
Overview
This module describes how to give post-exposure prophylaxis for tetanus and rabies. Both tetanus and rabies are notifiable diseases. Contact the Department of Environmental Health of your local municipality to report suspected cases.
Tetanus prophylaxis is given as primary immunisation for children, booster vaccines every 10 years, and post-exposure as a vaccine (passive) and an immunoglobulin (active). Rabies vaccines are only given to people at high risk of exposure such as veterinarians and animal handlers, or post-exposure with or without immunoglobulin.
Indications
Tetanus
Tetanus exposure
Tetanus-prone wounds tend to be:
All other wounds are considered non-tetanus-prone.
Tetanus prophylaxis schedule
Patient who was fully vaccinated as a child:
Tetanus-prone wound: administer an intramuscular tetanus vaccine in the deltoid if their last tetanus vaccine or booster was given more than
5 years ago
Many patients will not know when their last tetanus vaccine was. Try to prompt them by asking them if they had received sutures. If unsure, administer the vaccine.
. If giving the vaccine, also administer tetanus immunoglobulin into the opposite deltoid, only if immunodeficient/IV drug user. Other wound: give a tetanus vaccine if their last tetanus vaccine or booster was given more than 10 years ago.
Patient who was not fully vaccinated as a child:
Tetanus-prone wound: give a tetanus vaccine, and a dose of tetanus immunoglobulin. Other wound: give a tetanus vaccine, but no tetanus immunoglobulin. Refer these patients to their local clinic to complete their immunisation.
Rabies
Rabies exposure
Rabies is spread by
animal saliva
Rabies can be spread by any mammal, including domestic animals such as cows and sheep.
, and is rare in South Africa, but 100% fatal.
- Risk category I: Touching or feeding an animal suspected of rabies
- Risk category II: Animal nibbling skin or causing minor scratches without bleeding
- Risk category III: Animal bites, scratches drawing blood, contamination of mucus membranes, or licking broken skin
Rabies prophylaxis
schedule
If access to rabies vaccine and immunoglobulin is not immediately available, refer urgently.
- Risk category I: None required.
- Risk category II: Give one dose of the rabies vaccine into the deltoid on days 0, 3, 7, 14, and 28.
- Risk category III: Give one dose of the rabies vaccine into the deltoid on days 0, 3, 7, 14, and 28.
Give 20 IU/kg rabies immunoglobulin into and around the wound, with first dose as soon as possible. Inject the rest intramuscularly into the deltoid,
never the buttock
Increased risk of vaccination failure due to depositing vaccine in subcutaneous space.
, unless the wound is in the buttock.
Procedure
Refer to Intramuscular Injection for technique, troubleshooting, and risks.
Additionally, in suspected rabies cases: