NOT an indication for prophylaxis

NC State Students

Student Health Service: vaccine series, titer, or rabies immune globulin (if non-vaccinated). Payment will be required
Contract students Ross University, St George’s University)
Rx Urgent Care, Blue Ridge Road, or Rex Hospital: vaccine series, titer, or rabies immune globulin (if non-vaccinated)
Payment will be required at the time of service

Employees

NC State University Worker’s Compensation
Outside remit Student Health Service
Rx Urgent Care, Blue Ridge Road, or Rex Hospital: rabies vaccine series, titer, or rabies immune globulin (need to provide a completed WC form signed by the supervisor) and any follow up

NC Division of Public health
http://www.epi.state.nc.us/epi/rabies/vaccine.html
Source: Human Rabies Prevention – United States, 1999: Recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR 1999: Vol. 48, No. RR-1. Centers for Disease Control and Prevention.
http://www.epi.stste.nc.us/epi/rabies/pdf/ACIP99.pdf

Person has NOT had prior rabies vaccination with a diploid cell vaccine -Human Diploid Cell Vaccine (HDCV), Rabies Vaccine Adsorbed (RVA), Purified Chick Embryo Cell (PCEC).
Give Rabies Vaccine, either RVA, HDVC, or PCEC (RabAvert) 1.0 ml IM deltoid on days 0, 3, 7, 14, 28 (all days relative to day 0)
Give Rabies Immune Globulin (RIG), 20 IU per kg of body weight, as much of the material as possible should be infiltrated into and around the site of the wound; the remainder should be given IM in the gluteals. It is only given once; on day 0. If it is not given immediately, it may be given up until 7 days after the initial rabies vaccination (day 0). After that time, immune response to vaccination is presumed to have started and subsequent administration of RIG is contraindicated.

Person HAS had prior rabies vaccination with a diploid cell vaccine (HDCV, RVA, PCEC)
Give Rabies Vaccine either RVA, HDCV, or PCEC 1.0 ml IM deltoid on days 0, 3*
Rabies Immune Globulin

State Division of Public Health – diagnostic procedure performed at the laboratory
State Department of Agriculture – confirmation of rabies positive case