What are the recommended vaccines, including dose, route, schedule, duration, and booster, for bites from dogs, cats, bats, snakes, spiders, and centipedes?

Animal Bite Vaccination Protocols

For dog, cat, and bat bites with rabies risk, administer rabies post-exposure prophylaxis (PEP) consisting of rabies immune globulin (RIG) 20 IU/kg plus a 4-dose vaccine series (days 0,3,7,14) given intramuscularly in the deltoid; snakes, spiders, and centipedes do not require vaccination—only supportive care and species-specific antivenoms when indicated.

Rabies Post-Exposure Prophylaxis (Dogs, Cats, Bats)

For Previously Unvaccinated Persons

Immediate wound management is critical and must begin before any vaccination:

• Thoroughly cleanse all wounds with soap and water
• Irrigate with povidone-iodine solution if available
• This step alone significantly reduces rabies transmission risk 1

Rabies Immune Globulin (HRIG):

• Dose: 20 IU/kg body weight (0.133 mL/kg)
• Route: Infiltrate the full dose around and into the wound(s) if anatomically feasible
• Any remaining volume should be given intramuscularly at a site distant from vaccine administration
• Timing: Administer once on day 0; can be given up to day 7 if initially missed
• Critical: Never exceed the recommended dose as it can suppress active antibody production
• Never administer in the same syringe as vaccine 1, 2

Rabies Vaccine (HDCV or PCECV):

• Dose: 1.0 mL per injection
• Route: Intramuscular in deltoid area (adults and older children); anterolateral thigh acceptable for young children
• Never use gluteal area - results in diminished immune response
• Schedule: Days 0,3,7, and 14 (4-dose regimen)
• Day 0 is when the first dose is administered 1

Special consideration for immunocompromised patients: Use 5-dose schedule (days 0,3,7,14,28) instead of the standard 4-dose regimen 1

For Previously Vaccinated Persons

If the patient has documented prior rabies vaccination (pre-exposure or post-exposure with cell culture vaccine):

• No RIG required
• Vaccine only: 1.0 mL IM on days 0 and 3
• Wound cleansing remains essential 1

Pre-Exposure Prophylaxis (High-Risk Individuals)

For veterinarians, animal handlers, rabies researchers, laboratory workers, and international travelers to rabies-endemic areas:

• Primary series: 3 doses of 1.0 mL IM on days 0,7, and 21 or 28
• Booster considerations:
  • Continuous risk (lab workers with rabies virus): Check antibody titers every 6 months; booster if titer falls below 1:5 dilution
  • Frequent risk (veterinarians, wildlife officers, bat handlers): Check titers every 2 years 2

Non-Rabies Animal Bites

Snakes, Spiders, Centipedes

No vaccines exist for these envenomations. Management focuses on:

• Wound care and cleaning
• Species-specific antivenom when indicated (not a vaccine)
• Supportive care
• Tetanus prophylaxis: Assess tetanus vaccination status and provide booster if indicated 2, 3

Tetanus Considerations for All Bite Wounds

Evaluate tetanus immunization status for all animal bites:

• Administer tetanus booster if last dose was >5 years ago (for contaminated wounds) or >10 years ago (for clean wounds)
• This applies to all animal bites regardless of species 2, 3

Critical Pitfalls to Avoid

1. Never delay rabies PEP while awaiting animal testing results if exposure risk is significant
2. Never administer rabies vaccine in gluteal area - this is associated with treatment failures
3. Never exceed recommended RIG dose - suppresses active antibody production
4. Never give RIG and vaccine in same syringe or same anatomical site
5. Do not omit wound infiltration with RIG - local passive immunity at wound site is crucial
6. Do not discontinue PEP prematurely unless laboratory testing confirms the animal was not rabid 1, 2

When to Initiate Rabies PEP

Start immediately for:

• Any bite or scratch from a bat (bats are high-risk regardless of visible wound)
• Bites from wild carnivores (raccoons, skunks, foxes)
• Bites from dogs/cats that cannot be observed or tested
• Any bite where the animal shows signs of rabies

The combination of proper wound care, RIG infiltration, and the 4-dose vaccine schedule is highly effective when administered correctly, with no documented failures in the United States since modern biologics have been used 2.