What is the treatment for potential rabies infection through an abrasion on the skin exposed to emesis (vomit)?

Treatment for Potential Rabies Infection Through Abrasion on Skin Exposed to Emesis

Postexposure prophylaxis should be administered for contamination of open wounds or abrasions with potentially infectious material such as saliva (emesis) from a rabid animal, consisting of thorough wound cleansing, rabies immune globulin, and a full course of rabies vaccine. 1

Risk Assessment for Rabies Transmission via Emesis

Rabies transmission requires the introduction of the virus into open cuts, wounds in skin, or mucous membranes. The contamination of open wounds or abrasions with saliva or other potentially infectious material from a rabid animal constitutes a nonbite exposure that warrants postexposure prophylaxis 1.

Key considerations for this scenario:

• Emesis (vomit) contains saliva, which can carry rabies virus
• Pre-existing abrasion on skin provides a potential entry point for the virus
• Nonbite exposures from terrestrial animals rarely cause rabies, but documented cases exist 1

Treatment Protocol

1. Wound Management (Immediate Priority)

• Immediate and thorough cleansing of the abrasion with soap and water 1
• Follow with irrigation using a virucidal agent such as povidone-iodine solution 1
• This step alone can markedly reduce the likelihood of rabies infection 1

2. Postexposure Prophylaxis (Medical Urgency)

For previously unvaccinated individuals:

A. Rabies Immune Globulin (RIG)

• Administer 20 IU/kg body weight 1
• Infiltrate the full dose around and into the wound area if anatomically feasible 2, 3
• Any remaining volume should be injected intramuscularly at a site distant from vaccine administration 1
• Must be given with the first dose of vaccine, or can be administered up to day 7 of the vaccination series if not given initially 3

B. Rabies Vaccine

• Administer a 5-dose regimen of rabies vaccine 1, 2
• Schedule: Days 0,3,7,14, and 28 (day 0 being the first day of treatment) 1
• Administer intramuscularly in the deltoid area for adults or anterolateral thigh for children 1
• Never administer in the gluteal area 1

For previously vaccinated individuals:

• Only the vaccine is required (2 doses on days 0 and 3)
• RIG is not necessary 2, 3

Important Considerations

1. Timing: While postexposure prophylaxis is a medical urgency (not emergency), treatment should not be delayed. Even with delayed presentation, prophylaxis should be administered regardless of the time interval since exposure 1.

2. Animal Assessment: If the animal responsible for the emesis is available, it should be evaluated for rabies. If testing confirms the animal is not rabid, prophylaxis can be discontinued 1.

3. Consultation: Contact local or state public health officials for assistance in determining the likelihood of rabies exposure in specific situations 1, 2.

4. Potential Adverse Effects: While generally safe, monitor for potential adverse reactions to rabies vaccine, which may include local pain, erythema, headache, or rarely, more severe skin reactions 4, 5.

Pitfalls to Avoid

1. Underestimating nonbite exposures: Nonbite exposures involving open wounds contaminated with saliva require the same treatment as bite exposures 1.

2. Delaying treatment: While not an immediate emergency, treatment should not be unnecessarily delayed as incubation periods vary widely 1.

3. Incomplete RIG administration: Failure to properly infiltrate the wound area with RIG has been associated with rare prophylaxis failures 1.

4. Improper vaccine administration: Never administer rabies vaccine in the gluteal area as this may result in lower antibody response 1.

5. Neglecting wound cleansing: Thorough wound cleansing is a critical component of prophylaxis and should never be skipped 1.