Rabies Prevention Flowchart - introduction
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IMPORTANT: First-time users are
encouraged to read this introduction in its entirety, but at a
minimum, they must read the "limitations and
By clicking on the hyperlink below to
begin the algorithm, the user acknowledges that she/he has read
the "limitations and caveats" portion of this
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Purpose of this electronic flowchart
The goal of all rabies prevention information, including this
electronic algorithm, is to prevent human cases of rabies while avoiding
the unnecessary administration of post exposure prophylaxis.
Fortunately, human rabies has become a rare event in the United
States. Because of this rarity, however, rabies prevention is usually
not a high priority for healthcare providers and law enforcement
officers who commonly deal with animal bite victims. Therefore, it is up
to public health practitioners to stay up to date with the latest
information on rabies prevention so that they can advise clinicians,
police, and the public about current guidelines.
We hope that this computerized flow chart enables local health
department staff to become more efficient and self-directed when
managing commonly encountered rabies exposure situations.
Limitations and caveats
Although no set of general recommendations can address every possible
rabies exposure scenario, this flowchart should be able to provide
guidance for the management of the more common and straightforward
situations that local public health department staff must address. This
program was never intended to be all-inclusive of every contingency. In
fact, some exposure circumstances were deliberately omitted from these
recommendations, either because they are uncommonly encountered or
because their complexities do not lend themselves to simple answers.
These guidelines are not meant to be a substitute for basic knowledge
about rabies and its prevention, nor will they obviate the need for good
judgment and common sense. It is the user's responsibility to recognize
when the circumstances of an exposure are not exactly addressed by this
algorithm, and in such cases, to consult with knowledgeable experts
about such situations.
The user will need to scroll down when viewing some of the screens in
this electronic algorithm in order to read them in their entirety. Some
screens also contain footnotes. Please be sure to read the entire
screen. Each screen ends with either a question to be answered by the
user or with a line which reads "- END -".
This term "- END -" found at the bottom of certain
screens denotes the endpoint of a particular line of questioning,
concluding with a recommendation. By clicking the "back"
button on your browser, the user can backtrack and follow a different
branch of the decision tree to its conclusion.
Primary information source
This flowchart is based on information from multiple sources, both
published and unpublished. The primary reference, and one which should
be required reading for anyone involved with rabies issues:
CDC Morbidity and
Mortality Weekly Report (MMWR) 05/07/2008 Human Rabies Prevention
U.S. 2008 with an important revision at: CDC MMWR
Additional information sources
11/04/2011 Compendium of Animal Rabies Prevention and Control
statutes (s.95.21) on rabies control
The Communicable Disease Epidemiology Section of the Wisconsin
Division of Public Health offers consultation on situations involving
potential human exposures to rabies. Local health department staff or
health care providers can call 608-267-9003 during regular office hours,
or the DPH emergency answering service at 608-258-0099 on nights and
weekends in order to consult with an epidemiologist.
Questions regarding the submission of specimens for rabies testing to
the State Laboratory of Hygiene, or about the reporting of test results
can be addressed to the SLH Rabies Unit at 608-262-7323 during regular
office hours. The
SLH Rabies Requisition Form must accompany submitted
To consult about potential animal exposures to rabies,
callers can contact Dr. Yvonne Bellay at the Wisconsin Division of
Animal Health at 608-224-4888. It should be noted that domestic animals
which are exposed to rabies constitute a very real threat to their human
owners. Accordingly, Wisconsin statute 95.21 also addresses animal
exposures to rabies and defines circumstances under which such an animal
is subject to quarantine.
This flowchart written by James J Kazmierczak, DVM, MS
Wisconsin Division of Public Health
Bureau of Communicable Diseases and Emergency Response
November 01, 2013