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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
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
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
http://folio.legis.state.wi.us/cgi-bin/om_isapi.dll?infobase=stats.nfo&jump=95.21
Consultation Services
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 —
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)
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