2.2.4 Why do human rabies surveillance and post-exposure prophylaxis go hand in hand?

Rabies is invariably fatal in the absence of timely medical intervention and application of modern biologics. Consequently, human rabies surveillance must be time-sensitive so that action can be taken in real time, well before the onset of clinical signs, to prevent a fatal productive infection.

Animal species (domestic or wild) and geographic location of the exposure event are two pieces of critical surveillance information to better evaluate risks. Potential rabies exposure from bats often present the greatest complexity: they are a diverse faunal group, not all species present the same level of risk, and visible evidence of bites has not been present in all bat-related human rabies deaths. Human surveillance contact details for countries or areas endemic for rabies are a primary concern, and incidents related to suspected or confirmed rabid (domestic or wild) animals are categorized by WHO (see Chapter 8, here) as:

Category I): touching or feeding animals, licks on intact skin, contact of intact skin with secretions or excretions of a rabid animal or human. These are not regarded as exposures, and no post-exposure prophylaxis is required.

Category II): nibbling of uncovered skin, minor scratches or abrasions without bleeding. Vaccine should be administered as soon as possible.

Category III): single or multiple transdermal bites or scratches, licks on broken skin, contamination of mucous membranes with saliva from licks, and exposure to bats.

Post-exposure prophylaxis, including rabies immunoglobulin, should always be administered when category III exposure is recognized, even months after contact.
For categories II and III, thorough local wound care is important.

In terms of post-exposure prophylaxis, animal rabies surveillance varies between domestic animals and wildlife. Domestic dogs should be vaccinated against rabies to greatly reduce the risk of disease, so their individual vaccination status is a critical piece of information. If the vaccination status of the specific domestic animal cannot be identified in an exposure event, then the animal will need to be put into quarantine for 10 days and observed for clinical signs (if the animal was shedding virus at the time point of exposure it will exhibit symptoms of rabies and die within this time period) or be euthanized and tested. In wildlife surveillance, suspect animals involved in either a human or domestic animal exposure should be euthanized and tested, if possible.

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[en]Version 1 Last updated December 2014[fr]Première version, dernière mise à jour Juin 2015