Post-Exposure Prophylaxis is Absolutely Indicated
If a dog that licked a person 7 days ago has now died of rabies, full post-exposure prophylaxis (PEP) must be initiated immediately, consisting of rabies immune globulin (RIG) plus a 4-dose vaccine series, regardless of the 7-day delay. 1
Why This Exposure Requires PEP
Licking Constitutes a Rabies Exposure
- A lick from a rabid animal on broken skin, open wounds, or mucous membranes is classified as a nonbite exposure and requires full PEP. 2, 3
- Rabies virus is transmitted when saliva or potentially infectious material contacts open cuts, wounds, or mucous membranes. 2
- If the lick contacted intact skin only with no wounds or mucous membrane exposure, PEP would not be indicated. However, given the dog died of rabies, err on the side of caution and assume there was some breach in skin integrity. 2
The 7-Day Delay Does Not Eliminate the Need for PEP
- PEP should be initiated regardless of the interval from exposure, even if many months have passed, as long as clinical rabies symptoms have not yet appeared. 1
- Rabies incubation periods can range from days to over 1 year in humans, making delayed treatment still potentially life-saving. 1
- The fact that treatment is starting 7 days post-exposure is not ideal but does not contraindicate PEP—this is a medical urgency, not an emergency, but action must not be delayed further. 1
Complete PEP Protocol Required
For Previously Unvaccinated Persons
The full regimen consists of:
Immediate thorough wound washing with soap and water for approximately 15 minutes, even 7 days later. 1, 2, 4
Rabies immune globulin (RIG) administered once:
- Infiltrate as much as anatomically feasible into and around the wound site (even if healing has begun). 2
- Administer any remaining volume intramuscularly at a site distant from vaccine administration. 2
- RIG can be given through day 7 after the first vaccine dose; beyond day 7, it should not be given as antibody response to vaccine is presumed to have occurred. 2
Rabies vaccine series - 4 doses administered intramuscularly (deltoid area in adults):
- Day 0 (immediately)
- Day 3
- Day 7
- Day 14 1
Critical Timing Consideration
- Since the exposure occurred 7 days ago, if you administer the first vaccine dose today (day 7), RIG can still be given simultaneously. 2
- If treatment is delayed beyond day 7 from the first vaccine dose, RIG should be omitted and only vaccine continued. 2
Why the Dog's Death Confirms Rabies Risk
- A dog that died of confirmed rabies 7 days after licking someone was infectious at the time of the lick. 1
- The standard 10-day observation period for healthy dogs exists because dogs do not shed rabies virus in saliva more than 10 days before showing clinical signs. 1
- A dog that died of rabies within 7 days of the exposure was either already symptomatic or in the late incubation period with viral shedding at the time of contact. 1
Common Pitfalls to Avoid
- Do not delay PEP waiting for laboratory confirmation if the dog died with rabies-compatible illness—begin immediately and discontinue only if testing proves negative. 2
- Do not administer vaccine in the gluteal area—this has been associated with PEP failures; use the deltoid muscle in adults. 1
- Do not omit RIG in previously unvaccinated persons—vaccine alone following severe exposure has failed to provide protection. 5
- Do not assume a "lick" is harmless—carefully assess whether mucous membranes or any breaks in skin were contacted. 2, 3
Special Populations
- For previously vaccinated persons (completed pre-exposure or prior PEP series): Give only 2 doses of vaccine on days 0 and 3, without RIG. 6
- For immunocompromised persons: Use a 5-dose vaccine regimen (days 0,3,7,14,28) plus RIG. 1
Human rabies is 100% fatal once symptoms develop but is entirely preventable with prompt, complete PEP. 7, 8 Given the confirmed rabid dog exposure, full PEP must be initiated without further delay.