WHO Recommended Treatment After Exposure to a Potentially Rabid Animal
The World Health Organization (WHO) recommends immediate wound cleansing with soap and water or povidone-iodine solution, followed by administration of rabies immune globulin (RIG) at 20 IU/kg body weight infiltrated around the wound(s), and a series of rabies vaccinations for post-exposure prophylaxis after contact with a potentially rabid animal. 1
Immediate Post-Exposure Management
1. Wound Treatment
- Immediate and thorough washing of all bite wounds and scratches with soap and water and a virucidal agent (preferably povidone-iodine solution) 1
- This step alone has been shown to markedly reduce the likelihood of rabies in animal studies 1
- Avoid suturing wounds when possible 1
- Consider tetanus prophylaxis and antibiotics as appropriate 1
2. Rabies Immunoglobulin (RIG)
- Administer human RIG (HRIG) at 20 IU/kg body weight 1
- If anatomically feasible, infiltrate the full dose of RIG in and around the wound(s) 1
- Any remaining volume should be injected intramuscularly at a site distant from vaccine administration 1
- RIG should be administered only once, at the beginning of post-exposure prophylaxis 1
- If not given initially, RIG can be administered up to day 7 after the first vaccine dose 1
3. Rabies Vaccination
- For previously unvaccinated individuals: 5 doses of rabies vaccine administered intramuscularly 1
- First dose: As soon as possible after exposure (day 0)
- Additional doses: Days 3,7,14, and 28 after the first dose
- For adults: Administer in the deltoid area only (never in the gluteal area) 1
- For children: Anterolateral aspect of the thigh is also acceptable 1
Special Considerations
Animal Assessment
- Domestic dogs, cats, or ferrets that bite a person may be confined and observed for 10 days 1
- If the animal shows signs of rabies during observation, it should be euthanized and tested 1
- Stray or unwanted animals should be euthanized immediately and tested 1
- Unprovoked attacks are more likely to indicate rabies than provoked attacks 1
Previously Vaccinated Individuals
- Persons who have previously received complete rabies vaccination should receive only vaccine (no RIG) 1
- Two doses of vaccine on days 0 and 3 1
Important Caveats
- Post-exposure prophylaxis is a medical urgency, not an emergency, but should not be delayed 1
- Even with delays after exposure, prophylaxis should be administered as long as clinical signs of rabies are not present 1
- Once clinical rabies develops, the disease is almost invariably fatal 2, 3
- In developing countries where dogs are the major vector, exposures carry higher risk; some authorities recommend immediate initiation of post-exposure prophylaxis 1
- The WHO goal is to reduce dog-mediated human rabies to zero by 2030 through a comprehensive approach including dog vaccination campaigns 3
This protocol has been proven safe and effective in protecting persons bitten by animals proven to be rabid and induces an excellent antibody response in all recipients 1.