lHE JOURNAL OF lNF'ECTlOUS DISEASES. VOL. 1,\9,
;,\0,
4 • APRIL 1979
From the Center , for Disease Control
The use of aqueous quaternary ammonium compounds (AQAC) for local treatment of wounds potentially contaminated with rabies virus has been a subject of numerous queries to the Center for Disease Control (CDC; Atlanta, Ga.). Because of the problems associated with bacterial contamination of AQAC in many clinical settings [1], in December 1976 the Advisory Committee on Immunization Practices (ACIP) dropped its recommendation that AQAC be used for local treatment of wounds potentially contaminated with rabies virus [2, 3]. The original recommendation for use of AQAC was based on studies showing that mortality decreased by 43%-90% in mice and guinea pigs when rabies virus-infected deep wounds were treated with 1%-4% benzalkonium chloride (BZC) [4-6] (table 1) and that pathogenicity for mice decreased when rabies virus was incubated Please address requests for reprints to Dr. Larry J. Anderson, Respiratory and Special Pathogens Branch, Viral Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta, Georgia 30333.
Table 1. Treatment with 20% soap and benzalkonium chloride (BZC) for wounds exposed four independent studies in animals. Interval between exposure and treatment
Group
Type of wound
Solution used
Shaughnessy and Zichis [7] (1943)
Laceration Laceration
20% soap 20% soap
30 min 2 hr
Irrigation Irrigation
Dean et al, [5] (1963)
Puncture Puncture Superficial Superficial
2%BZC 2%BZC I%BZC 20% soap
1 hr 1 and 3 hr 3 hr 3 hr
Swabbing Swabbing, flushing Scrubbing, flushing Scrubbing, flushing
Shaughnessy and Zichis [4] (1954)
Laceration Laceration Laceration Laceration
20% soap 4%BZC I%BZC 0.1% BZC
30min 30 min 30 min 30min
Swabbing Swabbing Swabbing Swabbing
Kaplan et aI. [6] (1962)
Puncture Puncture Puncture
2%BZC 20% soap 20% soap
I hr 1 hr 1 hr
Swabbing, flushing Flushing Swabbing, flushing
'No. of deaths/no. of exposed animals whose wounds were treated. tNo. of deaths/no. of animals whose wounds were not treated.
494
Type of treatment
to
rabies virus: results of
Mortality Mortality in in treatment control group * group T
Statistical significance
8/75 12/80
46/75 58/80
P
;,\0,
4 • APRIL 1979
From the Center , for Disease Control
The use of aqueous quaternary ammonium compounds (AQAC) for local treatment of wounds potentially contaminated with rabies virus has been a subject of numerous queries to the Center for Disease Control (CDC; Atlanta, Ga.). Because of the problems associated with bacterial contamination of AQAC in many clinical settings [1], in December 1976 the Advisory Committee on Immunization Practices (ACIP) dropped its recommendation that AQAC be used for local treatment of wounds potentially contaminated with rabies virus [2, 3]. The original recommendation for use of AQAC was based on studies showing that mortality decreased by 43%-90% in mice and guinea pigs when rabies virus-infected deep wounds were treated with 1%-4% benzalkonium chloride (BZC) [4-6] (table 1) and that pathogenicity for mice decreased when rabies virus was incubated Please address requests for reprints to Dr. Larry J. Anderson, Respiratory and Special Pathogens Branch, Viral Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta, Georgia 30333.
Table 1. Treatment with 20% soap and benzalkonium chloride (BZC) for wounds exposed four independent studies in animals. Interval between exposure and treatment
Group
Type of wound
Solution used
Shaughnessy and Zichis [7] (1943)
Laceration Laceration
20% soap 20% soap
30 min 2 hr
Irrigation Irrigation
Dean et al, [5] (1963)
Puncture Puncture Superficial Superficial
2%BZC 2%BZC I%BZC 20% soap
1 hr 1 and 3 hr 3 hr 3 hr
Swabbing Swabbing, flushing Scrubbing, flushing Scrubbing, flushing
Shaughnessy and Zichis [4] (1954)
Laceration Laceration Laceration Laceration
20% soap 4%BZC I%BZC 0.1% BZC
30min 30 min 30 min 30min
Swabbing Swabbing Swabbing Swabbing
Kaplan et aI. [6] (1962)
Puncture Puncture Puncture
2%BZC 20% soap 20% soap
I hr 1 hr 1 hr
Swabbing, flushing Flushing Swabbing, flushing
'No. of deaths/no. of exposed animals whose wounds were treated. tNo. of deaths/no. of animals whose wounds were not treated.
494
Type of treatment
to
rabies virus: results of
Mortality Mortality in in treatment control group * group T
Statistical significance
8/75 12/80
46/75 58/80
P
