Management of Rabid Dog bites
"last update: 13 Oct 2024"
- POST-EXPOSURE TREATMENT IN HUMANS
This must be started at the earliest to ensure that the individual will be immunized before the rabies virus reaches the Central Nervous System.
➡️Decision to treat
In rabies endemic countries, where every animal bite is potentially suspected as a rabid animal bite the treatment should be started immediately. To bring out uniformity globally, the WHO recommended classification of animal bite for post-exposure treatment should be followed
WHO Guide for post-exposure treatment against rabies
|
Category |
Type of contact with a suspect or confirmed rabid diagnostic or wild animal, or animal unavailable for observation |
Recommended treatment |
|
I
|
Touching or feeding of animals Licks on intact skin |
None, if reliable case history is available |
|
II |
Nibbling of uncovered skin Minor scratches of abrasions without bleeding Licks on broken skin |
Administer vaccine immediately b Stop treatment if animal remains healthy throughout an observation period c of 10 days or if animal is killed humanely and found to be negative for rabies by appropriate laboratory techniques |
|
III |
Single or multiple transdermal bites or scratches Contamination of mucous membrane with saliva (i.e. licks) |
Administer rabies immunoglobulin and vaccine immediately b Stop treatment if animal remains healthy throughout an observation period c of 10 days or if animal is killed humanely and found to be negative for rabies by appropriate laboratory techniques |
|
a Exposure to rodents, rabbits and hares seldom, if ever, requires specific anti-rabies treatment b If an apparently healthy dog or cat in or from a low-risk area is placed under observation, the situation may warrant delaying initiation of treatment c This observation period applies only to dogs and cats. Except in the case of threatened or endangered species, other domestic and wild animals suspected as rabid should be killed humanely and their tissues examined using appropriate laboratory techniques |
||
Source: Guidelines for post-exposure treatment in 8th Report of the WHO Expert Committee on
Rabies, WHO Technical report Series 824, 1992
Although unvaccinated animals are more likely to transmit rabies, vaccinated animals can also do so if the vaccination of the biting animal was ineffective for any reason.
The treatment should be started immediately after the bite. The treatment may be discontinued if animal involved (dog or cat) remains healthy throughout an observation period of 10 days. The observation period is valid for dogs and cats only. Bite by all wild animals should be treated as category III exposure. It should be noted that bites by rats, mice, squirrel and rabbits seldom require treatment. It is re-emphasized that the treatment should be started as early as possible after exposure, but it should not be denied to person reporting late for treatment.
The post-exposure treatment includes three equally important approaches and should be done simultaneously.
· Management of wound
· Passive immunization
· Active immunization.
