What if a rabid dog scratches my leg with its paw?

Rabies Risk from Dog Paw Scratch

A scratch from a rabid dog's paw requires the same rabies post-exposure prophylaxis as a bite, because scratches contaminated with saliva constitute a nonbite exposure that can transmit rabies virus. 1

Understanding the Exposure Risk

Scratches are explicitly classified as rabies exposures when they involve contamination with saliva or other potentially infectious material from a rabid animal. 1 The FDA-approved rabies immunoglobulin labeling specifically defines nonbite exposures as "scratches, abrasions, open wounds or mucous membranes contaminated with saliva or any potentially infectious material, such as brain tissue, from a rabid animal." 1

Key Mechanism of Transmission

• Rabies virus is transmitted when introduced into open cuts, wounds in skin, or via mucous membranes 1
• A dog's paw can easily be contaminated with saliva from licking, making scratches a legitimate transmission route 1
• The virus must penetrate the skin barrier to cause infection 2

Immediate Wound Management

Thoroughly wash the scratch wound immediately with soap and water - this is perhaps the most effective measure for preventing rabies and should be done for at least 5 minutes. 3, 1

• Use soap and water followed by a virucidal agent such as povidone-iodine solution 3
• In experimental animals, simple local wound cleansing has been shown to markedly reduce the likelihood of rabies 1
• This should be done immediately, even before seeking medical care 3, 1

Determining Need for Post-Exposure Prophylaxis

If the Dog Can Be Observed

If the dog is healthy and available, confine and observe it for 10 days without administering rabies vaccine during the observation period. 3, 2

• Any healthy domestic dog that scratches a person should be confined and observed for 10 days 3
• Dogs that remain alive and healthy 10 days after the exposure would not have been shedding rabies virus at the time of the scratch 3
• Begin post-exposure prophylaxis immediately if the animal develops any signs of illness during the 10-day observation period 3, 1
• If the animal exhibits clinical signs of rabies, it should be euthanized immediately and tested 3, 1

If the Dog Cannot Be Observed

Initiate rabies post-exposure prophylaxis immediately if the dog is stray, unwanted, or cannot be confined for observation. 3, 2

• Stray or unwanted dogs should either be observed for 10 days or euthanized immediately and submitted for rabies examination 3
• In developing countries where dog rabies is endemic, some authorities recommend initiating treatment immediately after exposures, which can be discontinued if the dog remains healthy during observation 3

Post-Exposure Prophylaxis Protocol

For previously unvaccinated individuals, administer both rabies immune globulin (RIG) and rabies vaccine as soon as possible, regardless of the interval from exposure. 3, 1

Components of Treatment

• Rabies Immune Globulin (RIG): Should be administered as promptly as possible after exposure, but can be given up to the eighth day after the first vaccine dose 1
• Rabies Vaccine Series: Five doses over a 28-day period for previously unvaccinated persons 3
• Incubation periods greater than 1 year have been reported in humans, so prophylaxis is indicated regardless of delay, provided clinical signs of rabies are not present 3

Previously Vaccinated Individuals

• Persons who have been previously immunized with rabies vaccine and have documented adequate rabies antibody titer should receive vaccine only, without RIG 1

Additional Wound Care Considerations

• Tetanus prophylaxis: Administer to patients without vaccination within the past 10 years 2
• Antibiotic prophylaxis: Consider for 3-5 days if the wound is moderate to severe, or if the patient is immunocompromised 2
• Follow-up evaluation: All patients should be seen within 48-72 hours to assess for signs of infection 2

Critical Pitfalls to Avoid

• Do not dismiss scratches as non-exposures - they are explicitly recognized as rabies transmission routes when contaminated with saliva 1
• Do not delay wound washing - this is the single most important immediate intervention 3, 1
• Do not wait for the dog to show symptoms before washing the wound - immediate cleansing is critical 3, 1
• Do not assume casual contact without skin penetration requires prophylaxis - only scratches that break the skin or contact mucous membranes constitute exposures 1

Consultation Recommendation

Contact local or state public health officials to determine the specific need for rabies prophylaxis based on regional rabies epidemiology. 3, 2, 1 The likelihood of rabies in domestic animals varies by region, and local health departments can provide current interpretations based on regional rabies prevalence 3, 1