|Title:||Australian Bat Lyssavirus Guidelines 2004|
|Document ID:||Operational Circular OP 1824/04|
|Date of issue:||Thursday, 12 August 2004|
|Status:||NO LONGER APPLICABLE|
|Description:||The purpose of this Operational Circular is to describe the Department of Health recommended procedures for the public health management of cases of potential human exposure to Australian Bat Lyssavirus.|
|Period of effect:||from 12 August 2004|
|Authorised by:||Dr Shirley Bowen, Director, Communicable Disease Control Directorate, 02-Aug-2004|
|Print version:||View print version|
Australian Bat Lyssavirus Guidelines 2004
This Operational Circular is designed to advise Department of Health staff on Department of Health policies and procedures.
The purpose of this document is to describe the Department of Health's (DoH) recommended procedures for the public health management of cases of potential human exposure to Australian Bat Lyssavirus (ABL). It should be used in conjunction with the documents CDNA Australian Bat Lyssavirus Guidelines1 and The Australian Immunisation Handbook2.
ABL is a new species of lyssavirus identified in 1996 that is closely related to classical rabies virus and is widely distributed in the flying fox population and some insectivorous bat species in Australia.
There have been two ABL fatalities reported in Australia- one in a bat-handler in 1996 and another in a 27 year old Queensland woman in 1998 who had been bitten by a flying fox two years previously.
Any bat that bites or scratches a person in Australia should be presumed to be infected with ABL until proven otherwise.
Rabies post exposure treatment (PET), which is considered to be protective against ABL infection, is recommended for any parenteral (e.g. bite, scratch) or mucous membrane (e.g. kiss, lick) exposure to bat saliva or neural tissue. Bat blood, bat urine, or bat faeces are not considered infectious.
The primary objectives of the public health management of cases of potential human exposure to ABL are to:
Persons exposed to the saliva or neural tissue of any bat (e.g. from biting or scratching or kissing or licking) may be exposed to ABL and should immediately be offered thorough wound cleansing and post-exposure treatment (PET) with rabies immunoglobulin and/or rabies vaccine.
Rabies immunoglobulin and vaccine supply
Human rabies immunoglobulin (HRIG) and/or human rabies vaccines (HRV) for PET for ABL potential exposures are available from the Central Immunisation Clinic (metropolitan area) or Regional Population Health Unit (regional areas). Table 1 lists the current contact telephone and fax numbers for the Central Immunisation Clinic and Regional Public Health Units.
Table 1: Telephone and fax numbers for reporting possible ABL exposures
Public health management
The Central Immunisation Clinic (CIC) or the regional Population Health Unit (PHU) should interview the attending doctor and:
ABL wound management
Wounds (e.g. bites, scratches) should immediately be cleansed thoroughly (e.g. for 5 minutes) with soap and water before being rinsed with a viral antiseptic (e.g. povidone-iodine, iodine tincture, aqueous iodine, ethanol). Exposed mucous membranes (e.g. mouth, eyes, nostrils) should be flushed well with water. If appropriate, tetanus and/or antibiotic prophylaxis should also be given.
ABL Pre-Exposure Vaccination
Pre-exposure vaccination should be recommended to those people whose occupation or recreational activities place them at increased risk of being bitten or scratched by a bat. For example:
Pre-exposure vaccination consists of three deep subcutaneous or intramuscular doses of 1.0mL rabies vaccine given on days 0, 7 and 28. Doses should be given in the deltoid area, as rabies neutralising antibody titres may be reduced after administration in other sites. In children under 12 months of age, administration into the anterolateral aspect of the thigh is also acceptable. Vaccine should not be administered by the intradermal route.
ABL Post Exposure Treatment
Post exposure treatment for ABL should only be delayed if the bat can be tested for ABL within 48 hours of exposure. Currently, the time taken to transport and test bats from Western Australia to the Australian Animal Health Laboratories (AAHL) in Victoria is at least 48 hours. Consequently, until further notice, post exposure treatment should commence as soon as possible for all potential lyssavirus exposures in Western Australia.
Bat ABL Testing
Wherever possible, the implicated bat/s should, without putting any person at risk of further lyssavirus exposure, be captured and sent to the State Animal Health Laboratory, which will then send specimens to the Australian Animal Health Laboratories in Victoria for ABL testing.
Dr Shirley Bowen
BIBLIOGRAPHY / REFERENCES:
This circular last updated: Thursday, 12 August 2004 at 12:00am