Post-Exposure Prophylaxis for Category 3 Bite from a Vaccinated Dog
For a category 3 bite from a vaccinated dog, initiate immediate thorough wound cleansing with soap and water, confine and observe the dog for 10 days, and withhold rabies vaccine and immunoglobulin unless the dog develops signs of rabies during observation. 1
Risk Assessment Based on Dog's Vaccination Status
A fully vaccinated dog (with at least two doses of rabies vaccine) is extremely unlikely to transmit rabies. 1 In a nationwide U.S. study, only one dog and two cats that were vaccinated contracted rabies, and all three had received only single doses of vaccine—no documented vaccine failures occurred among dogs or cats that had received two vaccinations. 1
Immediate Wound Management (Critical First Step)
Immediately wash all bite wounds thoroughly with soap and water for approximately 15 minutes—this is the single most effective measure for preventing rabies and can markedly reduce transmission likelihood even without other prophylaxis. 1
Use a virucidal agent such as povidone-iodine solution to irrigate the wound if available. 1
Administer tetanus prophylaxis if the patient's immunization status is not current. 1, 2
Consider antibiotic prophylaxis based on wound characteristics—amoxicillin-clavulanate is first-line for deep wounds or signs of infection. 2
The 10-Day Observation Protocol
Confine the healthy vaccinated dog and observe for 10 days. 1 During this period:
Any illness in the animal should be evaluated immediately by a veterinarian and reported to the local health department. 1
If signs suggestive of rabies develop, the animal should be euthanized immediately and its head submitted for laboratory examination. 1
If the dog remains healthy throughout the 10-day observation period, no rabies post-exposure prophylaxis is needed. 1
When to Initiate Post-Exposure Prophylaxis
Do NOT initiate rabies vaccine or immunoglobulin immediately for bites from healthy, vaccinated dogs that can be observed. 1, 2
Initiate PEP immediately only if:
- The dog develops signs of rabies during the 10-day observation period 1
- The dog escapes and cannot be observed 1
- The dog's vaccination status cannot be verified or was inadequate (single dose only) 1, 2
- The exposure occurred in a canine rabies-enzootic area outside the United States 1
Complete Post-Exposure Prophylaxis Regimen (If Indicated)
If PEP becomes necessary, administer:
Rabies Immune Globulin (RIG): 20 IU/kg body weight on day 0—infiltrate the full dose around and into the wound if anatomically feasible, with any remaining volume administered IM at a site distant from vaccine administration. 1
Rabies vaccine: 4 doses of 1.0 mL IM (deltoid in adults, anterolateral thigh in children) on days 0,3,7, and 14. 1 (Note: The 5-dose regimen including day 28 was replaced by the 4-dose regimen in 2010 based on equivalent efficacy and cost savings.) 1
Never administer RIG in the same syringe or anatomical site as the first vaccine dose. 1
RIG can be given up to day 7 after the first vaccine dose if not given initially; beyond day 7, RIG is not indicated. 1
Geographic Considerations
In the United States (where canine rabies is not enzootic), the 10-day observation period is reliable and standard practice. 1
In canine rabies-enzootic areas (most of Asia, Africa, and Central/South America), some authorities recommend initiating PEP immediately even for vaccinated dogs, with discontinuation if the dog remains healthy during observation. 1
Common Pitfalls to Avoid
Do not administer unnecessary rabies PEP to patients bitten by healthy, vaccinated dogs that can be observed—this wastes resources and exposes patients to unnecessary medication risks. 2
Do not neglect thorough wound cleansing—inadequate washing is the most common error and significantly increases infection risk. 1, 2
Do not fail to establish a concrete 10-day observation plan with documented follow-up—ensure the dog's owner understands reporting requirements. 2
Do not use the gluteal area for vaccine administration—this results in lower antibody titers; always use the deltoid in adults. 1
Do not exceed the recommended RIG dose—excess RIG can partially suppress active antibody production. 1