Rabies Post-Exposure Prophylaxis for Cat Bites

Immediate Wound Management

Immediately and thoroughly wash all bite wounds with soap and water for 15 minutes, as this is the single most effective measure for preventing rabies, according to the Centers for Disease Control and Prevention 3, 4
Use povidone-iodine solution for irrigation after soap and water cleansing, as recommended by the Centers for Disease Control and Prevention 4
Administer tetanus prophylaxis as indicated, following guidelines from the Centers for Disease Control and Prevention 3, 4

Confine and observe the cat for 10 days, as cats that remain healthy during this period were not shedding rabies virus at the time of the bite, according to the Centers for Disease Control and Prevention 1, 2
Immediately initiate rabies PEP if the cat is stray, unwanted, or cannot be confined, as recommended by the Centers for Disease Control and Prevention 1, 2

In the United States, more cats than dogs were reported rabid between 2000-2006, primarily due to lower vaccination rates and exposure to wildlife reservoirs like raccoons, according to the Centers for Disease Control and Prevention 1, 2
Cat bites in developing countries of Asia, Africa, and Latin America warrant heightened concern due to higher regional rabies prevalence, as noted by the World Health Organization 1, 5

The standard regimen consists of both passive and active immunization, including Human Rabies Immune Globulin (HRIG) 20 IU/kg body weight administered once on day 0, as recommended by the Centers for Disease Control and Prevention 4
Administer 5 doses of rabies vaccine (HDCV or PCECV) on days 0, 3, 7, 14, and 28, following guidelines from the Centers for Disease Control and Prevention 4, 5
Individuals with documented prior complete rabies vaccination receive vaccine only (no HRIG) - 2 doses on days 0 and 3, as recommended by the Centers for Disease Control and Prevention 4

Never delay wound cleansing, as this is your first and most important intervention, according to the American College of Emergency Physicians 5
Do not initiate unnecessary PEP for healthy domestic cats that can be observed, as this wastes resources and exposes patients to unnecessary treatment, as noted by the American College of Emergency Physicians 5
Do not assume vaccination status alone eliminates risk, as even vaccinated cats can rarely develop rabies, though this is extremely uncommon, according to the Centers for Disease Control and Prevention 3, 1
Do not exceed the recommended HRIG dose, as excess HRIG can suppress active antibody production, as warned by the Centers for Disease Control and Prevention 4
Do not administer HRIG and vaccine at the same anatomical site, as recommended by the Centers for Disease Control and Prevention 4

Unprovoked attacks are more likely to indicate rabies than provoked attacks, according to the Centers for Disease Control and Prevention 3, 1
Consult local or state health departments for region-specific rabies epidemiology and guidance, as recommended by the Centers for Disease Control and Prevention 1
If the cat tests negative for rabies by laboratory testing, discontinue PEP immediately, as recommended by the Centers for Disease Control and Prevention 4