Columbus County Health Department Policy and Procedure
Rabies Prevention and Management
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Policy Title:
Rabies Prevention and Management
Program Area:
Director of Nursing, Adult Health
Policy Identifier:
(optional)
Approval Date:
Effective Date:
5/3/2009
Revision
Date(s):
Approved by:
Kim Smith RN, BSN, MSHCA, Director
Approved by:
Hilda Memory RN, Director of Nursing
5/3/2009
8/3/2009, 8/16/2010, 5/1/2013, 4/5/2014
Purpose:
The purpose of this policy is to establish guidelines for the management of human rabies
and prevention.
Definitions:
Columbus County Health Department (CCHD) will instruct victims of animal exposure of the need for postexposure prophylaxis (PEP) evaluation. Since human rabies is almost always fatal, a follow-up phone call is
made to the victim by the Director of Nursing. She provides information about animal and human rabies,
and encourages the victim to come to Columbus County Health Department for evaluation and PEP if
warranted. The nurse uses North Carolina Manual for Rabies Prevention and Animal Bite Management as
her primary resource.
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Columbus County Health Department Policy and Procedure
Rabies Prevention and Management
Responsibilities:
Director of Nursing, Medical Director
Procedures:
Animal bites/exposures are reported to the Columbus County Health Director by the State of North
Carolina or Columbus County Animal Control or MD. Office. The Director of Nursing (DON) will
then follow up utilizing the N. C. Public Health Manual for Rabies Prevention and Animal Bite
Management*. The report may be received by telephone or in written form (Rabies Prevention
Referral Form). Another source of prevention and management for Rabies is the Pre Exposure
Rabies Immunization in Humans.
Pre Exposure Immunization:
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Pre Exposure rabies vaccination is recommended for people at high risk for exposure to
rabies such as veterinarians, animal handlers, and certain laboratory workers.
Pre exposure vaccination also should be considered for other persons whose activities bring
them into frequent contact with rabies virus or potentially rabid bats, raccoons, skunks, cats,
dogs, or other species at risk for having rabies.
Pre exposure vaccination consists of three 1.0-mL injections of RabAvert or Imovax administered
intramuscularly (deltoid area) -- one injection per day on days 0, 7, and 21 or 28.
People that receive pre exposure immunizations still will require post-exposure immunizations. Pre
exposure Immunization allows for a rapid anamanestic response when the two doses of post –exposure
rabies vaccine boosters are given and eliminates the need for the administration of Human Rabies
Immune Globulin (HRIG). Imovax or RabAvert vaccine 1ml will be given on day 0, and day 3.
Pre Exposure persons who have received the rabies pre exposure immunization need to have a serum
sample collected ever two years to measure serum neutralizing antibodies. If the lab identifies the titer
is below a defined level then a single dose booster of vaccine should be administered.
(See the NC Public Health Manual for Rabies Prevention and Animal Bite Management Protocol)
Upon receipt of the report of an animal bite/ post exposure Prophylaxis (PEP), the Health
Director :
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Notes the date received in the space provided on the form.
Provides the Director of Nursing with the information.
The Nursing Director:
 Contacts the client in order to provide information, answer questions, and determine
if client has sought medical evaluation. The DON assesses Td (Tdap or DTaP)
immunization status and offers the vaccination at the HD if indicated. The Director
of Nursing (DON) also informs the client about human rabies prevention medical
treatment as described in North Carolina Manual for Rabies Prevention and Animal
Bite Management*
 Completes Rabies Risk Assessment (located in Rabies manual click on link)
 Documents education and recommendation provided.
 Documents action taken or to be taken by the client.
 Delivers the Rabies Prevention Referral Form (and additional notes if required) to a
Communicable Disease nurse for logging and filing.
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Columbus County Health Department Policy and Procedure
Rabies Prevention and Management
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*Routine follow-up is demonstrated by no less than two phone call attempts to the victim. The DON
also has the option to send a letter to the victim to initiate contact when either a high-risk exposure
has occurred or the victim has no known phone number.
Post exposure treatment includes: Immune Globulin 20 IU/kg body weight on day 0 and the
Imovax or RabAvert vaccine on day 0, 3, 7, and 14 and day 28 for immunosuppressed patients.
Availability of Rabies Vaccine From State Laboratory of Public Health (SLPH)
If needed rabies vaccine (RabAvert) by Novartis) and Rabies Immune Globulin (HyperRAB S/S by
Talecris) can be ordered from the SLPH by calling Veterinary Public Health at 919-707-5900. The
cost of the vaccine is approximately $150.00/dose and the cost of the RIG is approximately
$600.00/10 ml vial (1500 IU). In the event that a patient is not able to afford vaccine the SLPH will
supply vaccine and RIG free of cost IF the following criteria are met.
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The individual’s family income is at or below the federal poverty level in effect on July 1 st of
each fiscal year as determined by the local health department;
The individual meets the residency and other requirements set forth in 15A NCAC 24A
.0200, except that the individual shall not be eligible for Medicaid or health insurance
reimbursement for rabies post-exposure treatment as determined by the local health
department; and
The treatment is recommended by a physician licensed to practice medicine.
This ONLY applies to vaccine and RIG from the SLPH. You may not request a reimbursement for
vaccine and RIG that have been ordered elsewhere. In order to receive free vaccine an affidavit
(see attached) must be completed, notarized, and submitted to the SLPH. The cost for the vaccine
and RIG will then be waived. Sale of rabies vaccine from the SLPH is available only to human
health care providers and local health departments.
(See the NC Public Health Manual for Rabies Prevention and Animal Bite Management Protocol)
* The Manual can be located on line. (Click on link) NC Rabies Manual
CDC Tools:
http://www.cdc.gov/vaccines/hcp/vis/vis-statements/rabies.html
http://www.immunize.org/vis/sp_rab06.pdf
Laws and Rules:
N.C Statutes and Laws 130-184 through 130A-201
Reference(s):
North Carolina Rabies Public Health Program Manual
http://www.cdc.gov/rabies/resources/acip_recommendations.html
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