Post-Exposure Prophylaxis for Rabies

Immediate Actions Upon Exposure

The Centers for Disease Control and Prevention recommends thoroughly washing all bite wounds and scratches with soap and water for 15 minutes immediately, and applying a virucidal agent such as povidone-iodine solution after washing, to significantly reduce rabies transmission risk 1, 2
Local wound treatment alone significantly reduces rabies transmission risk 1, 2

The American College of Physicians recommends initiating prophylaxis immediately for dogs/cats in rabies-endemic areas, and can discontinue if animal remains healthy during 10-day observation 1
The Centers for Disease Control and Prevention recommends euthanizing stray or unwanted dogs/cats immediately and testing, and beginning prophylaxis pending results 3, 4

The Advisory Committee on Immunization Practices recommends a 4-dose regimen of rabies vaccine on days 0, 3, 7, and 14, or an alternative 5-dose regimen on days 0, 3, 7, 14, and 28, for previously unvaccinated persons 1, 2
The World Health Organization recommends administering rabies immune globulin (RIG) 20 IU/kg body weight given once on day 0, infiltrating full dose into and around all wounds if anatomically feasible, and injecting remainder intramuscularly at site distant from vaccine 2
The Centers for Disease Control and Prevention recommends giving vaccine only (no RIG) for previously vaccinated persons, with a 2-dose schedule on days 0 and 3 2

The American College of Emergency Physicians recommends beginning treatment regardless of interval between exposure and presentation, even if months have passed, as incubation periods exceeding 1 year have been documented in humans 1, 2
The Centers for Disease Control and Prevention recommends confining and observing healthy dogs, cats, or ferrets that bite for 10 days, and not vaccinating the animal during observation period to avoid confusing rabies signs with vaccine side effects 3, 5, 4, 2
The World Health Organization recommends discontinuing human prophylaxis if animal remains healthy for 10 days, and continuing human prophylaxis if animal develops illness, euthanizing immediately and testing brain tissue 1, 2, 4