ACEP ID:

Rabies

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Section IconRabies
Overview
Provide local wound care and consider antibiotics and possible surgical consultation for infected wounds. Consult local health departments for guidance
Give rabies vaccine concurrently with rabies immunoglobulin (RIG), with RIG given only with first dose of vaccine
Consider the need for tetanus prophylaxis
Questions to ask/consider
Bite
  • What type of animal bit the patient?
  • Is the animal available for testing?
  • Has the human or animal who bit the patient been vaccinated for rabies previously and was the vaccine received over 90 days prior?
    • If yes, no vaccine necessary
Non-bite: vaccinate only if wet saliva introduced into fresh wound
  • Finding a bat in a room where someone was sleeping is considered a possible bite.
Bats
  • Available for testing: do not administer rabies vaccine
    • Animal should be submitted to local health department for testing
  • Not available for testing - administer vaccine
    • Including if unsure of bite (e.g., child sleeping in room with a bat)
Wild terrestrial carnivores (e.g., raccoons, skunks, foxes)
  • Available for testing: do not administer rabies vaccine
    • Animal should be submitted to local health department for testing
    • Can still administer vaccine if either:
      • High clinical suspicion based on behavior
      • No testing of animals through the health department
  • Not available for testing: administer rabies vaccine
Other wild animals
  • Small rodents (squirrels, rats, chipmunks): do not administer (not reservoirs)
  • Lagomorphs (rabbits/hares): do not administer (no known transmission)
  • Other wild animals: consult local health department
Human bite
  • do not administer rabies vaccine No documented human-to-human exposure outside of organ transplant
Guidelines
Domesticated animals (e.g., dog, cat, ferret)
  • Available for quarantine: do not administer rabies vaccine
    • Unless animal suspicious for infection: administer rabies vaccine
    • Observe the animal for 10 days
  • Not available for quarantine
    • Consult local health department for guidance on local epidemiology
References
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