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Rabies

Jamie Hope, MD and Anand Swaminathan, MD FAAEM
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11:33
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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03:51

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EMRAP 2018 12 December Written Summary 508 KB - PDF

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Scott W., M.D. -

Regarding repeat vaccination for 2nd bite....is there a period of time that they would not need repeat vaccine (bit a week after last dose vaccine or 2 months after last dose)? Also, is the incidence of rabies in cats around the same as dogs?

Anand S., M.D. -

Scott - Answer from Jaime

Jaime Hope
11:22 AM (5 hours ago)
to me

If a patient has been re-bitten (is that a word?) in less than 6 months, no need to repeat. The vaccine can be given as often as every 6 months, according to the CDC.

The incidence of rabies in cats in the US is greater than dogs. In 2015, there were 244 rabid cats reported and 67 dogs. Dog owners are more likely to get their pets vaccinated, likely accounting for some of the difference. Also, there are more cats as pets (86 million) compared to dogs (78 million) which will affect the numbers.

Fortunately, more than 90% of cases of animals with rabies occur in wildlife (skunks, bats, foxes, raccoons bats...the ones that don't get it are the rabbits, squirrels, gerbils. That seems to come up on boards exams!). There are great programs to vaccinate wildlife with vaccine-laden food, but bats have been historically hard to do this with; bats being responsible for 87% of human rabies cases makes this a concern. At TEDMED 2018, data was released about a new vaccine topical for bats that gets spread and absorbed via their grooming behavior and might radically reduce the incidence in bats. Gotta love science!

Warmly,
Jaime

Paul R. -

In the summary you mention that all dog bites require prophylaxis if immunization status cannot be confirmed. According to the CDC website statement on rabies (https://www.cdc.gov/rabies/exposure/animals/domestic.html), all dog bites don't unquestionably require rabies ppx immediately but "If you were bitten by a cat, dog, or ferret that appeared healthy at the time you were bitten, it can be confined by its owner for 10 days and observed. No anti-rabies prophylaxis is needed." Subsequently, if the animal becomes ill then you can pursue ppx.

Anand S., M.D. -

Paul - agree 100% with these recs. Jaime and I mentioned that in the case presented, owner unknown so can't track down dog and I find that this is the most typical circumstance in the patients I see.
However, if you know the owner but the immunization status is unknown of the dog, observation seems like a reasonable approach if the local heath department can get it done.

Jaime H., MD -

Paul, yes I agree. I was unable to find a single case report of a person who developed rabies from an animal that was captured and observed to be normal for 10 full days. This is very beneficial in any instance where the animal can be observed. This can potentially save the life of the animal as well as prevent unnecessary vaccination. Notably, the observation period is often only used in domestic animals. In wild animals, it can be difficult to determine what behavior is 'normal' because most don't appreciate being captured. Wild animal are usually sacrificed and tested for rabies. And in any case where the animal cannot be captured or observed in the setting of unknown vaccination status, that is where we broadly apply the recommendations for prophylaxis.

Paul R. -

Thanks guys.

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EM:RAP 2018 December Full episode audio for MD edition 222:26 min - 208 MB - M4AEM:RAP 2018 December German Edition Deutsche 94:28 min - 83 MB - MP3EM:RAP 2018 December Spanish Edition Español 74:31 min - 102 MB - MP3EM:RAP 2018 December French Edition Français 18:41 min - 26 MB - MP3EMRAP 2018 12 December Board Review Answers 133 KB - PDFEMRAP 2018 12 December Board Review Questions 125 KB - PDFEM:RAP 2018 12 December Individual Written Summaries 925 KB - ZIPEMRAP 2018 12 December Written Summary 508 KB - PDFEMRAP 2018 December Individual MP3 299 MB - ZIP

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