Rabies Post-Exposure Prophylaxis for Monkey Bites

Risk Assessment and Immediate Treatment

Any penetration of skin by teeth constitutes a bite exposure and represents potential rabies risk, regardless of the animal species, and monkeys should be treated as high-risk exposures when the animal cannot be captured and tested 1
The Centers for Disease Control and Prevention recommends applying a povidone-iodine solution or other virucidal agent to the wound if available, as local wound cleansing alone has been shown to markedly reduce the likelihood of rabies in experimental animals 2

The World Health Organization recommends administering human rabies immunoglobulin (HRIG) at 20 IU/kg body weight as soon as possible, ideally within 24 hours of exposure, and infiltrating up to the full dose thoroughly around and into the wound(s) 2, 3
RIG can be administered up to day 7 after the first vaccine dose if not given initially, but beyond day 7 it is not indicated, according to the Centers for Disease Control and Prevention 2, 3

The American Academy of Pediatrics recommends a 4-dose vaccine schedule with doses on days 0, 3, 7, and 14 for previously unvaccinated persons, using Human Diploid Cell Vaccine (HDCV) or Purified Chick Embryo Cell Vaccine (PCECV) 3
For previously vaccinated persons, the Centers for Disease Control and Prevention recommends administering only a 2-dose vaccine schedule on days 0 and 3 without RIG 3

The World Health Organization recommends beginning PEP immediately after exposure, regardless of the time interval between exposure and treatment initiation, as rabies incubation periods exceeding 1 year have been documented in humans 2, 3
This is a medical urgency—do not delay treatment while attempting to locate or test the animal, according to the American College of Emergency Physicians 3