Does an 18-year-old patient who touched a bleeding beaver with an abrasion, but no skin break, and received a tetanus shot, require rabies prophylaxis after getting beaver blood on their face?

From the Guidelines

Rabies prophylaxis is recommended in this case due to the potential risk of transmission through mucous membrane contact with the beaver's blood. Since the patient had contact with a potentially rabid beaver's blood on their face and had an abrasion (even though it didn't break the skin), post-exposure prophylaxis (PEP) should be initiated, as recommended by the Advisory Committee on Immunization Practices 1. The PEP regimen consists of rabies immune globulin (RIG) administered at 20 IU/kg body weight infiltrated around the wound area if possible, with any remaining volume given intramuscularly at a site distant from the vaccine. Additionally, four doses of rabies vaccine should be administered intramuscularly in the deltoid on days 0,3,7, and 14.

The key factors to consider in this case are:

• The type of exposure: contact with potentially rabid animal's blood
• The epidemiology of animal rabies in the area: beavers are known rabies vector species
• The circumstances of the exposure incident: mucous membrane contact poses a transmission risk
• The reliability of the information: the patient had direct contact with the beaver's blood

As stated in the guidelines, administration of rabies postexposure prophylaxis is a medical urgency, not a medical emergency, and a risk assessment should be conducted in each situation involving a possible rabies exposure 1. However, given the potential risk of transmission and the fact that rabies is nearly always fatal once symptoms develop, prophylaxis is warranted when there's reasonable risk of exposure, especially with wildlife contact. The tetanus shot already received was appropriate but doesn't protect against rabies.

It's essential to note that the decision to initiate rabies postexposure prophylaxis depends on the availability of the exposing animal for observation or rabies testing, and clinicians should seek assistance from local or state public health officials for evaluating exposures or determining the need for postexposure management in situations that are not routine 1.

From the FDA Drug Label

Bites from squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, other small rodents, rabbits, and hares almost never require antirabies post-exposure prophylaxis. Livestock, small rodents, lagomorphs (rabbits and hares), large rodents (woodchucks and beavers), and other mammalsConsider individuallyConsult public health officials

The patient touched a bleeding beaver and got blood in his face, but there was an abrasion that did not break the skin. Rabies prophylaxis is not clearly indicated in this scenario.

• The patient should consult public health officials to determine the need for rabies prophylaxis, as the beaver is a large rodent and the situation should be considered individually 2.
• It is also important to note that the patient has already received a tetanus shot, which is appropriate for preventing tetanus infection, but this does not address the potential risk of rabies.
• The decision to administer rabies immune globulin (RIG) and vaccine should be made in consultation with public health officials, taking into account the specific circumstances of the exposure and the animal involved 2.

From the Research

Rabies Prophylaxis

• The patient in question touched a bleeding beaver, which may potentially expose them to the rabies virus 3, 4.
• Although there was an abrasion, it did not break the skin, which reduces the risk of transmission 5.
• The patient received a tetanus shot, but the primary concern is the potential exposure to rabies 6, 7.

Postexposure Prophylaxis

• Postexposure prophylaxis (PEP) is essential for preventing rabies after a potential exposure 3, 4.
• PEP typically consists of a series of rabies vaccinations and, in some cases, the administration of human rabies immune globulin 5, 6.
• The decision to administer PEP depends on the severity of the exposure and the patient's vaccination history 3, 7.

Patient's Situation

• Given that the patient touched a bleeding beaver and got blood in their face, but did not have a break in the skin, the risk of transmission is relatively low 4, 5.
• However, as a precautionary measure, the patient may still require rabies prophylaxis, which should be determined by a healthcare professional based on the patient's individual circumstances and the severity of the exposure 3, 6, 7.