On September 13, 2023, the National Bureau of Disease Control and Prevention issued the "Rabies Exposure Prevention and Disposal Work Standards (2023 Edition)", which clearly stipulates some principles and requirements for wound disposal and vaccination.
Let's take a look together today, what should I do if I was bitten by a dog? and some contents of "Rabies Exposure Prevention and Disposal Work Standards (2023 Edition)".
Rabies Exposure Prevention and Disposal Work Standards (2023 Edition)
In order to strengthen and standardize the prevention and treatment of rabies exposure, reduce the incidence of rabies, and protect the health of the people, this standard is formulated in accordance with the "Law of the People's Republic of my country on the Prevention and Control of Infectious Diseases", "Vaccine Management Law of the People's Republic of China" and other relevant provisions, combined with the progress of the development of rabies vaccines and passive immunization preparations in China.
Chapter 1 Principles for determining and disposing of exposure level
Article 1 Rabies exposure refers to biting, scratching, licking the mucosa or broken skin by rabies, suspected rabies, or host animals that cannot be determined to have rabies, or directly contacting saliva or tissue that may contain rabies virus.
Article 2: Rabies exposure is divided into three levels according to the contact method and exposure degree.
Contact or feeding animals, or intact skin is licked to level I exposure.
Naked skin is nibbled, or minor scratches or abrasions without obvious bleeding are grade II exposure.
Single or multiple penetrating skin bites or scratches, or broken skin is licked, or open wounds, mucosa are contaminated by saliva or tissue, or direct contact with bats is exposed to level III.
Article 3 After determining the exposure level, the medical staff of the rabies prevention and treatment clinic shall promptly inform the exposed person of the rabies hazards and the disposal measures they should take. After obtaining informed consent (see the attachment for the template of the informed consent form, each province can also formulate it on its own based on local actual conditions), medical personnel will take corresponding measures to deal with the wound.
Article 4: If a person is judged as a Level I exposure, the exposed area is cleaned without medical treatment.
Article 5: Those who are judged as Class II exposure should be treated with wounds and vaccinated with rabies. If the wound is confirmed to be Class II exposure and severely low immune function, or if the wound of the Class II exposure is located on the head and face and the health of the injured animal cannot be determined, the treatment will be performed as a Class III exposure.
Article 6: Those who are judged as Class III exposure should be treated with wounds and injected with passive rabies immunization preparations and vaccinated with rabies vaccine.
Chapter 2 Wound disposal
Article 7 Wound disposal includes thorough flushing and standardized debridement disposal. The earlier the wound is, the better. If the wound has scabbed or healed during treatment, it is not recommended to treat the wound. If the pain is severe during rinsing or debridement, local anesthesia can be given.
Wound rinse: Use soapy water (or other weakly alkaline detergent, professional rinse fluid) and certain pressure of running water to thoroughly rinse all bites and scratches for about 15 minutes, then wash the wound with normal saline, and finally use sterile degreasing cotton to suck off the residual liquid at the wound to avoid residual soapy water or detergent at the wound. When rinsing deeper wounds, you can use a syringe or special flushing equipment to inject and rinse the inside of the wound to achieve a comprehensive and thoroughness.
Disinfection treatment: After rinsing the wound, apply the wound with diluted iodine or other skin and mucosa disinfectants (such as quaternary ammonium salt disinfectants, etc.). If there is a lot of broken tissue in the wound, it should be cleaned first.
Article 8: The wound is treated differently based on factors such as the type of exposed animals, the size and location of wounds, and the time interval after exposure.
When the wound is mild, cover the wound with a breathable dressing.
When the wound is large or the facial injury affects the face or function, the wound should be closed as early as possible. Debridement and passive immune preparation infiltration injection should be completed before closing the wound. Wound drainage as needed.
Article 9: Use antibiotics reasonably according to wound contamination or infection situation to reduce other infections other than rabies virus.
The prevention and treatment of tetanus should comply with the relevant provisions of the non-neon tetanus diagnosis and treatment standards. If you need to inject rabies vaccine and tetanus vaccine at the same time, you should inject it on the left and right upper arm deltoid muscles respectively; if you inject it on the ipsilateral deltoid muscles, you should have a spacing of at least 2.5 cm.
Article 10 When dealing with wounds in special areas, it is recommended that the conditional rabies prevention and treatment outpatient clinic be completed with the assistance of relevant professional doctors.
Eye: When dealing with intraocular wounds, rinse with sterile saline, and generally no disinfectant is used.
Oral: When rinsing oral wounds, be careful to keep the patient's head low to avoid suffocation from rinsing fluid flowing into the throat, causing suffocation
External genitals or anal mucosa: The wound treatment and flushing method are the same as ordinary wounds. Pay attention to the direction of the flushing outward to avoid contaminating the deep mucosa.
Chapter 3 Vaccination and the use of passive immunization preparations Article 11 The earlier the rabies vaccination after the first exposure, the better. Recommended immunization procedures are limited to rabies vaccine products that have been approved for use of the corresponding procedures. If the state approves new immunization procedures for rabies vaccine products, they will be implemented as the latest requirements.
5-dose immunization procedure: 1 dose of rabies vaccine was injected on 0 (on the day of injection, the same below), 3, 7, 14 and 28 days, and a total of 5 doses were injected.
"2-1-1" immunization procedure: 2 doses of rabies vaccine were injected on 0 days (1 dose for each of the deltoid muscles of the left and right upper arm), 1 dose for each of the 7th and 21st days, and 4 doses were injected in total.
Article 12: The freeze-dried rabies vaccine dilution should be used strictly in accordance with the instructions.
Article 13 Rabies vaccination is not divided into weight and age, and one dose is given for each dose..
Article 29 The outpatient clinic of rabies should reasonably set up functional zones such as trauma treatment and vaccination, and have necessary wound flushing, cold chain and other equipment, as well as rabies vaccines and their passive immunization preparations, emergency rescue drugs, etc. In principle, at least two different types of rabies vaccines should be equipped. The rabies prevention and treatment clinics that need to be carried out for tetanus prevention and treatment should be equipped with tetanus vaccine and its passive immunization preparations.
Article 30 The outpatient clinic of rabies should establish and improve corresponding management systems, mainly including personnel management, vaccine and cold chain management, informed notification, vaccination information collection report, and suspected abnormal response monitoring report of vaccination. After the vaccination is completed, fill in the vaccination information in the Immunization Program Information System in a timely manner.