GUIDE TO TETANUS PROPHYLAXIS IN ROUTINE WOUNDMANAGEMENT

Vaccination History

Type of Injury Unknown or <3 doses 3 or more Doses

Td* TIG/ATS Td* TIG/ATS

All Animal Bites YES YES NO** NO

*Tdap may be substitutes for Td if the person has received Tdap and is 10 years or older;
DPT may be given for patients <7 years old; TT may be given if Td is not available

- 1 dose each on days 0, 1 month and 6 months

** Yes, if more than 5 years since last dose

Immune individual – has received at least 3 doses of DPT or TT

CATEGORIES OF RABIES EXPOSURE WITH CORRESPONDINGMANAGEMENT

Category I Management

a) Feeding/touching an animal 1. Wash exposed skin

immediately w/ soap and
b) Licks on intact skin (w/ reliable history and thorough water
physical examination)
2. No vaccine or Rabies
c) Exposure to patient with signs and symptoms of rabiesby immunoglobulin (RIG)
sharing of eating or drinking utensils needed

d) Casual contact (talking to, visiting and feeding 3. Pre-exposure vaccination

suspected rabies cases) and routine delivery of healthcare may be considered for high
to patient with signs and symptoms of rabies risk persons
 Category II Management

a) Nibbling of uncovered skin with or without bruising or 1. Wash wound with soap and water.
hematoma
2. Start vaccine immediately:
b) Minor scratches or abrasions without bleeding

c) Licks on broken skin.

d) All Category II exposures on the head and neck areas are

considered Cat. III and should be managed as such
 Category III Management

a) Single or multiple transdermalbites or scratches with 1. Wash wound with soap and water.
spontaneous bleeding.
2. Start vaccine and RIG immediately.
b) Contamination of mucous membrane with saliva from
licks.

c) Exposure to bat bites or scratches

d) Exposure to a rabies patient through bites,

contamination of mucous membranes (eyes, oral/nasal
mucosa, genital/anal mucous membrane) or open skin
lesions with body fluids through splattering and mouth-
to-mouth resuscitation

e) Handling of carcass or ingestion of raw infected meat

f) All Category II exposures on headand neck area

MANAGEMENT OF PATIENTS WITH CATEGORY II AND III EXPOSURE WHETHER BITING ANIMAL
CANNOT BE OBSERVED OR DIES WITHIN THE 14 DAYS OBSERVATION PERIOD

FAT SSx of Rabies in Biting

Give 3 doses (D0, D3,D7) Give 4th dose(D28/30)
Result Animal

+ + Yes Yes

+ - Yes Yes

- + Yes Yes

- - Yes No

Not done + Yes Yes

Not done - Yes Yes