Laceration — Considerations for All Wounds: Rabies — Clinical Pathway: Emergency

Laceration Clinical Pathway — Emergency Department

Rabies Prophylaxis

  • Report any animal bites (wild, stray or domestic) to Philadelphia Department of Public Health at 215-685-6748 or print form from discharge order set, fill out and fax
  • For all other locations, refer to county-specific department of health recommendations
  • Exposure potentially warranting prophylaxis include:
    • Bites
    • Scratches - cat, ferret, or any wild animal
    • Animal saliva in contact with open wound or mucous membranes
  • Children previously vaccinated against rabies should not receive Rabies Immune Globulin (RIG), but should receive rabies vaccine on day 0 and day 3, if indicated per table below
Animal Type Evaluation Observation outcome Rabies Postexposure Prophylaxis (PEP) – Rabies Vaccine and
Rabies Immune Globulin (RIG)
Dogs, Cats, and Ferrets Address of animal is known, and
animal can be observed for 10 days		 Animal healthy after 10 days No PEP
Animal dies within 10 days or
develops signs of rabies		 Rabies vaccine + RIG
Discontinue rabies vaccine if
rabies result for animal is negative
Animal is a stray, unknown, rabid or suspected of being rabid Observation not recommended Rabies vaccine + RIG
Bats
  • Felt or saw bat bite
  • Asleep or unconscious
    in room with bat
  • Child or mentally/physically disabled adult in room with bat
 Location known and bat captured/tested Bat negative for rabies Rabies vaccine +RIG; Discontinue rabies vaccine once rabies result is known
to be negative
Bat positive for rabies Rabies vaccine +RIG
Unknown location or
bat not captured/tested		 Bat presumed to be positive for rabies Rabies vaccine + RIG
Raccoons, Skunks, Foxes, Coyotes, Groundhogs, and Most Other Wild Mammals Location known and
animal captured/tested		 Animal negative for rabies Rabies vaccine +RIG; Discontinue rabies vaccine once rabies result is known
to be negative
Animal positive for rabies Rabies vaccine +RIG
Unknown location or
animal not captured/tested		 Animal presumed to be positive
for rabies		 Rabies vaccine + RIG
Livestock, Small Rodents, Rabbits and Hares
  • Not known to transmit rabies to humans
  • Exposures to these animals usually do not require PEP
  • Consult PDPH for unusual situations, such as bites to the face and unprovoked attacks

Rabies Post Exposure Prophylaxis (PEP) Recommendations

Rabies Immune Globulin (RIG)* 20 units/kg/dose once
  • Full dose should be infiltrated around the wound(s), if possible
  • Administer any remaining volume intramuscularly (IM) at a site distant to rabies vaccine administration site
  • Administer full dose IM if no visible wound
    • Gluteal area should be avoided to reduce the risk of sciatic nerve damage or unpredictable absorbance; unless exposure area is the gluteal area
Rabies Vaccine 1 mL IM
Do not administer in gluteal area
  • Administer on days 0, 3, 7, and 14
    • If a vaccine dose is delayed for any reason, the PEP schedule should be resumed, not restarted, and the dosing interval should be maintained
  • Note: Children who are immunocompromised should receive an additional vaccine dose on day 28.
  • *RIG should ideally be administered within 24 hrs of the exposure. If RIG is not available to administer on day 0 when the first vaccine is given, it can be administered up to and including day 7 of PEP. Vaccine doses should never be withheld, regardless of availability of RIG.