Rabies and Australian Bat Lyssavirus (ABLV): Contact management protocol for urgent care and GPs

Post exposure treatment

• Post exposure treatment consists of appropriate wound care and post-exposure prophylaxis (PEP).  
• Lyssavirus PEP is funded by NSW Health for individuals exposed to terrestrial mammals in rabi​es enzootic areas​ and for any potential exposure to bats in Australia and overseas.
  
• The local PHU will assess exposed individuals and determine if they need PEP (vaccines and/or HRIG).

Wound care

• Thoroughly wash all bite wounds and scratches with soap and water for at least 15 minutes as soon as possible.
• Apply a virucidal antiseptic (e.g. povidone-iodine or alcohol solution).
• Wounds should not be sutured unless unavoidable. If suturing is unavoidable, HRIG, if indicated, should be given prior to suturing.
• Assess tetanus immunisation status and administer tetanus vaccine if indicated.

 Rabies vaccine

• Rabies vaccine is administered as an intramuscular (IM) injection into the deltoid muscle.
• The recommended PEP rabies vaccine schedule in Australia is detailed in the Australian Immunisation Handbook – Rabies and other lyssaviruses​
  
  
• The vaccine schedule can vary if commenced overseas. If a patient has started a course overseas, contact the local PHU to check the appropriate schedule.
• The NSW State Vaccine Centre supplies two brands of commercial rabies vaccines:
• Rabipur (not recommended in individuals with a history of egg allergy)
• Verorab.

Human Rabies Immunoglobulin

• HRIG is indicated for PEP as assessed by the local PHU. HRIG dose will be calculated by the PHU where required.
• If HRIG is indicated, it should be administered at the same time as the first dose of rabies vaccine (ideally the day of the exposure).
• If the wound is visible:
• Infiltrate as much HRIG as can be given safely in and around the anatomical site of the wound.
• Remaining HRIG: IM injection into a site distant from the rabies vaccine site (e.g., opposite deltoid, gluteal, or lateral thigh).
• If there is no obvious wound to infiltrate or wound has healed, then:
• Administer full HRIG dose IM into any or all the above muscles on the opposite side to the vaccine site.
• HRIG should not be given more than 7 days after the first rabies PEP vaccine.

A video demonstrating how to administer HRIG is available at HRIG administration demonstration video​​ (with acknowledgements to the Metro North Public Health Unit, Queensland Government).​

Feedback to PHU

• Primary care providers should record administration of the rabies vaccine in the Australian Immunisation Register​​
  
  
• A record of HRIG administration must be conveyed to the referring PHU.
• Any adverse events following immunisation (AEFI) must be conveyed to the referring PHU.
• Patient refusal to accept PEP or PEP administration failure must be conveyed to the referring PHU.
• If PEP cannot be given on a scheduled day, please contact the local PHU for further advice.

More information

• For further information, please call your local Public Health Unit on 1300 066 055
• Rabies and other Lyssavirus infections (including Australian Bat Lyssavirus) control guidelines for public health units
• Rabies and Australian bat lyssavirus infection including patient fact sheet
• AIH rabies and other lyssaviruses chapter​