Animal Bite

Management
Presented by: Marymount Hospital; ER
Department

RABIES
Is a viral disease that causes inflammation in

the brain in humans and other warm blooded

animals.
Without Rabies: Rodents, Rabbits, Guinea

pigs.
With Rabies: Dogs, Cats, Cattle pigs, Horses,

Monkeys, Bats.

Signs and Symptoms

Incubation period: 2-12 weeks, can be as short as 4

days. The closer the site to the brain, the shorter the
incubation period.
Observe animal for 14 days from time of bite.
Initial:
- Febrile; 38 and above
Chills, fatigue, problems sleeping
Lack of appetite, headache, irritability
Anxiety, sore throat, vomiting
Pain and tingling sensation at the site

After 2-10 days of initial symptoms

and/or have reached the central nervous

system:
-aggressive behaviour
-agitation
-hallucinations
-delusions
-excessive production of saliva
-hydrophobia; aerophobia
-excessive sweating
-sustained erection (for men)
-coma
-and eventually death due to heart or lung

failure

What happens to the animal that was bitten

by a rabies-carrier ?
- loss of appetite
- change in behaviour
- constantly barking
- no fear of natural enemies
- attacks anything
- choking
- foaming of mouth
- dropping of lower jaw (for dogs)

Categories
Category I
Feeding of touching an animal
Licking of intact skin
Exposure to patient with signs and symptoms of
rabies
Sharing of eating and drinking utensils

Management for Cat. I

Wash expose skin immediately with soap and

water for 10mins

No vaccines or immunoglobulin needed

Category II
Nibbling of uncovered skin with or without

bruising/hematoma
Minor superficial abrasions/scratches which
are induced to bleeding
Note:
All category II exposures on the head and neck
area are considered Category III

Management for Cat II

Wash wound with soap and water
Start vaccine immediately:
A: Complete vaccination regimen until day
28/30 if;
Biting
Biting
Biting
Biting
days

animal
animal
animal
animal

is laboratory proven to be rabid OR

is killed without lab testing OR
has signs and symptoms of rabies OR
is NOT available for observation for 14

B: May omit day 28/30 if;

Biting animal is alive and remains healthy after
14 days observation period OR
Biting animal died within the 14 days
observation period confirmed by veterinarian to
have no signs and symptoms of rabies

Category III
Transdermal bites (punctured wounds, lacerations,

avulsions) or scratches/abrasions with spontaneous

bleeding
Licks on large open wounds
Exposure to a rabies patient thru bites, contamination
of mucous membrane (eyes, oral/nasal mucosa/genital
or anal mucus membranes) or open skin lesions with
body fluids thru splattering and mouth to mouth
rescusitation
Handling of infected cadaver or ingestion of raw
infected meat
All Category II exposure to HEAD and NECK area

Management for Cat III

A: Complete vaccination regimen until day

28/30 if;
Biting animal is lab proven to be rabid OR
Biting animal is killed/died without lab tests OR
Biting animal has signs and symptoms of rabies

OR
Biting animal is NOT available for observation
for 14 days

B: May omit day 28/30 if;

Biting animal is alive and remains healthy after
14 day observation period OR
Biting animal died within the 14 day
observation period, confirmed by Vet to have no
signs and symptoms of rabies

Local Wound Care

WASH WOUND IMMEDIATELY
Vigorously with soap and water for 10 mins
Alcohol and/or betadine
Mucus membranes such as eyes, nose or mouth
should be flushed with irrigating solution
Note: Avoid using traditional methods of wound
care such as rubbing of garlic, tandok, bato,
sucking blood out of bite area

Note: Suturing should be avoided.

WHY?

It may inoculate the virus deeper into the wound

- Use sterile strips instead

If unavoidable, delay for 2 hours after administration of RIG to

allow diffusion of antibodies to the tissues

ATS / Tetanus Toxoid should be given after immunization is reviewed

- Remember: Animal bites are considered tetanus prone

wounds !

Exposure Prophylaxis
PURIFIED VEROCELL RABIES VACCINE

(Rabievax, Speeda, Verorab, etc etc)

Route: Intradermal each deltoid / anterolateral

thigh in infants on Day 0, 3, 7, 28/30 (2-2-2-02)

3mm wheal
1cc syringe with G.26 should be used

Route: Intramuscular
Day 0, 3, 7, 14, 28 (1-1-1-1-1)
Deltoid muscle Left OR Right
Total of 5 visits
Vaccine should NEVER be injected in the

GLUTEAL area as absorption is unpredictable

Troubleshooting of missed doses in

Intradermal Route
Delay in day 3 dose:
If delay is 1-2 days from day 3, give day 3 dose
upon visit and follow original schedule of day 7,
28
If delay is 3-4 days from day 3, give day 3 dose
upon visit, ADJUST succeeding doses (day 7, 28)
according to the prescribed interval
If delay is more than 4 days from day 3,
RESTART on a new course

Delay in day 7 dose:

If delay is less than 7 days from day 7, give day
7 dose upon visit, give day 28 dose as originally
scheduled
If delay is greater than 7-14 days from day 7,
repeat day 3 dose and ADJUST to prescribed
interval
If delay is more than 14 days from day 7,
RESTART a new course!

Delay in day 28/30 dose:

Give day 28/30 dose upon visit; this may be
considered as booster dose
If RIG has been administered, OMIT day 28/30
dose

Troubleshooting of missed doses in

Intramuscular Route
Delay in day 3 dose:
If delay is 1-2 days from day 3, give day 3 dose
upon visit and follow the original schedule of
day 7,14,28/30
If delay is 3-4 days from day 3, give day 3 dose
upon visit , ADJUST succeeding doses (day 7,
14,28/30) according to the prescribed intervals
If delay is greater than 4 days from day 3,
RESTART a new course!

Delay in day 7 dose:

If delay is less than 7 days from day 7, give day
7 upon visit, give day 14, 28/30 dose as
originally scheduled
If delay is greater than 7-14 days from day 7,
repeat day 3 dose and ADUST according to
prescribed interval
If delay is greater than 14 days from day 7,
RESTART a new course!

Delay in day 14 dose:

Give day 14 dose upon visit and give day 28/30
after 2 weeks

Delay in day 28/30 dose:

Give day 28/30 upon visit
If RIG has been administered, it should not be
given

Disposal of Dead Bodies

Humans who died of rabies generally present a small risk of

transmission to others
Blood does not contain virus but virus may be present in
many tissues such as CNS , salivary glands and muscle
It is also present in saliva and urine of cadavers
Embalming should be DISCOURAGED
Performing necropsies carelessly can lead to mucus
membrane and inhalation exposures
Wearing protective clothing (goggles, face mask, thick
gloves) should provide sufficient protection
Instruments must be AUTOCLAVED or BOILED after use
Early disposal of body by cremation or burial is
RECOMMENDED

Frequently Asked Questions

I was biten by a stray dog in the middle of

my treatment regimen of Anti Rabies, should I

restart my schedule?
My dog is complete with immunization, but

my dog bit my neighbor, should my neighbor

get Anti Rabies?
How long is the effectivity of my completed

Anti Rabies vaccine?

On my day 0, the nurse administered the

brand Speeda, but I went out of town and on

my day 14, and local hospital only carries the
brand Verorab, is it advisable to switch
brands?
My dog remained healthy after 14 days of

observation, should I still get the last 2

doses?
Nurse nurse nurse!! Nakagat ako ng daga sa

bahay namin habang natutulog, may rabies

ba sila?

THANK YOU !