Animal Bites

Non-pharmacological

• Thorough cleansing and debridement of the wound is essential
• Avoid suturing most bite wounds
• Large lacerations that are aping or bleeding may require loose approximation

Pharmacological

Adults and Children

• Give Tetanus Toxoid Vaccination (TTV) see Section 12.3
• Flush and cleanse (scrub) the wound with cetrimide 15% (savlon) + chlorhexidine solution 1.5% diluted 1 part in 20 parts with water

Alternatively:

• Wash with Hydrogen peroxide solution 3% OR Iodine 10% OR soap or detergent
• Rinse thoroughly with 1-2 liters of Normal Saline and dress with a weak Iodine

Solution 10% or Iodine Cream

• Give Anti-Rabies Vaccine, only if necessary accordingto the recommendations in Section 20.1.2
• Give Co-amoxiclav 625mg 8 hourly plus Metronidazole 400mg 8 hourly for 7 days
• For children use oral Co-amoxiclav (dose dependent on the age) 1-11 months 0.25 ml/kg of oral suspension (125/31) 1-5 years 5ml of oral suspension (125/31) 6-11 years 5 ml of oral suspension (250/62) 12-17 years 250/125 mg tablet
• If possible, capture and observe the animal for 10 days. If the animal is still alive after this time period, it does not have rabies

Rabies Prevention

• Thorough prompt local treatment of all bite wounds and scratches which may be contaminated with rabies virus is very important as elimination of the rabies virus at the site of infection by chemical and physical means is the most effective method of protection
• Only mammals can transmit rabies (example: dogs, cats, bats)
• The combination of local wound treatment, passive immunization with rabies immunoglobulin (RIG), and vaccination with anti-rabies vaccine is recommended for all severe exposures to rabies (see Table on Section 20.1.2)
• Since prolonged rabies incubation periods are possible, persons who present for evaluation and treatment even months after having been bitten should be treated in the same way as if the contact occurred recently
• Avoid contact with the patient's saliva which is potentially infective. If possible, wear eye protection as patients may spit and infection through the conjunctiva can occur
• Human bites should be managed as animal bites except for the use of anti-rabies vaccine

Post- exposure immunization

• Give Anti-rabies vaccines to all patients unvaccinated against rabies, together with local wound treatment, and in severe cases, rabies immunoglobulin (see recommendation in Section 20.1.2)

Administration of anti-rabies vaccine

• Use intra-dermal injection regimes for Anti Rabies Vaccine whenever possible
• Give a 0.1 ml dose of Anti Rabies Vaccine intradermally in either the forearm or upper arm, on days 0, 3 and 7 ,14, 21,28

Alternative intramuscular regime

• Give one 1 ml dose of Anti Rabies vaccine IM on days 0, 3, 7, 14 and 28

Suitable injection sites

• In adults: always inject the anti-rabies vaccine into the deltoid area of the arm
• In young children: the anterolateral area of the thigh may also be used
• Never use the gluteal area for vaccination as it is then much less effective

Recommendations for Anti-Rabies Vaccination

NA NATURE OF EXPOSURE CONDITION OF ANIMAL RECOMMENDED ACTION

At the time of exposure 10 days later

Saliva in contact with Skin, but no skin lesion

Healthy Healthy Do not vaccinate

Rabid Do not vaccinate

Suspect Healthy Do not vaccinate

Rabid Do not vaccinate 2. 2. 2. Saliva in contact with skin that has lesions, minor bites on trunk or proximal limbs

Healthy Healthy Do not vaccinate

Rabid Do not vaccinate

Healthy Vaccinate, but stop course if animal healthy

Rabid Vaccinate

Unknown Vaccinate 3. 3. 3 3. Saliva in contact with mucosae, serious bites (face, head, fingers or multiple bites

Domestic or wild rabid animal or suspect

Vaccinate and give anti rabies serum

Healthy domestic animal vaccinate, but stop course if animal healthy after 10days

Post-exposure immunization in previously vaccinated patients

• In persons known to have previously received full pre-or post-exposure treatment with rabies vaccine within the last 3 years
• Give one booster dose of 0.1 ml Anti Rabies Vaccine intradermally on days 0 and 3

Alternative intramuscular regime:

• Give one booster dose of 1 ml Anti Rabies Vaccine IM as above
• If completely vaccinated more than 3 years before or if incompletely vaccinated, give a complete post-exposure vaccination course