Checklist: Treatment for Rabies

Rabies Exposure
Step 1: Patient needs to be seen by the ER or their primary care physician (PCP) to have the wound assessed and treated and antibiotics started if deemed necessary by the physician. If Rabies Post Exposure Prophylaxis (PEP) ends up being required pending the steps below, this would be a good time to go ahead and get the physician to write your prescription(s) that we will need here at the Health District before we can dispense the Immunoglobulin and Vaccines. See steps below for what is required on the prescription before we can dispense.

Step 2: The patient will need to file a bite report with Animal Control. This can be done at the ER/PCP’s office. In rural areas they should contact the Sheriff’s Department. Animal Control/Sheriff’s Department can patrol the area to capture the animal for quarantine/testing. If the patient knows who the animal belongs to, this is very helpful too. If the offending animal has a current Rabies vaccine, the patient will not require treatment with the Post Exposure. If the animal is able to be located, it will stay in quarantine for 10 days. If it passes quarantine, the patient will not require treatment with PEP. If it does not pass quarantine, it will be tested at the Texas State Laboratory in Austin, results usually take 24-48 hours. The patient will be treated with PEP if the results are positive or equivocal from the state lab.

If the offending animal is unable to be caught or already deceased, the patient will automatically be treated.

Also that if the patient was exposed to blood or body fluids (not to include skunk spray) and the patient could have had any cuts or scrapes on their hands or any other mucous membrane contact, they may require Rabies PEP.

Rabies is 99% fatal in humans!

The typical treatment will go as follows:
Day 0: Patient will receive HRIG based on their weight and 1 dose of vaccine
Day 3: Patient will receive next dose of vaccine
Day 7: Patient will receive next dose of vaccine
Day 14: Patient will receive last dose of vaccine (unless immunocompromised, see day 28)
Day 28: Immunocompromised patient will receive last dose of vaccine.

Step 3: All prescriptions will be required to have:
Patient’s Full Name
Patient’s DOB
Prescribing Physician/NP/PA Name, credentials, address, phone number, NPI or UPIN
Patient’s most current weight (this needs to be accurate as the HRIG is based on weight)
For patient with Private insurance who live in the close surrounding area (WF, IP, Burk) they will need to contact Walgreens on 9th street to see if their insurance will cover the cost of the 3 or 4 doses of Rabies vaccine. If their insurance will pay and not require the patient to pay a huge copay, they will need two prescriptions. One for us to dispense and one for Walgreens to order the vaccine doses and dispense. These prescriptions need to have the above items plus:
Rx for us:
The verbiage on the order needs to read something like: Dispense Rabies Post Exposure Prophylaxis to include HRIG and one dose of Rabies vaccine.
Rx for Walgreens:
The verbiage on the order needs to read: Dispense 3 (or 4, if immunocompromised) doses of the post exposure Rabies Vaccine.

For a patient with Private Insurance who lives in a rural area we will go ahead and dispense all the HRIG and Vaccine for them.

For patients with NO insurance- and / or those who likely will have large copay to Walgreens. For all of these scenarios we will dispense HRIG and all their vaccine doses from the Rabies Depot. Their Rx needs to read:
Dispense Rabies Post Exposure Prophylaxis to include HRIG and 4 (or 5, if immunocompromised) doses of Rabies vaccine.

For patients who have had the Rabies PRE-exposure vaccines and have had titers drawn that are at appropriate levels they are only required to get 2 doses of vaccines. When this happens, State Zoonosis should also be notified.

Step 4: Physician dispenses the vials of treatement.