My patient found a bat in her son’s bedroom yesterday morning. She opened the window and the bat flew out. She doesn’t think the bat bit her son. Do she and her son require rabies post-exposure prophylaxis (PEP)?
Only the son requires rabies PEP because he was asleep in a room with a bat that cannot be tested, and we can’t know for certain whether or not the bat bit him while he was asleep. The mother does not need PEP because she wasn’t exposed to the bat while asleep and had no physical contact with the bat.
My patient started rabies PEP and is scheduled for her 3rd rabies vaccination (day 7) tomorrow. She is currently out of town – is it OK to give the day 7 vaccination 2 or 3 days late? If so, when should her fourth (day 14) vaccination be given?
After the day 0 and 3 vaccinations, minor deviations from the recommended schedule are not important. Give the third vaccination as close to the recommended time as possible, then shift the schedule and resume as though the patient were on schedule, giving the fourth vaccination 7 days later.
A neighbor’s cat that bit a child on the hand can’t be found after one day of searching. How long should I advise the parent to look for the cat before starting the child on rabies PEP?
Because the bite was to an extremity, you can allow the mother to continue searching for the cat for 2 to 3 more days. If the cat has not been found at that point, begin PEP.
What are the signs of rabies in cats (or dogs)? My patient is confining a cat that bit her for a 10 day period following the bite. What signs should she be looking for?
An animal that had rabies virus in its saliva at the time of biting someone would develop severe illness or die within 3 to 4 days of the bite. (The 10-day observation period includes a safety factor.) Signs to watch for include loss of appetite, depression, lameness, fever, and neurologic signs such as behavior changes, vocalization, circling, or seizures. If the cat develops any of these signs the patient should contact her veterinarian immediately. If the cat is alive and well 10 days following the bite, then there was no risk of rabies at the time of the bite.
I have a patient who was bitten by a dog in Mexico two weeks ago. He had a rabies vaccine there and was told that he was protected. Should I restart the entire PEP series?
In situations like this it is best to get as much information as possible about vaccinations given outside the U.S. and then call MDH for a consultation.
A patient who was bitten by a bat a few months ago is wondering if it is too late to receive rabies PEP.
There is no time limit regarding the administration of PEP after an exposure. In this case it is still appropriate to initiate PEP. Administration of both human rabies immune globulin (HRIG) and four doses of rabies vaccine is recommended regardless of the time elapsed since the exposure.
A 7 year-old boy was bitten by a squirrel he was chasing around a tree. The squirrel is not available for testing. What should be done?
Rabies PEP is not indicated following a squirrel bite in Minnesota. Wash the wound well with soap and water and check that the boy’s tetanus vaccination is up to date. Squirrels, chipmunks, mice, rats and other small rodents do not pose a rabies risk in Minnesota.
How long does the rabies virus last in the environment?
Rabies virus does not persist in the environment; it is inactivated almost immediately by UV light and desiccation. Rabies is transmitted only through direct contact with a rabid animal through a bite or saliva contact with a mucous membrane. Rabies is not transmitted through environmental contact or through aerosols.