Did the animal exhibit abnormal behavior, signs of illness, have unexplained wounds, have known contact with wild animals, or was the bite unprovoked?
Yes → Refer for PEP (Class III)
No → Consult state or local DOH at minimum, or refer for consideration of PEP (Indeterminate)
Reporting and/or involving state or local health departments in decisions regarding potential rabies exposures and need for PEP is strongly recommended, and mandatory in many areas of the United States. Animal control departments can provide useful information on the vaccination status of domestic animals, direct quarantine/observation of animals in question, and ensure that animal euthanasia and testing are performed when needed. Clinicians should resist the temptation to “go it alone” when faced with uncertain scenarios or those that involve animals that could require observation periods or rabies testing.