5.5.4. How do we deal with or prevent exposures?

I have been bitten by a dog, what should I do?
Immediate washing of the wound with soap and water is extremely important and one of the most effective ways of reducing the risk of contracting rabies. Since rabies is transmitted through the bite of a rabid animal, thorough washing of the wound will allow you to remove as much saliva (hence virus) from the wound as possible and will greatly decrease chances of infection. Wash the wound with soap (or detergent, povidone iodine or other substances with rabies virus killing activity) and water for at least 15 minutes and seek medical treatment. If no soap is available, at minimum wash the wound with water for at least 15 minutes. Then go straight to hospital (see below) for appropriate medical attention. Click here for more information on management of bite wounds and rabies prophylaxis.

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Photo courtesy of Serengeti Carnivore Disease Project

Can I just observe the dog and not get vaccinated?
Dogs can shed rabies virus several before showing clinical signs of rabies. In the event of a dog bite, wound care should be applied immediately (washing of the wound with soap and water for at least 15 minutes) and the advice of a medical expert should be sought. Vaccination should be initiated and if the suspect dog is alive after 10 days, the vaccination series can be stopped.

How do I take care of the wound I just received from a dog that may have had rabies?
Wash the wound with soap, or detergent and lots of water for at least 15 minutes and then seek medical help. It is important not to suture the wound before RIG has been applied and avoid any other procedure that may further contaminate or enlarge the wound.

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Photo courtesy of Dr. S.R. Garg, Hisar, Índia

I was bitten by a dog three months ago and the dog died four days after it bit me. I have not taken any treatment. Am I at risk? What should I do?
In areas where canine rabies is present, it is advisable to get post-exposure vaccination. You should seek medical advice as soon as possible.

After I have been exposed, how long can I wait before getting PEP?
You should seek PEP as soon as possible. Do not wait.

Should I receive PEP even for a small scratch or wound?
Yes, if the animal was a suspect or confirmed rabid animal.

What do I need to do when dressing out/butchering animals that may have been exposed to rabies?
Be sure to wear protective clothing (gloves, mask, goggles) to avoid being exposed to infected tissue. If the animal was exposed less than seven days previously, cut out a large section around where they were exposed and destroy the tissue. If they were exposed more than seven days previously, destroy the animal and do not eat the meat.

Why do I have to have RIG injected into the wound as it may be painful?
RIG is injected into the wound because, in order for it to be effective, it needs to come in direct physical contact with the rabies virus deposited into the wound site through the bite or scratch of a rabid animal.

Do I really need to have RIG when I have PEP?
If at all possible, RIG should be included in PEP because it begins to work immediately to destroy rabies virus that may have been deposited in bite or scratch wounds. It is generally recommended for more severe exposures or people in poor health, given that in many countries/areas it is not promptly available.

I have been vaccinated previously with a CCV, and now I have been exposed to a rabid animal, do I need to go through the full PEP regimen again?
No. You will need either two IM booster doses (on day 0 and 3), or 4 ID booster doses (all given on day 0). No RIG is needed. You should get these booster doses as soon as possible following the exposure.

I have been vaccinated previously with a CCV, and now I have been exposed to a rabid animal, am I protected against rabies or do I need to be vaccinated again?
Yes, you will need either two IM booster doses (on day 0 and 3), or 4 ID booster doses (all given on day 0) as soon as possible after exposure.

The dog that bit me was vaccinated, do I still need to get PEP?
In principle no. In rare occasions, vaccinated dogs have contracted rabies. Therefore, the vaccination history of the dog should be verified by a public health official. If it is questionable, PEP should be administered immediately and the dog should be observed daily for 10 days for signs of rabies under the care of a competent public health official or in the care of the owners with supervision of the public health official. If the dog does show clinical signs of rabies, it should be examined by a veterinarian and he/she should determine if it needs to be euthanized and tested for rabies. If the dog remains healthy throughout the observation period, the vaccination series can be stopped.

Is it necessary to be vaccinated PEP if the dog that bit me is still alive?
Dogs can shed rabies virus several days prior to showing clinical signs of disease. In areas where canine rabies is present and there are no available facilities to test the animal, then PEP should be initiated immediately. If the dog is healthy after a 10 day observation period the PEP can be discontinued.

What do I need to do if a rabies outbreak has occurred? Contact public health officials. Avoid contact with animals that could have been exposed to rabies. Educate your family members about rabies and avoiding animals that have potentially been exposed to rabies.

CCV - Cell-culture vaccine
ID – Intradermal
IM - Intramuscular
PEP - Post-exposure prophylaxis
RIG - Rabies immunoglobulin

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Version 4 - last updated May 2017