Management of Stray Cat Bite with Previous Rabies Vaccination
This patient requires rabies booster vaccination (2 doses on days 0 and 3) without rabies immunoglobulin, plus thorough wound care and tetanus assessment.
Immediate Wound Management
Wash the puncture wound immediately and thoroughly with soap and water for approximately 15 minutes, which is the single most important intervention to reduce rabies transmission risk 1, 2.
Irrigate with a virucidal agent such as povidone-iodine solution if available 1, 2.
Assess tetanus immunization status—since the patient is up to date with tetanus vaccine, no tetanus immunoglobulin is needed, though a tetanus booster may be considered if the last dose was >5 years ago for a contaminated wound 3.
Consider antibiotic prophylaxis with amoxicillin-clavulanate for cat bites, as they have high infection rates due to deep puncture wounds 3.
Rabies Post-Exposure Prophylaxis for Previously Vaccinated Persons
The patient should receive only rabies vaccine (2 doses), NOT rabies immunoglobulin:
Administer 2 doses of rabies vaccine (1.0 mL IM in deltoid): one immediately (day 0) and one on day 3 1, 2, 4.
Do NOT administer rabies immunoglobulin (RIG)—this is critical because RIG can suppress the anamnestic antibody response in previously vaccinated individuals 1, 2.
Previously vaccinated persons are immunologically primed and mount a rapid secondary immune response with vaccine alone 1.
Why This Patient Needs Treatment Despite Previous Vaccination
A stray cat represents an unknown rabies risk—the cat's vaccination status cannot be verified and it cannot be observed for 10 days 1, 4.
Cat bites carry significant rabies risk in areas where rabies is enzootic, and stray animals have higher rabies prevalence than owned pets 1, 4.
The 2-hour timeframe is well within the window for effective post-exposure prophylaxis, which should be initiated as soon as possible but can be given even months after exposure 1, 2.
Why Other Options Are Incorrect
Option A (tetanus vaccine and immunoglobulin) is incomplete—it addresses tetanus but ignores the rabies risk from a stray cat 1.
Option B (rabies vaccine AND immunoglobulin) is incorrect—previously vaccinated persons should never receive RIG as it may blunt the rapid antibody response 1, 2.
Option C (observe and reassess after 48 hours) is dangerous—this delays necessary prophylaxis for a stray animal that cannot be observed 1, 2.
Option D (reassurance) is completely inappropriate—the cat is a stray with unknown health status, not a healthy observable pet 1, 4.
Critical Distinction: Previously Vaccinated vs. Unvaccinated
For previously UNVACCINATED persons, the regimen would be:
- RIG (20 IU/kg) infiltrated around the wound plus 4-5 doses of vaccine on days 0,3,7,14 (and 28) 1, 2, 4.
For previously VACCINATED persons (this patient):
Common Pitfalls to Avoid
Never administer RIG to previously vaccinated individuals—this is the most critical error and can interfere with the protective immune response 1, 2.
Do not delay treatment waiting to observe a stray animal—stray cats cannot be reliably observed for the required 10-day period 1, 4.
Never assume a stray animal is "healthy" without proper observation—rabies can be present before obvious clinical signs appear 1, 4.
Ensure vaccine is administered in the deltoid muscle (or anterolateral thigh in young children), never in the gluteal region, as this results in lower antibody titers 2, 4.