What is the recommended rabies prophylaxis for someone exposed to a bat through a bite or scratch?

Rabies Prophylaxis for Bat Exposures

Rabies postexposure prophylaxis is recommended for all persons with bite, scratch, or mucous membrane exposure to a bat, unless the bat is available for testing and is negative for evidence of rabies. 1

Assessment of Bat Exposures

When evaluating a potential bat exposure, consider the following:

• Direct contact exposures require immediate prophylaxis:

  • Confirmed bites or scratches
  • Mucous membrane contact with bat saliva
  • Direct physical contact with a bat where bite/scratch cannot be excluded 1

• Potential unrecognized exposures that warrant prophylaxis:

  • Finding a bat in the same room as:
    • A sleeping person
    • An unattended child
    • A mentally disabled person
    • An intoxicated person 1

• Not considered exposures (prophylaxis not indicated):

  • Being in the same room as a bat with no direct contact
  • Other household members without direct contact
  • Contact with bat blood, urine, or feces (guano)
  • Contact with dry material containing virus (inactivated by desiccation) 1, 2

Recommended Prophylaxis Protocol

1. Immediate Wound Management

• Thoroughly wash and flush all wounds for approximately 15 minutes with soap and water 3, 2
• Apply an iodine-containing or similarly virucidal topical preparation to the wound 2
• This step alone can significantly reduce the likelihood of rabies infection 3

2. For Previously Unvaccinated Individuals

• Rabies Immune Globulin (RIG):

  • Administer 20 IU/kg body weight 3, 2
  • Infiltrate the full dose around and into the wound if anatomically feasible
  • Inject any remaining volume intramuscularly at a site distant from vaccine administration
  • Must be given with the first dose of vaccine or up to day 7 of vaccination series 3, 2

• Rabies Vaccine:

  • Administer 4 doses on days 0,3,7, and 14 4
  • Inject intramuscularly in the deltoid area (adults) or anterolateral thigh (children)
  • Never administer in the gluteal area 3

3. For Previously Vaccinated Individuals

• Only vaccine is required (2 doses on days 0 and 3)
• RIG is not necessary 3, 2

Bat Testing and Discontinuation of Prophylaxis

• If possible, safely collect the bat for rabies testing 1
• If the bat tests negative for rabies, prophylaxis can be discontinued 2
• If the bat is unavailable for testing, complete the full prophylaxis regimen 1

Special Considerations

• Bat bites may be minor and difficult to recognize, yet still transmit rabies 2, 5
• Rabies is almost invariably fatal once clinical symptoms develop, making prompt prophylaxis essential 6
• Children should be taught to avoid contact with bats, especially those that appear sick or injured 5
• Consult local or state public health officials for guidance in complex exposure situations 1, 2

Common Pitfalls to Avoid

• Delaying treatment while waiting for bat test results - begin prophylaxis immediately and discontinue if testing is negative 2
• Underestimating the risk of bat exposures due to minimal or unrecognized wounds 1
• Improper RIG administration - ensure thorough wound infiltration 3
• Neglecting proper wound cleansing, which is a critical first step 3
• Administering vaccine in the gluteal area, which may result in inadequate antibody response 3