What is the standard treatment for rabies after a dog bite in Louisiana where the dog's vaccination status is unknown?

Standard Treatment for Rabies After Dog Bite in Louisiana

For a dog bite in Louisiana where the vaccination status is unknown, immediate wound cleansing followed by rabies post-exposure prophylaxis (including both rabies immune globulin and vaccine) should be initiated, unless the dog can be confined and observed for 10 days. 1, 2

Initial Management

Wound Care

• Thoroughly wash and flush all bite wounds immediately for about 15 minutes with soap and copious amounts of water 2
• Apply an iodine-containing or similarly viricidal topical preparation to the wound 2
• Avoid suturing puncture wounds when possible to prevent trapping bacteria 1
• Administer tetanus prophylaxis if the last dose was >5 years ago for dirty wounds 1

Dog Observation Protocol

• A healthy dog that bites a person should be confined and observed for 10 days 3
• Rabies vaccine should not be administered to the dog during the observation period 3
• The dog should be evaluated by a veterinarian at the first sign of illness during confinement 1
• Any illness in the dog should be reported immediately to the local health department 3

Rabies Post-Exposure Prophylaxis (PEP)

When to Initiate PEP

• If the dog is unavailable for observation or testing, begin PEP immediately 2
• If the dog is available for observation, PEP can be delayed unless the animal develops signs of rabies 2
• If signs suggestive of rabies develop in the dog, it should be euthanized, the head submitted for testing, and PEP initiated immediately 3

PEP Components for Previously Unvaccinated Persons

1. Rabies Immune Globulin (RIG):

   • Administer 20 IU/kg body weight on day 0 4
   • Infiltrate the full dose of RIG thoroughly around and into the wounds if anatomically feasible 4
   • Inject any remaining volume intramuscularly at a site distant from vaccine administration 4

2. Rabies Vaccine:

   • Complete course consists of 5 injections of 1 mL each 4
   • Administer on days 0,3,7,14, and 28 4
   • Inject intramuscularly in the deltoid area (never in the gluteal area) 4

PEP for Previously Vaccinated Persons

• Administer 2 IM doses (1 mL each) of rabies vaccine: one immediately and one 3 days later 4
• RIG is not necessary for previously vaccinated individuals 4

Special Considerations

Stray or Unwanted Dogs

• If the biting dog is stray or unwanted, it may be euthanized immediately and the head submitted for rabies examination 3
• The head should be shipped under refrigeration (not frozen) to a qualified laboratory designated by the local or state health department 3

Documentation Requirements

• Document wound characteristics, treatment provided, and rabies vaccination status of the dog 1
• Record contact information for the dog owner and animal control 1
• Document that the patient has been informed about the observation protocol and when to seek further care 1

Public Health Implications

• Rabies is virtually 100% fatal once clinical symptoms develop 5, 6
• With proper and timely post-exposure prophylaxis, rabies is nearly 100% preventable 7
• Approximately 59,000 people die from rabies worldwide each year, with dogs being the primary vector 8

Remember that rabies post-exposure treatment should be initiated as soon as possible following exposure, and consultation with local public health officials is recommended if questions arise about the need for rabies prophylaxis 2.