Wisconsin Rabies Prevention Flowchart

IMPORTANT: First-time users are encouraged to read this introduction in its entirety, but at a minimum, they must read the "limitations and caveats" section. By clicking on the hyperlink below to begin the algorithm, the user acknowledges that s/he has read the "limitations and caveats" portion of this introduction.

 

 To skip this introduction and begin the algorithm, click here.

 

Purpose of this electronic flowchart

The goal of all rabies prevention information, including this electronic algorithm, is to prevent human cases of rabies while avoiding the unnecessary administration of postexposure prophylaxis.

Fortunately, human rabies has become a rare event in the United States. Because of this rarity, however, rabies prevention is usually not a high priority for healthcare providers and law enforcement officers who commonly deal with animal bite victims. Therefore, it is up to public health practitioners to stay up to date with the latest information on rabies prevention so that they can advise clinicians, police, and the public about current guidelines.

We hope that this computerized flow chart enables local health department staff to become more efficient and self-directed when managing commonly encountered rabies exposure situations.

 

Limitations and Caveats

Although no set of general recommendations can address every possible rabies exposure scenario, this flowchart should be able to provide guidance for the management of the more common and straightforward situations that local public health department staff must address. This program was never intended to be all-inclusive of every contingency. In fact, some exposure circumstances were deliberately omitted from these recommendations, either because they are uncommonly encountered or because their complexities do not lend themselves to simple answers.

These guidelines are not meant to be a substitute for basic knowledge about rabies and its prevention, nor will they obviate the need for good judgement and common sense. It is the user's responsibility to recognize when the circumstances of an exposure are not exactly addressed by this algorithm, and in such cases, to consult with knowledgeable experts about such situations.

The user will need to scroll down when viewing some of the screens in this electronic algorithm in order to read them in their entirety. Some screens also contain footnotes. Please be sure to read the entire screen. Each screen ends with either a question to be answered by the user or with a line which reads "- - END - -".
This term "- - END - -" found at the bottom of certain screens denotes the endpoint of a particular line of questioning, concluding with a recommendation. By clicking the "back" button on your browser, the user can backtrack and follow a different branch of the decision tree to its conclusion.

 

Information Sources

This flowchart is based on information from multiple sources, both published and unpublished. The primary reference, and one which should be required reading for anyone involved with rabies issues, is the May 7, 2008 issue of Morbidity and Mortality Weekly Report - Recommendations and Reports.1 This document is available at http://www.cdc.gov/mmwr/pdf/rr/rr5703.pdf with an important revision at http://www.cdc.gov/mmwr/pdf/rr/rr5902.pdf.  In addition to recommendations about potential rabies exposures, it contains information on the biologics used for rabies pre- and post-exposure prophylaxis, vaccination regimens, adverse reactions, precautions and contraindications, and treatment outside of the USA.

Another valuable written resource is the Compendium of Animal Rabies Prevention and Control, also published in the MMWR2, available at www.nasphv.org/Documents/RabiesCompendium.pdf .

The Wisconsin statutes on rabies control can be found in s.95.21 at
http://folio.legis.state.wi.us/cgi-bin/om_isapi.dll?infobase=stats.nfo&jump=95.21

 

Consultation Services

  1. The Communicable Disease Epidemiology Section of the Wisconsin Division of Public Health offers consultation on situations involving potential human exposures to rabies. Local health department staff or health care providers can call 608/267-7321 during regular office hours, or the DPH emergency answering service at 608/258-0099 on nights and weekends in order to consult with an epidemiologist.
  2. Questions regarding the submission of specimens for rabies testing to the State Laboratory of Hygiene, or about the reporting of test results can be addressed to the SLH Rabies Unit at 608/262-7323 during regular office hours.
  3. To consult about potential animal exposures to rabies, callers can contact Dr. Yvonne Bellay at the Wisconsin Division of Animal Health at 608/224-4888. It should be noted that domestic animals which are exposed to rabies constitute a very real threat to their human owners. Accordingly, Wisconsin statute 95.21 also addresses animal exposures to rabies and defines circumstances under which such an animal is subject to quarantine.

 

This flowchart written by James J. Kazmierczak, DVM, MS
Wisconsin Division of Public Health, Communicable Disease Epidemiology Section 

 

 Click here to begin the algorithm.

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1 Centers for Disease Control and Prevention. Human rabies prevention — United States, 2008: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2008;57(No. RR-3)

2 Centers for Disease Control and Prevention. Compendium of Animal Rabies Prevention and Control, 2000: National Association of State Public Health Veterinarians , Inc. MMWR 2000;49(No.RR-8)