COMMUNICABLE DISEASE MANUAL POLICIES / PROCEDURES
RABIES
OBJECTIVE:
Control and management of Rabies.
DESCRIPTION:
The rabies (rhabdovirus family) virus infection produces an acute febrile illness
with rapidly progressive CNS manifestations. The virus is present in saliva and is
transmitted by bites or by licking of mucosa or open wounds. Most commonly
carried by raccoons, skunks, bats, foxes’ and may be carried by dogs and cats
as well. The incubation period in humans’ ranges from 5 days to more than 1
year, but 2 months is the average. Once symptoms have developed, no drug or
vaccine improves prognosis.
EQUIPMENT:
Referral Rabies Educational Pamphlet, Current “Michigan Rabies Manual”
including Guidelines for Animal Bites and Rabies Testing and Treatment, MDCH
flow charts: “Rabies Protocol for Mammals which have bitten People or Pets”
and “Human Rabies Post-Exposure Prophylaxis (PEP) Protocol”. Rabies Clinical
Specimen for Rabies Testing Shipping Unit (available from MDCH lab support
unit) Virology Test Requisition Form (FB200).
POLICY:
Legal Responsibility: Refer to Section II A.
referral.
Follow-up time is 24 hours post
PROCEDURE:
A.
B.
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Case Investigation:
1.
Referral received from P.M.D., Veterinarian clinic, client, family,
Emergency Room or Animal Control.
2.
Document all case investigation proceedings.
3.
Contact Animal Control to be sure they have completed an Animal Bite
Report form. NOTE: Bite or scratched victims should always contact a
physician and physician’s name entered on this form.
Control Measures:
1.
Prompt and thorough cleansing of wound with soap and water should be
done.
2.
Determine tetanus history. Tetanus prophylaxis and measures to control
bacterial infections should be considered.
3.
Ask who aggressor was (animal or human). *An unprovoked attack is
more suggestive of a rabid animal than a bite during attempts to feed or
handle an animal. A bite is unprovoked when an animal attacks for no
reason.
4.
Determine, if possible, if rabies vaccinations are up to date for animal.
5.
Refer to Van Buren or Cass County animal control authorities for any
domesticated animal bite. The animal should be confined for 10 days. If
it becomes ill or dies during confinement, it needs to be tested.
Wild animals needing to be tested must be euthanized. There is no 10
day observation for wild animals. They should be taken by the client to
a Veterinarian to be decapitated and sent for testing. Instruct client to
handle animal only with gloves and caution to avoid further exposure.
County Animal Control staff are sometimes able to help in difficult
situations.
6.
Discuss with client, as appropriate, that the following animals will not be
tested except by special arrangements with MDCH.
Chipmunk
Gerbil
Mouse
Shrew
Gopher
Guinea Pig
Rabbit
Squirrel
Hamster
Mole
Rat
7.
Educate client regarding signs of Rabies. If animal shows signs of
Rabies, animal should be euthanized and tested.
8.
For examination for Rabies, the Veterinarian decapitates the animal.
Unless it is a bat, then the whole carcass is sent. *VB and/or Cass
County Health Department does not pay for vet bills but may mail head to
State Health Department. Health Department and may pick up specimen
from veterinarian. Refer to book Control of Communicable Diseases in
Man and MDCH Guidelines for Animal Bites and Rabies for preservation,
storage, and shipment of specimen. MDCH Lab must be notified in
advance of heads being sent in for a weekend/holiday testing. Phone:
517-335-8165. At the beginning of each day, MDCH lab tests all rabies
specimens that have been received. The test takes most of the day and
results are called to whoever submitted the specimen at the end of the
day.
Specimen containers are available from MDCH Lab and usually kept on hand
at local veterinarian offices, Animal Control and the Health Dept. Specimens
must be packaged according to the instructions inside the container. Most
specimens are packaged at the County Animal Control office and brought to the
Health Department to be refrigerated until placed in the Quest pick up box.
Procedure for specimen pick up:
Hartford office— The one gallon size containers will fit in the large
Quest pick up box. Keep the box refrigerated until the end of the
day, then place in the Quest box before leaving for the day at 5:00
pm. (If it is a routine pick-up day). Check Quest pick-up schedule
(located in the Lab in Hartford clinic, in far left hand cabinet inside
the cabinet door) for days Quest routinely picks up—be sure clinic
staff have not cancelled the daily pick up for some reason. There is
no reason to contact Quest if it is a routine pick up on a scheduled
day. If it is not a scheduled pick up day, the specimen may be held
over in the refrigerator until next routine pickup day. If testing must
not wait, or the animal head is large and must be packaged in the 3
gallon container, (which will not fit in the Quest box) then contact
Quest for a “special pickup”. Phone Quest 2866-697-8378 --Id.
Code is “MDCH—Hartf” --- and ask specifically for “pick up inside
the building before 5:00 pm”.
Cassopolis office—There is no large Quest box here—Quest must be
contacted for all pickups to be made at that site as a special or transport
the specimen to Hartford office for pick up.
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DOCUMENTING SPECIAL QUEST PICK-UP.
If a special pickup is requested of Quest on a day not routinely set for
pickup or a request is made to pick up inside before 5:00 pm for a large
specimen box, this must be recorded to track the additional billing from
Quest. This recording is done in a dark blue manual titled “Quality
Control Lab- 090- Hartford” which is located on the shelf with the other
manuals in the Hartford office clinic area. Inside the front cover of this
book is a blue folder labeled “Quest Pickup Varification”. This will hold a
white sheet of paper which lists the list of pickups for the month. Note the
date and reason for pickup with your initials. The same procedure can be
done in Cass office, if needed.
9.
10.
C.
D.
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The client’s physician determines whether RIG and rabies vaccines are to
be given. If a doctor has questions regarding treatment, refer him to the
Red Book, Medical Director, or MDCH Rabies Section. The Health
Department does not assume the cost of RIG or Rabies Vaccine nor
do they administer the vaccine.
a.
RIG: The dosage of RIG is determined by weight. The doctor has
to contact the local hospital or Emergency Room to obtain RIG.
Clients are most often referred there for treatment. Van
Buren/Cass County Health Department does not administer RIG
to the client.
b.
Rabies Vaccine: The doctor has to contact a local hospital
Emergency Room or the vaccine manufacturer to obtain Rabies
Vaccine. Van Buren/Cass County Health Department does not
administer Rabies Vaccine to the client. If a variation in policy is
requested, the PHN is to contact the Medical Director for a final
decision.
c.
Uninsured or Underinsured persons may be able to obtain
assistance from the vaccine manufacturer through their indigent
vaccine replacement program. Go to www.cdc.gov/rabies and
search for “programs for uninsured and underinsured patients for
rabies vaccine” for applications.
.
MDCH lab results will be reported to the agency which submitted the
specimen for testing. All positive results will be reported to the local
Health Department to assure the bitten person understands the positive
test results and the need for immediate treatment and to facilitate as
needed. Record results on client’s record.
Complete Case Report and Documentation.
1.
Record activities of case investigation and follow-up in “comments”
section of case report.
2.
Copy completed case report from MDSS and place in specific disease
file.
3.
Notify Nursing Director that case report has been completed.
Refer to Current Red Book: Report of the Committee on Infectious Diseases, and
Benenson Abram, Control of Communicable Diseases Manual
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