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No → Administer PEP (Class III)

Background

Bites from wildlife (including raccoons, foxes, skunks, and coyotes) as well as nonbite saliva contact with nonintact skin or mucous membranes all warrant administration of PEP unless the animal is available and laboratory testing can be performed expeditiously. Factors to consider that may influence the urgency of PEP include the animal’s appearance and behavior, whether the exposure was provoked, and the severity and location of bites. If the animal was captured, it should be euthanized and its refrigerated head submitted for testing.25^{25}

Any potential contact with bats requires special attention, as exposures deemed trivial may warrant PEP. The number of human rabies cases from nonbite contact with bats, including scratches, crawling or landing on a person, handling bats, or sleeping in a room with a bat, outnumber cases with known bites.7^7 History must include assessing for any contact with a bat or for situations in which contact may have occurred. If a sleeping person awakens to find a bat in the room or if a bat is found in the room of an unattended child or a mentally disabled or intoxicated person, PEP is warranted unless there is certainty that no physical contact occurred.25^{25} The bat should be collected safely and sent for testing, if possible. Every patient with potential bat exposure should have a full-body skin examination for bites or scratches. Observing bats outdoors in their normal environment does not warrant PEP unless contact occurred.25^{25}

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References
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  2. Hampson K, Coudeville L, Lembo T, et al. Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis. 2015;9(4):e0003709. (Retrospective)
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  5. Nigg AJ, Walker PL. Overview, prevention, and treatment of rabies. Pharmacotherapy. 2009;29(10):1182-1195. (Review) DOI: 10.1592/phco.29.10.1182
  6. Ma X, Monroe BP, Cleaton JM, et al. Public veterinary medicine: public health: rabies surveillance in the United States during 2018. J Am Vet Med Assoc. 2020;256(2):195-208. (Surveillance)
  7. Dato VM, Campagnolo ER, Long J, et al. A systematic review of human bat rabies virus variant cases: evaluating unprotected physical contact with claws and teeth in support of accurate risk assessments. PLoS One. 2016;11(7):e0159443. (Systematic review)
  8. US Centers for Disease Control and Prevention. “Domestic Animals.“ 2018. Accessed March 10, 2021. (CDC website)
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  25. Manning SE, Rupprecht CE, Fishbein D, et al. Human rabies prevention--United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2008;57(RR-3):1-28. Accessed March 10, 2021. (CDC ACIP practice guidelines)
  26. Nicholson KG, Farrow PR, Bijok U, et al. Pre-exposure studies with purified chick embryo cell culture rabies vaccine and human diploid cell vaccine: serological and clinical responses in man. Vaccine. 1987;5(3):208-210. (Randomized controlled trial; 177 patients)
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  29. Rupprecht CE, Briggs D, Brown CM, et al. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep. 2010;59(Rr-2):1-9. Accessed March 10, 2021. (CDC ACIP clinical practice guidelines)
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  43. Pappaioanou M, Fishbein DB, Dreesen DW, et al. Antibody response to preexposure human diploid-cell rabies vaccine given concurrently with chloroquine. N Engl J Med. 1986;314(5):280-284. (Randomized controlled trial; 51 patients)
  44. Tantawichien T, Jaijaroensup W, Khawplod P, et al. Failure of multiple-site intradermal postexposure rabies vaccination in patients with human immunodeficiency virus with low CD4+ T lymphocyte counts. Clin Infect Dis. 2001;33(10):E122-E124. (Observational; 10 patients)
  45. Nasser R, Rakedzon S, Dickstein Y, et al. Are all vaccines safe for the pregnant traveller? A systematic review and meta-analysis. J Travel Med. 2020;27(2). (Systematic review, meta-analysis)
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  47. Kessels J, Tarantola A, Salahuddin N, et al. Rabies post-exposure prophylaxis: a systematic review on abridged vaccination schedules and the effect of changing administration routes during a single course. Vaccine. 2019;37 Suppl 1:A107-A117. (Systematic review)
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  49. De Pijper CA, Boersma J, Terryn S, et al. Rabies antibody response after two intradermal pre-exposure prophylaxis immunizations: An observational cohort study. Travel Med Infect Dis. 2018;22:36-39. (Observational; 430 patients)
  50. Kerdpanich P, Chanthavanich P, De Los Reyes MR, et al. Shortening intradermal rabies post-exposure prophylaxis regimens to 1 week: results from a phase III clinical trial in children, adolescents and adults. PLoS Negl Trop Dis. 2018;12(6):e0006340. (Randomized controlled trial; 885 patients)
  51. Soentjens P, Andries P, Aerssens A, et al. Preexposure intradermal rabies vaccination: a noninferiority trial in healthy adults on shortening the vaccination schedule from 28 to 7 days. Clin Infect Dis. 2019;68(4):607-614. (Randomized controlled trial; 500 patients)
  52. Tarantola A, Ly S, Chan M, et al. Intradermal rabies post-exposure prophylaxis can be abridged with no measurable impact on clinical outcome in Cambodia, 2003-2014. Vaccine. 2019;37 Suppl 1:A118-A127. (Retrospective; 3318 patients)
  53. Cantaert T, Borand L, Kergoat L, et al. A 1-week intradermal dose-sparing regimen for rabies post-exposure prophylaxis (RESIST-2): an observational cohort study. Lancet Infect Dis. 2019;19(12):1355-1362. (Observational; 116 patients)
  54. Bharti OK, Madhusudana SN, Gaunta PL, et al. Local infiltration of rabies immunoglobulins without systemic intramuscular administration: an alternative cost effective approach for passive immunization against rabies. Hum Vaccin Immunother. 2016;12(3):837-842. (Observational; 269 patients)
  55. Bakker AB, Python C, Kissling CJ, et al. First administration to humans of a monoclonal antibody cocktail against rabies virus: safety, tolerability, and neutralizing activity. Vaccine. 2008;26(47):5922-5927. (Prospective, basic science; 57 patients)
  56. Gogtay NJ, Munshi R, Ashwath Narayana DH, et al. Comparison of a novel human rabies monoclonal antibody to human rabies immunoglobulin for postexposure prophylaxis: a phase 2/3, randomized, single-blind, noninferiority, controlled study. Clin Infect Dis. 2018;66(3):387-395. (Randomized controlled trial; 199 patients)
  57. De Benedictis P, Minola A, Rota Nodari E, et al. Development of broad-spectrum human monoclonal antibodies for rabies post-exposure prophylaxis. EMBO Mol Med. 2016;8(4):407-421. (Prospective, basic science)
  58. Alberer M, Gnad-Vogt U, Hong HS, et al. Safety and immunogenicity of a mRNA rabies vaccine in healthy adults: an open-label, non-randomised, prospective, first-in-human phase 1 clinical trial. Lancet. 2017;390(10101):1511-1520. (Prospective; 101 patients)

Animal available for testing
Animal available for testing
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