What is the protocol for managing a dog bite with unknown vaccination status?

Management Protocol for Dog Bite with Unknown Vaccination Status

For a dog bite with unknown vaccination status, immediate wound cleaning with soap and water followed by prompt medical evaluation is essential, with rabies post-exposure prophylaxis (including both rabies immune globulin and vaccine) strongly recommended if the dog cannot be observed for 10 days.

Initial Management

Immediate Wound Care

• Clean all bite wounds thoroughly and immediately with soap and water 1, 2
• If available, irrigate with a virucidal agent such as povidone-iodine solution 2
• This simple local wound cleansing has been shown to markedly reduce the likelihood of rabies 1, 2

Medical Assessment

• Evaluate for:
  • Tetanus prophylaxis needs
  • Need for antibiotics to prevent bacterial infection
  • Structural damage (nerve, tendon, or vascular injury)
  • Cosmetic considerations for wound closure 1

Rabies Risk Assessment

Dog Status Evaluation

1. If dog is available and appears healthy:

   • Confine and observe the dog for 10 days 1
   • Do not administer rabies vaccine to the dog during observation period 1
   • Have the dog evaluated by a veterinarian at first sign of illness 1
   • Report any illness in the animal immediately to local health department 1

2. If dog is stray, unwanted, or cannot be observed:

   • Consider immediate rabies post-exposure prophylaxis 1, 2
   • If the dog is captured, it may be euthanized immediately and its head submitted for rabies examination 1

3. If dog shows signs of rabies:

   • Euthanize the dog immediately
   • Submit head for rabies examination under refrigeration (not frozen) 1

Exposure Assessment

• Consider circumstances of bite (provoked vs. unprovoked) 1, 2
  • Unprovoked attacks are more likely to indicate rabies 2
  • Bites during attempts to feed or handle an animal may be considered provoked 2
• Consider geographic location (rabies endemicity in area) 2
  • Exposures to dogs in canine rabies-enzootic areas (Asia, Africa, Central and South America) carry higher risk 1

Post-Exposure Prophylaxis Protocol

When to Initiate PEP

• Begin treatment within 24 hours of exposure when possible 1
• For unknown/escaped dogs that cannot be observed, consult public health officials 2

PEP Regimen for Previously Unvaccinated Persons

1. Rabies Immune Globulin (RIG):

   • Administer 20 IU/kg body weight 1, 2
   • Infiltrate full dose around wound if anatomically feasible
   • Administer remaining volume IM in deltoid muscle or lateral thigh 2

2. Vaccine:

   • Five 1-mL doses of rabies vaccine (HDCV, RVA, or PCEC)
   • Administered IM in deltoid area (adults) or outer thigh (children)
   • Schedule: days 0,3,7,14, and 28 1, 2
   • Never administer in gluteal area due to risk of sciatic nerve injury 2

PEP for Previously Vaccinated Persons

• No RIG needed
• Two 1-mL doses of vaccine on days 0 and 3 2

Special Considerations

Reporting Requirements

• Report the bite incident to local health department immediately 1
• Follow local public health authority guidance for specific regional protocols

Common Pitfalls to Avoid

• Delayed treatment: Do not wait to begin PEP if the dog's status is unknown and it cannot be observed 1
• Improper wound care: Inadequate cleaning increases infection risk 1, 2
• Incorrect injection sites: Never administer vaccine in gluteal area 2
• Incomplete vaccination series: Failure to complete the full course leaves victims at risk of rabies 3
• Underestimating risk: Dog bites account for >99.9% of human rabies deaths worldwide 4, 5

High-Risk Situations

• Bites from stray dogs with unknown vaccination status
• Bites occurring in rabies-endemic regions
• Unprovoked attacks
• Bites to face, head, neck or hands (higher risk of rapid viral spread) 2

Remember that rabies is virtually 100% fatal once symptoms develop, but nearly 100% preventable with proper post-exposure prophylaxis. When in doubt about the vaccination status of a biting dog, err on the side of caution and initiate PEP, which can be discontinued if the dog remains healthy during the observation period or tests negative for rabies.