What is the post-exposure prophylaxis (PEP) for rabies after consuming milk from a rabid buffalo?

Post-Exposure Prophylaxis for Rabies After Consuming Milk from a Rabid Buffalo

Drinking pasteurized milk from a rabid buffalo does not constitute a rabies exposure and does not require post-exposure prophylaxis. 1

Key Principle: Pasteurization Inactivates Rabies Virus

• Pasteurization temperatures completely inactivate rabies virus, making consumption of pasteurized milk or cooked meat safe and not a rabies exposure. 1
• The National Association of State Public Health Veterinarians explicitly states that "drinking pasteurized milk or eating cooked meat does not constitute a rabies exposure." 1

Risk Assessment Based on Milk Processing

Pasteurized Milk (No PEP Required)

• No post-exposure prophylaxis is needed if the milk was pasteurized, regardless of whether the buffalo was rabid. 1
• The heat treatment during pasteurization destroys the rabies virus completely. 1

Raw (Unpasteurized) Milk (PEP Recommended)

• If raw milk from a confirmed or suspected rabid buffalo was consumed, this should be treated as a potential Category III exposure requiring full post-exposure prophylaxis. 2
• Guidelines explicitly state that "neither tissues nor milk from a rabid animal should be used for human or animal consumption." 1
• While oral transmission of rabies is extremely rare, the theoretical risk exists through contamination of mucous membranes in the mouth or gastrointestinal tract. 2

Post-Exposure Prophylaxis Protocol (If Raw Milk Consumed)

For Previously Unvaccinated Individuals

• Administer Human Rabies Immune Globulin (HRIG) at 20 IU/kg body weight immediately. 2
• Initiate rabies vaccine series: 5 doses of HDCV or PCECV (1.0 mL intramuscularly in the deltoid) on days 0,3,7,14, and 28. 2
• Never administer vaccine in the gluteal area. 2

For Previously Vaccinated Individuals

• Administer only 2 doses of rabies vaccine (1.0 mL intramuscularly) on days 0 and 3. 2, 3
• Do not administer HRIG, as it may interfere with the anamnestic immune response. 2, 3

Critical Decision Algorithm

1. Determine if milk was pasteurized:

   • If YES → No PEP required 1
   • If NO or UNKNOWN → Proceed to step 2

2. Confirm rabies status of buffalo:

   • If buffalo confirmed rabid AND milk was raw → Full PEP indicated 1, 2
   • If buffalo status unknown → Consult local public health authorities for risk assessment 2

3. Assess vaccination history:

   • Previously unvaccinated → HRIG + 5-dose vaccine series 2
   • Previously vaccinated → 2-dose vaccine series only 2, 3

Common Pitfalls to Avoid

• Do not delay prophylaxis while awaiting confirmation of the buffalo's rabies status if raw milk consumption from a suspected rabid animal occurred. 2
• Do not assume all commercially available milk is pasteurized—verify processing method, especially in rural or farm settings where raw milk consumption is more common. 1
• Do not confuse this scenario with direct bite or scratch exposures—the risk from oral consumption is theoretical but guidelines mandate caution with any products from rabid animals. 1, 2

Livestock Management Context

• Federal guidelines require that any livestock known to have been exposed to rabies within 8 months be rejected for slaughter. 1
• Unvaccinated livestock exposed to rabid animals should be slaughtered immediately, and if slaughtered within 7 days of exposure, tissues may be consumed if liberal portions of the exposed area are discarded. 1
• However, once an animal is confirmed rabid (not just exposed), no tissues or milk should be used for consumption. 1