What to do after a dog bite if already vaccinated against rabies (Rabies Virus Vaccine)?

Management of Dog Bite in Previously Rabies-Vaccinated Individuals

For individuals who have previously received rabies vaccination and experience a dog bite, immediate wound cleansing followed by a 2-dose booster vaccine series (on days 0 and 3) is recommended, without the need for rabies immunoglobulin. 1

Immediate Actions After Dog Bite

Wound Management

1. Immediate wound cleansing is critical regardless of vaccination status:
   • Thoroughly wash the wound with soap and water for 15 minutes 2
   • Irrigate with a virucidal agent (e.g., povidone-iodine) if available 1
   • Avoid closing infected wounds 1
   • Elevate the injured area if swollen 1

Evaluation of the Biting Animal

• Assess the circumstances of the bite (provoked vs. unprovoked) 3
• If possible, confine and observe the domestic dog for 10 days 3
• Any illness in the animal during confinement should be evaluated by a veterinarian and reported to public health authorities 3
• If the dog is stray or unwanted, it should be either confined for observation or euthanized and tested for rabies 3

Post-Exposure Prophylaxis for Previously Vaccinated Individuals

Vaccine Administration

• Previously vaccinated individuals require only a 2-dose booster series:
  • Administer 1.0 mL IM (in deltoid area) on days 0 and 3 1
  • No rabies immunoglobulin (RIG) is needed for previously vaccinated individuals 1

Important Considerations

• Never administer rabies vaccine in the gluteal area as this can result in diminished immune response and vaccine failure 1, 4
• Even with previous vaccination, post-exposure prophylaxis should be administered regardless of the time elapsed since exposure, provided no clinical signs of rabies are present 3

Additional Medical Considerations

Antibiotic Prophylaxis

• Consider broad-spectrum antibiotics for high-risk wounds:
  • Amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days is preferred 1
  • Alternative regimens for penicillin-allergic patients include doxycycline, fluoroquinolone plus metronidazole, or clindamycin plus TMP-SMZ 1

Tetanus Prophylaxis

• Administer tetanus toxoid (0.5 mL IM) if vaccination is outdated (>5 years) or status is unknown 1
• Tdap is preferred over Td if the former has not been previously given 1

Follow-up Care

• Schedule follow-up within 24-48 hours to assess for signs of infection 1
• Monitor for increasing redness, swelling, pain, warmth, or drainage 1
• Consider hospitalization if infection progresses despite appropriate therapy 1

Common Pitfalls to Avoid

1. Improper vaccine administration site: Administering the vaccine in the gluteal area can lead to vaccine failure 4
2. Delaying treatment: Even previously vaccinated individuals should receive prompt post-exposure prophylaxis
3. Inadequate wound cleansing: Thorough wound cleansing is essential regardless of vaccination status 2, 5
4. Applying inappropriate substances to wounds: Avoid applying herbs, "black stones," or unknown creams to bite wounds 5

Remember that while previous rabies vaccination significantly simplifies the post-exposure protocol (no RIG needed and fewer vaccine doses), proper wound care and timely medical attention remain essential for preventing rabies and other infections.