When is Rabies Post-Exposure Prophylaxis (PEP) indicated for a dog bite in Utah?

Rabies Post-Exposure Prophylaxis for Dog Bites in Utah

For dog bites in Utah, rabies post-exposure prophylaxis (PEP) is NOT routinely indicated for bites from healthy domestic dogs that can be observed for 10 days, but IS indicated for bites from stray, unwanted, or rabid dogs, or when the dog cannot be located for observation.

Decision Algorithm for Dog Bite PEP in Utah

Step 1: Assess the Dog's Status

• Owned, healthy domestic dog available for observation: No immediate PEP needed; observe dog for 10 days 1
• Stray or unwanted dog: Consider immediate euthanasia of the dog and testing for rabies 1
• Dog escaped/cannot be located: Consult public health officials about need for PEP 2
• Dog showing signs of rabies: Immediate PEP indicated 2

Step 2: Immediate Wound Management (Regardless of PEP Decision)

• Thoroughly wash and flush all bite wounds with soap and water for at least 15 minutes 3
• Apply povidone-iodine solution as a virucidal agent 3, 2
• Evaluate need for tetanus prophylaxis and antibiotics 3, 2

Step 3: Specific Circumstances Requiring PEP

• Dog develops clinical signs of rabies during the 10-day observation period 1
• Dog is confirmed rabid through testing 1
• Dog is unavailable for observation or testing (consult public health officials) 2
• Unprovoked attack (more likely to indicate rabies than a provoked attack) 1

PEP Protocol When Indicated

For Previously Unvaccinated Persons:

1. Rabies Immune Globulin (RIG): 20 IU/kg body weight, infiltrating the full dose around and into the wound if anatomically feasible 3
2. Rabies Vaccine: 5 doses administered on days 0,3,7,14, and 28 3

For Previously Vaccinated Persons:

• Vaccine alone (no RIG) on days 0 and 3 3

Important Considerations

Low Risk of Rabies in Utah Dogs

Utah has a very low incidence of rabies in domestic animals. The Advisory Committee on Immunization Practices (ACIP) notes that rabies among dogs is reported most commonly along the US-Mexico border and sporadically in areas with enzootic wildlife rabies 1.

Observation Period for Domestic Dogs

A healthy domestic dog that bites a person should be confined and observed for 10 days. If the dog remains alive and healthy during this period, it would not have been shedding rabies virus at the time of the bite 1.

Consultation with Public Health Officials

For any questions about the need for rabies prophylaxis, consult local or state public health officials who can provide guidance based on the specific circumstances and local epidemiology 2, 4.

Pitfalls and Caveats

• Don't delay wound cleaning: Immediate and thorough wound cleaning can significantly reduce the risk of rabies transmission 3
• Don't assume all dog bites require PEP: Healthy domestic dogs that can be observed for 10 days rarely require immediate PEP 1
• Don't wait for symptoms to appear: If PEP is indicated, it should be initiated immediately, as rabies is nearly 100% fatal once symptoms appear 5
• Don't forget to assess the circumstances: Unprovoked attacks are more likely to indicate rabies than provoked attacks 1
• Don't overlook the vaccination status of the dog: A currently vaccinated dog is unlikely to become infected with rabies 1

Remember that the decision to administer PEP should be made in consultation with local public health authorities who can provide guidance based on the specific circumstances of the bite and the local epidemiology of rabies.