Possible Rabies Exposure
Possible Rabies Exposure

Possible Rabies Exposure

Tags
Emerg. Med. Practice
Published
April 1, 2021
Author(s)
Bess Storch, MD

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Action

Patient presents with:

  • Mammal bite
  • Exposure to a bat
  • Contact to an open wound or mucous membrane with mammal saliva or brain tissue

Decision

Which animal?

Background

The percentage of travelers presenting to travel clinics requesting rabies PEP after a potential exposure increased from <0.5% of all visits in 2003 to 2% in 2012. An estimated 16,000 to 39,000 people receive PEP each year in the United States. Rabies biologics are costly and at times in short supply, so every case requires weighing the likelihood of rabies acquisition against the utilization of resources and possible adverse effects of PEP. Important considerations include: the type and circumstances of the exposure, epidemiology of rabies in the area, the animal species involved, and whether the animal is available for observation or testing. In most states, physicians are required to report animal bites to the state or local health department, and the local authorities will offer instructions and guidance for quarantine, capture, and/or submission of specimens.

In addition to a thorough exposure history, ask whether the patient has any immunocompromising illnesses and whether the patient is taking corticosteroids, immunosuppressive medications, or the antimalarial drug chloroquine, as adjustments to the PEP regimen may be necessary.

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References
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Full Postexposure Prophylaxis in Patients with Possible Rabies Exposure Pathway
Full Postexposure Prophylaxis in Patients with Possible Rabies Exposure Pathway
Domestic dog, cat, or ferret
Domestic dog, cat, or ferret
Small rodent, such as a squirrel, chipmunk, mouse, rat, or rabbit
Small rodent, such as a squirrel, chipmunk, mouse, rat, or rabbit
Other animal or unknown animal
Other animal or unknown animal
Testing
Testing