What if a dog that didn't have rabies bites someone?

Management of Dog Bites When the Dog Does Not Have Rabies

If a dog that does not have rabies bites someone, the bitten person should be observed for 10 days without initiating rabies post-exposure prophylaxis, while focusing on proper wound care and tetanus prophylaxis as needed. 1

Assessment of Dog Status

When evaluating a dog bite case, determining whether the dog has rabies is critical for appropriate management:

• Observation Period: A healthy domestic dog that bites a person should be confined and observed for 10 days 2, 1
• Vaccination Status: Fully vaccinated dogs are unlikely to become infected with rabies, though rare cases have been reported 2
• Behavior Assessment: An unprovoked attack is more concerning than a provoked one (e.g., attempting to feed or handle an animal) 2, 1

Immediate Management of Dog Bites

Wound Care

• Thoroughly clean the wound with soap and water immediately 1
• Consider using a virucidal agent such as povidone-iodine solution 1
• Assess need for tetanus prophylaxis based on immunization history 1

Antibiotic Considerations

• Antibiotic prophylaxis is particularly important for:
  • Hand bites (NNT = 4) 3
  • Deep puncture wounds
  • Crush injuries
  • Wounds with significant tissue damage

Management Algorithm Based on Dog Status

1. Known, healthy dog available for observation:

   • Confine and observe the dog for 10 days
   • No rabies post-exposure prophylaxis needed unless the dog develops signs of illness
   • Focus on wound care and tetanus prophylaxis

2. Stray or unavailable dog:

   • Consider rabies post-exposure prophylaxis based on local rabies epidemiology
   • Consult local health department

3. Dog showing signs of rabies:

   • Immediately initiate rabies post-exposure prophylaxis
   • The dog should be humanely killed and tested for rabies

Special Considerations

Bite Location

• Facial bites may warrant more aggressive management due to:
  • Proximity to the brain
  • Shorter incubation period for rabies
  • Cosmetic concerns

Severity of Bite

• Deep puncture wounds carry higher infection risk than superficial abrasions
• Multiple bites are associated with higher risk of rabies if the animal is infected 4

Common Pitfalls to Avoid

• Unnecessary rabies prophylaxis: If the dog is healthy and available for observation, delaying rabies prophylaxis is appropriate 1
• Inadequate wound care: Thorough cleaning is essential to prevent infection
• Failure to report: Dog bites should be reported to local health authorities for proper surveillance
• Overlooking tetanus status: Always assess need for tetanus prophylaxis

Public Health Considerations

• Dog bites account for up to 1% of all emergency room visits 3
• School-age children make up almost half of those bitten 3
• Ensuring dogs are vaccinated against rabies according to recommended schedules is a crucial preventive measure 1

By following these guidelines, healthcare providers can appropriately manage dog bites while avoiding unnecessary treatments when the dog does not have rabies.