Is anti-rabies (rabies) vaccine recommended for a cat bite?

Rabies Post-Exposure Prophylaxis for Cat Bites

For cat bites, rabies post-exposure prophylaxis (PEP) is recommended if the cat cannot be confined and observed for 10 days, if the cat is stray/unwanted, or if the cat develops signs of rabies during observation. 1

Immediate Wound Management (All Cat Bites)

• Immediately and thoroughly wash all bite wounds with soap and water for 15 minutes - this is the single most effective measure for preventing rabies. 1, 2
• Use povidone-iodine solution for irrigation after soap and water cleansing. 1, 2
• Administer tetanus prophylaxis as indicated. 1
• Consider antibiotic prophylaxis (amoxicillin/clavulanate is first-line) as cat bites have high infection rates. 3

Decision Algorithm for Rabies PEP

If the cat is healthy and available for observation:

• Confine and observe the cat for 10 days - cats that remain healthy during this period were not shedding rabies virus at the time of the bite. 1
• Do not initiate PEP during the observation period unless the cat develops signs of illness. 1
• If the cat develops any illness during confinement, immediately initiate PEP and euthanize the animal for rabies testing. 1

If the cat is stray, unwanted, or cannot be confined:

• Immediately initiate rabies PEP - the cat should either be confined for observation or euthanized immediately for rabies testing. 1
• A feral cat that cannot be quarantined must be assumed rabid. 4

Geographic and epidemiologic considerations:

• In the United States (2000-2006), more cats than dogs were reported rabid, primarily due to lower vaccination rates and exposure to wildlife reservoirs like raccoons. 1
• Cat bites in developing countries of Asia, Africa, and Latin America warrant heightened concern due to higher regional rabies prevalence. 1, 2

Rabies PEP Protocol (When Indicated)

The standard regimen consists of both passive and active immunization: 1, 2, 5

Passive immunization:

• Human Rabies Immune Globulin (HRIG) 20 IU/kg body weight administered once on day 0. 1, 5
• Infiltrate the full dose around and into the wound if anatomically feasible; inject remaining volume intramuscularly at a site distant from vaccine administration. 1
• HRIG can be given up to day 7 if not administered initially, but is not indicated beyond day 7. 1

Active immunization:

• 5 doses of rabies vaccine (HDCV or PCECV) on days 0,3,7,14, and 28. 1, 2
• Begin within 24 hours of exposure when possible, though delayed initiation is still effective. 1

Exception - Previously vaccinated persons:

• Individuals with documented prior complete rabies vaccination receive vaccine only (no HRIG) - 2 doses on days 0 and 3. 1

Critical Pitfalls to Avoid

• Never delay wound cleansing - this is your first and most important intervention. 2
• Do not initiate unnecessary PEP for healthy domestic cats that can be observed - this wastes resources and exposes patients to unnecessary treatment. 2
• Do not assume vaccination status alone eliminates risk - even vaccinated cats can rarely develop rabies, though this is extremely uncommon. 1
• Do not exceed the recommended HRIG dose - excess HRIG can suppress active antibody production. 1
• Do not administer HRIG and vaccine at the same anatomical site. 1

Additional Considerations

• Unprovoked attacks are more likely to indicate rabies than provoked attacks (e.g., attempting to feed or handle the animal). 1
• Consult local or state health departments for region-specific rabies epidemiology and guidance. 1, 5
• If the cat tests negative for rabies by laboratory testing, discontinue PEP immediately. 1