RABIES

1.1 Guidelines for Medical Management of Rabies in South Africa.

2.1

3.1 List of drugs in accordance with the Essential Drugs List.
3.2 Rabies vaccine and anti-rabies immunoglobulin are only available at certain centres – each clinic is aware of its nearest source.

4.1 Staff provide correct presumptive diagnosis and referral for post exposure treatment if possible and use the telephone hotline to obtain information if needed or to request vaccine.
4.2 Treatment according to exposure and rabies risk of area starts the same day and does not wait for laboratory results.
4.3 Treatment is free from district medical officers, hospitals and clinics.
4.4 The clinic takes details about the animal (e.g. dog, jackal, and yellow mongoose), whether there is an outbreak of rabies, if the animal was immunised, if there was abnormal behaviour and what degree of exposure the patient had (bites, licking, etc).
4.5 Management of the animal involved is by the local veterinary officer who is phoned to provide definitive diagnosis by transmission of the animal’s head to the correct laboratory after first deciding if tying up and observation is not indicated.
4.6 Immediate management if category 3 includes cleaning the wound with cetrimide or betadine, administering anti-tetanus vaccine, no suturing but antibiotic and referral if possible or telephoning for vaccine to be sent if patient cannot be referred.
4.7 Vaccine is given on day 0, 3, 7, 14 and 28. The vaccine is kept in the refrigerator. If more convenient for the patient vaccine is sent to the clinic to administer - it is given intramuscularly into the deltoid in adults and into the thigh in children.
4.8 Significant human exposure is notifiable.
4.9 Cases of rabies and deaths are also notifiable.
4.10 Staff dealing with such a patient and exposed to bites, scratches or saliva are immunised.

5.1 All patients are referred to the next level of care when their needs fall beyond the scope of competence. A suspected case of rabies is managed in hospital.
5.2 Staff suspect and refer urgently by ambulance if there is a history of dog or animal bite with or without post-exposure management.

6.1 All patients are educated on all matters relating to rabies.

7.1 Patients’ records kept up to date.

8.1 Immediate action in the community is carried out with the veterinary services, the nurse of the clinic and the environmental health officer, and aims at checking for other people in contact with the animal, arousing awareness of the condition, need for immunisation of dogs and urgency of seeking health service care if bitten by a dog.

9.1 Staff collaborate with the local veterinary services.