From the Guidelines
A cat scratch alone does not automatically indicate the need for a rabies vaccine. You should seek medical attention for a cat scratch, but rabies vaccination is typically only recommended if the cat was wild, unknown, or showing signs of rabies (unusual aggression, excessive drooling, paralysis) 1. For most scratches from healthy, vaccinated domestic cats, wound cleaning with soap and water for 15 minutes is the primary treatment, along with possible antibiotics if infection develops.
The decision to administer rabies post-exposure prophylaxis (PEP) is made by healthcare providers based on the specific circumstances of the exposure, including the epidemiology of rabies in the area, the biting animal's history and health status, and the potential for the animal to be exposed to rabies 1. If rabies PEP is needed, it consists of rabies immune globulin and a series of four rabies vaccine doses given on days 0,3,7, and 14 after exposure.
Some key factors to consider when evaluating a potential rabies exposure include:
- The animal's vaccination history: A dog, cat, or ferret with a history of continuously current vaccination is unlikely to become infected with rabies 1
- The animal's behavior: An unprovoked attack by an animal is more likely than a provoked attack to indicate that the animal is rabid 1
- The local epidemiology of rabies: The likelihood of rabies in a domestic animal varies by region, and the need for postexposure prophylaxis also varies 1
Rabies is nearly always fatal once symptoms develop, which is why proper wound care and risk assessment are important, but most cat scratches from domestic pets don't require rabies vaccination.
From the Research
Cat Scratch and Rabies Vaccine
- A cat scratch does not directly indicate the need for a rabies vaccine 2.
- Cat-scratch disease is an infection caused by Bartonella henselae, which is a different condition from rabies 3, 4.
- Rabies is a fatal zoonotic disease that requires post-exposure prophylaxis (PEP) for prevention, which includes wound washing, antisepsis, and a series of rabies vaccinations 5.
- The decision to administer rabies vaccine depends on the risk of exposure to rabies, not on the presence of a cat scratch 2, 5.
Diagnosis and Treatment of Cat-Scratch Disease
- Cat-scratch disease is commonly diagnosed by obtaining a history of exposure to cats and a serologic test with high titers of immunoglobulin G antibody to B. henselae 4.
- Most cases of cat-scratch disease are self-limited and do not require antibiotic treatment, but azithromycin has been shown to speed recovery in some cases 3, 4.
- Cat-scratch disease can present in a more disseminated form with hepatosplenomegaly or meningoencephalitis, or with bacillary angiomatosis in patients with AIDS 4.
Rabies Post-Exposure Prophylaxis
- Rabies PEP schedules have been reduced in dose and duration, with the 1-week, 2-site ID PEP schedule being the most advantageous 5.
- Changes in the rabies vaccine product and/or the route of administration during PEP are possible, but more research is needed to understand the safety and immunogenicity of novel PEP schedules in special populations 5.