Rabies Information for Health Care Providers

Rabies is a deadly virus spread to people from the saliva or neural tissue of infected animals. All mammals can get rabies. Animals in Iowa are infected with rabies every year; some animals are more likely to be infected than others. For example, wild animals (especially skunks and bats) most often get rabies. All domestic animals (such as dogs, cats, horses, and cattle) can be infected. Rodents (such as squirrels, hamsters, and mice) and rabbits very rarely get rabies. Once a person begins showing signs and symptoms of rabies, the disease is nearly always fatal. For that reason, immune globulin and rabies vaccine is recommended under certain circumstances to stop the rabies virus from infecting the body.

Rabid animals are found every year in Iowa

For more information, visit:

• 2018 Iowa Rabies Summary

What constitutes an exposure?

• There was a bite from an animal to a human.
• There was saliva/neural tissue contact from an animal to a human’s open cut or mucous membrane.
• A bat is found in the same room with a sleeping person, an unattended child, an intoxicated person, or anyone unable to confirm that they were NOT bitten.

Other contact, such as contact with blood, urine, skunk spray, or feces, does not constitute an exposure and is not an indication for prophylaxis.

• Bat Exposure: Rabies Exposure Management for Bat-Related Incidents
• Other Animal Exposure: Recommendations for Managing Human Rabies Exposure

Quarantine

State and local laws require that dogs, cats and ferrets that have bitten or exposed a human to their saliva be quarantined for 10 days regardless of their rabies vaccination status. If at any time during the quarantine period, a dog, cat, or ferret shows signs of rabies, the animal should be immediately euthanized and tested. Please see the following list to determine who enforces in your jurisdiction.

• Statewide Points of Contact for Animal Rabies Quarantine Enforcement

Testing Information

There are two laboratories in Iowa that provide animal rabies testing services:

• State Hygienic Laboratory at the University of Iowa (800-421-4692 )
  • There is no charge for rabies testing at SHL if there has been a human exposure
  • SHL test request form
  • SHL specimen collection and shipping instructions
• Iowa State University Veterinary Diagnostic Laboratory (515)-294-1950
  • There is a charge for rabies testing at ISU VDL; please note if human exposure has occurred to ensure prompt testing
• Animal Rabies Testing Resources in Iowa

Protocol for Post-Exposure Prophylaxis

If a person that has not been vaccinated is exposed to a rabid animal, what is required for post exposure prophylaxis?

• Human Rabies Immune-Globulin (HRIG) on day 0, plus a series of Human Rabies Vaccines (HRV) on days 0, 3, 7, and 14 (immune compromised patients should receive a 5th dose on day 28 and subsequent titer check).

If a person previously vaccinated with Human Rabies Vaccine is exposed to a rabid animal, what is required for post exposure prophylaxis?

• Persons with previous rabies vaccination [completed series of the three vaccine pre exposure prophylaxis or the series of four/five vaccines and Human Rabies Immune Globulin post exposure prophylaxis (using Human Diploid Cell Vaccine, Rabies Vaccine Adsorbed, or Purified Chick Embryo Vaccines)], should receive two doses of rabies vaccine on days 0 and 3. The person does not need Human Rabies Immune Globulin.

Other recommended measures include:

• Immediately and thoroughly wash all bite wounds and scratches with soap and water.
• Tetanus prophylaxis should be considered.
• Risk of bacterial infections should be assessed and addressed.
• Animal Rabies Post-Exposure Prophylaxis Resources in Iowa

Consultation

IDPH provides consultation to help health care providers, veterinarians, and the general public to determine whether a potential exposure occurred. Rabies exposure consultation can be obtained from the Center for Acute Disease Epidemiology:

During business hours call: (800) 362-2736

After hours call: (515) 323-4360 (the Iowa State Patrol will contact the person on call)

Additional Resources

• MMWR - Human Rabies Prevention (Advisory Committee on Immunization Practices)
• MMWR - Use of a Reduced (4-Dose) Vaccine Schedule for Post-Exposure Prophylaxis to Prevent Human Rabies (Advisory Committee on Immunization Practices)
• Rabies Information from the Iowa Department of Public Health Epi Manual
• 2016 Compendium of Animal Rabies Prevention and Control