20/10/2020
Top 10 General Considerations
in Rabies PEP
1. Wounds must be immediately washed/flushed for 15 minutes
and disinfected
2. Rabies PEP should be instituted immediately. PEP consists
of a course of potent, effective rabies vaccine that meets
WHO recommendations and administration of rabies
immunoglobulin
3. PEP must be applied using vaccine regimens and
administration routes that have been proven to be safe and
effective
4. PEP does not have contraindications if purified rabies
immunoglobulin and vaccine are used. Pregnancy and
infancy are not contraindications to PEP
5. If rabies immunoglobulin is not available on first visit, use
can be delayed by up to 7 days from the date of the first
vaccine dose
6. Initiation of PEP should not await the results of laboratory
diagnosis or be delayed by dog observation when rabies is
suspected
7. When suspect rabid animal contacts (excluding bats) occur
in areas free of carnivore-mediated rabies and where there is
adequate surveillance in place, PEP may not be required.
The decision must be based on expert risk assessment
8. Patients presenting for rabies PEP even months after having been
bitten should be treated as if the contact had recently occurred
9. PEP should be administered even if the suspect animal is not
available for testing or observation. However, vaccine and
immunoglobulin administration may be discontinued if the animal
involved: is a vaccinated dog (cat or ferret) that following observation
for 10 days, remains healthy or is humanely killed and declared
negative for rabies by a WHO prescribed laboratory test
10. In areas enzootic for (canine and wildlife) rabies, PEP should be
instituted immediately unless adequate laboratory surveillance and
data indicates that the species involved is not a vector of rabies
www.who.int/rabies/PEP_Prophylaxis_guideline_15...
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