How soon after a dog bite can I get a rabies (Rabies Virus Vaccine) vaccination?

Rabies Vaccination After Dog Bite: Timing Guidelines

Rabies post-exposure prophylaxis (PEP) should be initiated as soon as possible after a dog bite—ideally within 24 hours—but can and should still be administered regardless of delay, even if weeks or months have passed since the exposure, as long as clinical rabies symptoms have not yet developed. 1, 2

Immediate Action Required

Start Treatment Urgently, Not Emergently

• Rabies PEP is a medical urgency, not a medical emergency, but decisions must not be delayed 1, 2, 3
• Begin treatment as soon as possible after exposure to maximize effectiveness 2
• For bites from animals suspected or proven rabid, postexposure prophylaxis should begin immediately 1, 2

No Time Limit for Starting PEP

• When a documented or likely exposure has occurred, PEP should be administered regardless of the length of delay, provided clinical signs of rabies are not present in the exposed person 1, 2
• Incubation periods of more than 1 year have been reported in humans, which is why delayed treatment is still effective 1, 2
• Even if recognition of exposure is delayed by weeks or months, PEP should still be initiated 1, 2

Complete PEP Protocol

For Previously Unvaccinated Persons

The essential components are immediate wound treatment plus administration of both rabies immune globulin (RIG) and vaccine 1, 2, 3

Wound Care (Critical First Step)

• Immediately and thoroughly wash all bite wounds and scratches with soap and water for approximately 15 minutes 1, 3
• Simple local wound cleansing has been shown to markedly reduce the likelihood of rabies 1
• Apply iodine-containing or similarly viricidal topical preparation where available 3

Rabies Immune Globulin (RIG)

• Administer RIG as promptly as possible after exposure, along with the first dose of vaccine 3
• If RIG was not administered when vaccination began (day 0), it can still be administered up to and including day 7 of the PEP series 2, 3
• After day 7, do not give RIG as it may interfere with active antibody production 3

Vaccine Schedule

• Current recommended schedule: 4 doses administered on days 0,3,7, and 14 2
• Older protocols used 5 doses over 28 days (days 0,3,7,14, and 28), which remains acceptable 1, 4
• Administer in the deltoid muscle for adults and older children; anterolateral thigh for infants and younger children 4
• Never inject in the gluteal area—subcutaneous fat may interfere with immune response and has been associated with vaccine failure 4

For Previously Vaccinated Persons

• Administer vaccine only (no RIG needed) 3
• Previously vaccinated means documented rabies antibody titer and completed pre-exposure or post-exposure regimen with cell culture vaccine 3

Dog-Specific Considerations

In Areas Where Canine Rabies Is NOT Endemic (U.S. and Territories)

A healthy domestic dog that bites should be confined and observed for 10 days before starting PEP 1

• Dogs that remain healthy for 10 days after a bite would not have been shedding rabies virus at the time of the bite 1
• Begin PEP immediately at the first sign of illness in the confined animal during the observation period 1, 3
• If the dog is stray, unwanted, or cannot be observed, either confine and observe for 10 days OR euthanize immediately and test for rabies 1
• Treatment can be discontinued if the dog remains healthy during the 10-day observation period 1

In Areas Where Canine Rabies IS Endemic (Most of Asia, Africa, Central/South America)

Exposures to dogs in canine rabies-enzootic areas carry high risk—initiate PEP immediately after such exposures 1

• Greater than 50% of rabies cases among humans in the United States result from exposure to dogs outside the United States 1
• Treatment can be discontinued if the dog remains healthy during a 10-day observation period, but start treatment immediately rather than waiting 1

Critical Timing Considerations

Why Immediate Treatment Matters

• The incubation period is typically 2-6 weeks but varies based on severity and location of exposure 3
• After severe bites about the face, neck, and arms, incubation may be as short as 10 days 3
• It takes approximately one week after starting vaccine for immunity to develop, making immediate passive immunization with RIG crucial 3

Common Pitfalls to Avoid

• Do not delay treatment while waiting for animal testing results when exposure to high-risk species has occurred 2
• Do not assume it's "too late" for PEP—even months-delayed treatment can be effective 1, 2
• Do not skip wound cleansing—this alone markedly reduces transmission risk 1, 2
• Do not administer vaccine in the gluteal area 4

When PEP Is Ineffective

PEP is ineffective once clinical signs of rabies develop in the exposed person 2, 3

• Once symptoms appear, rabies is nearly 100% fatal 5
• This underscores the importance of not delaying treatment 2