What is the post-exposure prophylaxis for cat scratch disease, specifically regarding anti-rabies (Antirabies) treatment?

From the Guidelines

Rabies post-exposure prophylaxis is not typically needed for a cat scratch alone unless the cat is showing signs of rabies, is a stray or unknown cat, or the incident occurred in an area with high rabies prevalence. If the cat is a healthy, vaccinated pet that can be observed for 10 days, prophylaxis is usually unnecessary. However, if the cat is suspected of having rabies, a complete post-exposure prophylaxis regimen should be administered, consisting of rabies immune globulin (HRIG) at the wound site and a series of vaccinations, as recommended by the Advisory Committee on Immunization Practices 1.

Key Considerations

• The wound should be thoroughly cleaned with soap and water for at least 15 minutes.
• For persons who have never been vaccinated against rabies, postexposure antirabies vaccination should always include administration of both passive antibody (HRIG) and vaccine (human diploid cell vaccine [HDCV] or purified chick embryo cell vaccine [PCECV]), as outlined in the recommendations 1.
• A regimen of 5 1-mL doses of HDCV or PCECV should be administered intramuscularly to previously unvaccinated persons, with the first dose administered as soon as possible after exposure (day 0), and additional doses on days 3,7,14, and 28 after the first vaccination 1.
• Tetanus prophylaxis should be considered if the last booster was more than 5 years ago.
• Rabies is nearly always fatal once symptoms develop, which is why prophylaxis decisions should be made quickly, ideally within 24 hours of exposure.

Additional Recommendations

• If you're uncertain about the cat's health status, consult a healthcare provider immediately for proper risk assessment.
• The cat should be observed for 10 days for signs of rabies, and if it develops symptoms, post-exposure prophylaxis should be initiated promptly.

From the Research

Post-Exposure Prophylaxis for Cat Scratch Disease

• The post-exposure prophylaxis for cat scratch disease, specifically regarding anti-rabies (Antirabies) treatment, involves prompt and thorough wound cleansing and immunization with modern cell culture vaccine, together with administration of rabies immune globulin to those individuals who have not previously received preexposure prophylaxis 2.
• In cases where the individual has been scratched by a cat, the risk of rabies transmission is present, and post-exposure prophabelsis should be considered 3, 4.
• The use of anti-rabies virus monoclonal antibody (mAb) products is being developed as alternatives to rabies immune globulin (RIG) for post-exposure prophylaxis, with some products receiving regulatory approval in certain countries 5.
• The administration of intra-dermal anti-rabies cell culture vaccine is also used as post-exposure prophylaxis, but its effectiveness may vary depending on the individual case 4.

Anti-Rabies Treatment

• The treatment for post-exposure prophylaxis includes the infiltration of rabies immune globulin (RIG) into the lesion site after bite exposure, besides wound care and vaccination 5.
• The use of a broad-spectrum and highly potent human monoclonal antibody cocktail for rabies prophylaxis is being explored as an alternative to RIG 5.
• The selection of two most potent mAbs, NP-19-9 and 11B6, as a cocktail treatment for post-exposure prophylaxis has shown promising results, with broad reactivity to different types of lyssaviruses isolates and no interference with each other 5.

Considerations for Post-Exposure Prophylaxis

• The risk of rabies transmission through cat scratches is present, and post-exposure prophylaxis should be considered in cases where the individual has been scratched by a cat 3, 4.
• The effectiveness of post-exposure prophylaxis depends on the timely and appropriate administration of treatment, including wound care, vaccination, and administration of rabies immune globulin or alternative treatments 2, 5.