Interventions for Rabies

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Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation on rabies and prevention measures including preventing dog bites Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites and immediate care measures after a bite Community Health workers training on rabies ,prevention measures and its management	Eliminating rabies in dogs- through Vaccinating dogs (multi-sectoral approach with veterinary departments ) Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Recognition of animal bite exposures categorized as carrying a risk of developing rabies which include:if the biting mammal is a known rabies reservoir or vector species; the exposure occurs in a geographical area where rabies is still present,the animal looks sick or displays abnormal behavior,a wound was contaminated by the animal’s saliva,the bite was unprovoked, the animal has not been vaccinated,The vaccination status of the suspect animal is questionable First aid for the pregnant woman following a deep bite or scratch from an animal suspected to have rabies, through extensive wound washing—i.e thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, and /or anti septic’s such povidone iodine Relive any pain with pain killers such as paracetamol Immediate Referral to a health facility for PEP and further management Report/alert the veterinary services to remove the biting animal from the community /quarantined
Primary Care
Awareness creation on rabies and prevention measures including preventing dog bites Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers training on rabies, prevention measures and its management	Referral to hospitals for Pre-exposure immunization for women in high-risk occupations such as; laboratory workers handling live rabies and rabies-related (lyssavirus) viruses,elderly whose profession brings them direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis through Extensive washing, flushing and local treatment of the bite wound or scratch Relieve of any other symptoms such as pain with analgesics Immediate referral to a hospital after the initial management for further management including post exposure immunization Alert the veterinary services to remove the biting animal from the community/quarantine the animal
Referral Facility: General
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers training on rabies,prevention measures and its management	Immunization for mothers with rabies vaccine after exposure (PEP) Pre-exposure immunization for mothers in high-risk occupations such as, laboratory workers handling live rabies and rabies-related (lyssavirus) viruses and those whose profession brings them direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments		Physical and clinical examination Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of the pregnant women assessed as carrying a risk of developing rabies; Extensive washing ; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Foetal monitoring Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined		Counselling services to mothers on safety of using rabies vaccines and immunoglobulin in pregnancy.
Referral Facility: Specialist
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers training on rabies,prevention measures and its management	Immunization for mothers with rabies vaccine after exposure (PEP) Pre-exposure immunization for mothers in high-risk occupations such as, laboratory workers handling live rabies and rabies-related (lyssavirus) viruses and those whose profession brings them direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments		Physical and clinical examination Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of the pregnant women assessed as carrying a risk of developing rabies; Extensive washing ; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Foetal monitoring Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined		Counselling services to mothers on safety of using rabies vaccines and immunoglobulin in pregnancy.

Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation on rabies and prevention measures including preventing dog bites Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites and immediate care measures after a bite Community Health workers training on rabies , prevention measures and its management	Eliminating rabies in dogs- through Vaccinating dogs (multi-sectoral approach with veterinary departments) Advice and Referral to hospitals for Immunization consideration for children living in, high rabies exposure risk areas ( As they play with animals, they may receive more severe bites,may not report bites.) Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Recognition of animal bite exposures categorized as carrying a risk of developing rabies which include:if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated. The vaccination status of the suspect animal is questionable First aid to a child following a deep bite or scratch from an animal suspected to have rabies, through extensive wound washing—i.e thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent/anti septic’s such povidone iodine Relive any pain with pain killers such as paracetamol Immediate Referral to a health facility Report/alert the veterinary services to remove the biting animal from the community/quarantined
Primary Care
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, immediate care measures after a bite. Health workers education on rabies,prevention measures and its management			Advice and Referral to hospital for Immunization consideration for children living in, high rabies exposure risk areas ( As they play with animals, they may receive more severe bites, may not report bites.) Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments
Referral Facility: General
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers training on rabies ,prevention measures and its management	Immunization for children with rabies vaccine after exposure (PEP) or before exposure Immunization consideration for children living in, high rabies exposure risk areas ( As they play with animals, they may receive more severe bites, or may not report bites.) Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include:if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorized exposures assessed as carrying a risk of developing rabies; Extensive washing; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined.
Referral Facility: Specialist
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers training on rabies ,prevention measures and its management	Immunization for children with rabies vaccine after exposure (PEP) or before exposure Immunization consideration for children living in, high rabies exposure risk areas ( As they play with animals, they may receive more severe bites, or may not report bites.) Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include:if the biting mammal is a known rabies reservoir or vector species,the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorized exposures assessed as carrying a risk of developing rabies; Extensive washing ; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine under supervision of a physician the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Admission services/inpatient services Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/ alert the veterinary services to remove the biting animal from the community/quarantined.

Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation on rabies and prevention measures including preventing dog bites Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, immediate care measures after a bite. Community Health workers training on rabies ,prevention measures and its management	Eliminating rabies in dogs-through Vaccinating dogs (multi-sectoral approach with veterinary departments) Advice and Referral to hospital for Immunization consideration for children living in, high rabies exposure risk areas ( As they play with animals, they may receive more severe bites, or may not report bites) Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Recognition of animal bite exposures categorized as carrying a risk of developing rabies which include:if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated. The vaccination status of the suspect animal is questionable First aid to a child following a deep bite or scratch from an animal suspected to have rabies, through extensive wound washing—i.e thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent,anti septic’s such povidone iodine Relive any pain with pain killers such as paracetamol Immediate Referral to a health facility for PEP vaccination and further management Report/alert the veterinary services to remove the biting animal from the community/quarantined
Primary Care
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers training on rabies,prevention measures and its management	Advice and Referral to hospital for Immunization consideration for children living in, high rabies exposure risk areas ( As they play with animals, they may receive more severe bites, or may not report bites.) Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis through Extensive washing; flushing and local treatment of the bite wound or scratch Relieve of any other symptoms such as pain with analgesics Immediate Referral to a hospital for further management including Immunization of people with rabies vaccine after exposure (PEP) Integrated bite case management through alerting the veterinary services to remove the biting animal from the community /quarantined
Referral Facility: General
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers education on rabies ,prevention measures and its management	Immunization of children with rabies vaccine after exposure (PEP) or before exposure Immunization consideration for children living in, high rabies exposure risk areas ( As they play with animals, they may receive more severe bites, or may not report bites) Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include:if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present,the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorise exposures assessed as carrying a risk of developing rabies; Extensive washing; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure, Administration of rabies vaccine, the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined
Referral Facility: Specialist
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers education on rabies ,prevention measures and its management	Immunization of children with rabies vaccine after exposure (PEP) or before exposure Immunization consideration for children living in, high rabies exposure risk areas ( As they play with animals, they may receive more severe bites, or may not report bites) Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include; if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated,The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorised exposures assessed as carrying a risk of developing rabies Extensive washing ; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined

Age Cohort: 12 - 24 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, immediate care measures after a bite. Community Health workers education on rabies ,prevention measures and its management	Eliminating rabies in dogs- through Vaccinating dogs. (multi-sectoral approach with veterinary departments) Advice and Referral to hospital for Pre-exposure immunization for adolescents in high-risk occupations such as, laboratory workers handling live rabies and rabies-related (lyssavirus) viruses; and adolescents whose profession brings them direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Recognition of animal bite exposures categorized as carrying a risk of developing rabies which include:if the biting mammal is a known rabies reservoir or vector species; the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behaviour, a wound was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated. The vaccination status of the suspect animal is questionable First aid to an adolescent following a deep bite or scratch from an animal suspected to have rabies, through extensive wound washing—i.e thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent/anti septic’s such povidone iodine Relive any pain with pain killers such as paracetamol Immediate Referral to a health facility Report/alert the veterinary services to remove the biting animal from the community/quarantined
Primary Care
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers training on rabies , prevention measures and its management	Advice and Referral to hospital for Pre-exposure immunization for adolescents in high-risk activities such as direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly. Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis through Extensive washing, flushing and local treatment of the bite wound or scratch Relieve of any other symptoms such as pain with analgesics Immediate Referral to a hospital for further management including Immunization of adolescents with rabies vaccine after exposure (PEP) Integrated bite case management through alerting the veterinary services to remove the biting animal from the community/quarantined
Referral Facility: General
Awareness creation on rabies and prevention measures including preventing dog bites Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers training on rabies,prevention measures and its management	Immunization of adolescents with rabies vaccine after exposure (PEP) or before exposure Pre-exposure immunization is for adolescents in high-risk activities such as direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: * * if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorized exposure assessed as carrying a risk of developing rabies Extensive washing; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure ,Administration of rabies vaccine, the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantine the animal
Referral Facility: Specialist
Awareness creation on rabies and prevention measures including preventing dog bites Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers training on rabies,prevention measures and its management	Immunization of adolescents with rabies vaccine after exposure (PEP) or before exposure Pre-exposure immunization is for adolescents in high-risk activities such as direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorised exposures assessed as carrying a risk of developing rabies; Extensive washing ; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantine the animal

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites and immediate care measures after a bite. Community Health workers education on rabies ,prevention measures and its management	Eliminating rabies in dogs- through Vaccinating dogs Advice and Referral to hospital for Pre-exposure immunization for adults in high-risk occupations such as, laboratory workers handling live rabies and rabies-related (lyssavirus) viruses and those whose profession brings them direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Recognition of animal bite exposures categorized as carrying a risk of developing rabies which include:if the biting mammal is a known rabies reservoir or vector species; the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable First aid to an adult following a deep bite or scratch from an animal suspected to have rabies, through extensive wound washing—i.e Thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent/anti septic’s such povidone iodin Relive any pain with pain killers such as paracetamol Immediate Referral to a health facility Report/alert the veterinary services to remove the biting animal from the community/quarantined
Primary Care
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers education on rabies ,prevention measures and its management	Advice and Referral to hospital for Pre-exposure immunization for adults in high-risk occupations such as, laboratory workers handling live rabies and rabies-related (lyssavirus) viruses, and elderly whose profession brings them direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments.		Physical and clinical examination Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species; the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior; a wound or mucous membrane was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis through Extensive washing, flushing and local treatment of the bite wound or scratch Relieve of any other symptoms such as pain with analgesics Immediate Referral to a hospital for further management including Immunization of adults with rabies vaccine after exposure (PEP) Integrated bite case management through alerting the veterinary services to remove the biting animal from the community/quarantined
Referral Facility: General
Awareness creation on rabies and prevention measures including preventing dog bites Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers training on rabies ,prevention measures and its management	Immunization of adults with rabies vaccine after exposure (PEP) or before exposure Pre-exposure immunization is for adults in high-risk occupations such as; laboratory workers handling live rabies and rabies-related (lyssavirus) viruses and elderly whose profession brings them direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims,with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorized exposures assessed as carrying a risk of developing rabies; Extensive washing; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine, the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined
Referral Facility: Specialist
Awareness creation on rabies and prevention measures including preventing dog bites Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers training on rabies ,prevention measures and its management	Immunization of adults with rabies vaccine after exposure (PEP) or before exposure Pre-exposure immunization is for adults in high-risk occupations such as; laboratory workers handling live rabies and rabies-related (lyssavirus) viruses and elderly whose profession brings them direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims,with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all cotegorized exposures assessed as carrying a risk of developing rabies; Extensive washing ; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Community Health workers training on rabies ,prevention measures and its management	Eliminating rabies in dogs- through Vaccinating dogs Advice and Referrals to hospitals for Pre-exposure immunization for elderly in high-risk occupations such as; laboratory workers handling live rabies and rabies-related (lyssavirus) viruses, and elderly whose profession brings them direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Recognition of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species; the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable First aid to the elderly following a deep bite or scratch from an animal suspected to have rabies, through extensive wound washing—i.e; Thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent/anti septic’s such povidone iodine Relive any pain with pain killers such as paracetamol Immediate Referral to a health facility Report/alert the veterinary services to remove the biting animal from the community/to quarantine the animal
Primary Care
Awareness creation on rabies and prevention measures including preventing dog bites. Education on dog behavior and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership, how to prevent dog bites, and immediate care measures after a bite. Health workers training on rabies , prevention measures and its management	Advice and Referral to hospital for Pre-exposure immunization for elderly in high-risk occupations such as laboratory workers handling live rabies and rabies-related (lyssavirus) viruses and elderly whose profession brings them direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments		Physical and clinical examination Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species; the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva, the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis through Extensive washing,flushing and local treatment of the bite wound or scratch Relieve of any other symptoms such as pain with analgesics Immediate Referral to a hospital for further management including immunization of elderly with rabies vaccine after exposure (PEP) Integrated bite case management through alerting the veterinary services to remove the biting animal from the community /quarantined
Referral Facility: General
Awareness creation on rabies and prevention measures including preventing dog bites Education on dog behaviour and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership,how to prevent dog bites and immediate care measures after a bite. Health workers training on rabies ,prevention measures and its management	Immunization of elderly with rabies vaccine after exposure (PEP) or before exposure Pre-exposure immunization is for elderly in high-risk occupations such as, laboratory workers handling live rabies and rabies-related (lysavirus) viruses, and elderly whose profession brings them direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include:if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorized exposures assessed as carrying a risk of developing rabies Extensive washing; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine, the administration of rabies immunoglobulin (RIG), if indicated, Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined
Referral Facility: Specialist
Awareness creation on rabies and prevention measures including preventing dog bites Education on dog behaviour and bite prevention Increasing awareness of rabies prevention and control in communities including education and information on responsible pet ownership,how to prevent dog bites and immediate care measures after a bite. Health workers training on rabies ,prevention measures and its management	Immunization of elderly with rabies vaccine after exposure (PEP) or before exposure Pre-exposure immunization is for elderly in high-risk occupations such as, laboratory workers handling live rabies and rabies-related (lysavirus) viruses, and elderly whose profession brings them direct contact with animals e.g. wildlife rangers Joint contact tracing by veterinary and public health services to identify additional suspected rabid animals and human bite victims, with the goal to apply preventive measures accordingly Record keeping and reporting to the public health departments and veterinary departments		Physical and clinical examination, Recognition and categorization of animal bite exposures categorized as carrying a risk of developing rabies which include: if the biting mammal is a known rabies reservoir or vector species, the exposure occurs in a geographical area where rabies is still present, the animal looks sick or displays abnormal behavior, a wound or mucous membrane was contaminated by the animal’s saliva; the bite was unprovoked, the animal has not been vaccinated, The vaccination status of the suspect animal is questionable Immediate post exposure prophylaxis of all categorized exposures assessed as carrying a risk of developing rabies; Extensive washing ; flushing and local treatment of the bite wound or scratch as soon as possible after a suspected exposure; Administration of rabies vaccine the administration of rabies immunoglobulin (RIG), if indicated. Relieve of any other symptoms such as pain with analgesics Monitor and manage any complications depending on the two forms of rabies – such as cardiopulmonary arrest as a result of furious rabies or muscle paralysis and coma due to paralytic rabies ICU services for patients with complications e.g. those in coma Integrated bite case management/alert the veterinary services to remove the biting animal from the community/quarantined