Management of Primate Bites as Rabies Exposure

Immediate Wound Management

The Centers for Disease Control and Prevention recommends washing the wound extensively with water and soap for approximately 15 minutes as soon as possible, as this is the most effective measure to prevent rabies 4, 5
Irrigate gently with water or diluted povidone-iodine solution, taking care not to damage the skin or tissues, as recommended by the CDC 5, 4
Avoid suturing the wound when possible to allow for drainage, as advised by the CDC 5, 4
Administer tetanus prophylaxis as indicated, according to the CDC guidelines 5, 4
Consider antibiotic prophylaxis based on the characteristics of the wound, as recommended by the CDC 5, 4

The CDC recommends initiating post-exposure prophylaxis immediately with human rabies immunoglobulin (HRIG) and rabies vaccine, without waiting for the observation results of the animal, since non-human primates are considered high-risk for rabies 1, 2, 3
The World Health Organization suggests that HRIG and rabies vaccine should be administered simultaneously on the first presentation, in different anatomical sites 5, 6
The CDC advises a dose of HRIG of 20 IU/kg of body weight, applicable to all ages including children 5
The WHO recommends infiltrating the full dose of HRIG around and into the wounds if anatomically feasible; any remaining volume should be injected intramuscularly at a distant site 5
The CDC suggests initiating the rabies vaccine as soon as possible, ideally within the first 24 hours, with a regimen of 5 doses over 28 days (days 0, 3, 7, 14, 28) 5, 4

The administration of post-exposure prophylaxis is a medical urgency, not a medical emergency, but decisions should not be delayed, as recommended by the CDC 6, 4
HRIG is only administered once at the start of prophylaxis (day 0) to provide immediate antibody coverage until the patient responds actively to the vaccine, according to the CDC 5, 4
If HRIG was not administered on day 0, it can be administered up to day 7 inclusive of the vaccine series, as advised by the CDC 5, 4
Never administer HRIG after day 7, as it may interfere with active immunity, according to the CDC 5, 4

The CDC recommends reporting the biting animal to the local health department immediately 1, 2, 3
The primate should be considered for euthanasia and rabies examination if available, as recommended by the CDC 1, 2, 3
If the primate is in a licensed USDA research facility or accredited zoo, it should be evaluated on a case-by-case basis, but this does not delay the initiation of prophylaxis in the patient, according to the CDC 1
Do not wait for the results of the animal's tests to initiate prophylaxis, given the high risk, as recommended by the CDC 7, 6, 4

If the patient has documentation of complete prior rabies vaccination, administer only vaccine (without HRIG) in a regimen of 2 doses (days 0 and 3), as recommended by the CDC 5, 4
Prophylaxis can be discontinued only if laboratory tests confirm that the animal was not rabid, using the direct fluorescent antibody test, according to the CDC 5, 6, 4
Once clinical signs of rabies develop, post-exposure prophylaxis is consistently ineffective, and mortality is almost 100%, as reported by the CDC 4