What vaccinations are required after a cat bite?

Cat Bite Vaccination Requirements

After a cat bite, immediately wash the wound thoroughly with soap and water for 15 minutes, assess tetanus immunization status and provide prophylaxis if needed, and initiate rabies post-exposure prophylaxis (Rabies Immune Globulin plus a 4-5 dose vaccine series) unless the cat is healthy, available for 10-day observation, and properly vaccinated. 1, 2

Immediate Wound Management

• Thoroughly wash and flush all bite wounds immediately with soap and water for approximately 15 minutes to reduce infection risk and potential rabies transmission 1, 3, 4, 2
• Irrigate with povidone-iodine solution after soap and water cleansing, as this virucidal agent further reduces rabies risk 1, 3, 4
• Examine the wound carefully for depth, tendon involvement, bone involvement, or joint penetration 3, 4

Tetanus Prophylaxis

• Assess tetanus immunization status and administer tetanus prophylaxis as indicated 1, 3, 4, 2
• Administer tetanus toxoid to patients with unknown or incomplete tetanus immunization 4

Rabies Post-Exposure Prophylaxis Decision Algorithm

When Rabies Prophylaxis is NOT Required:

• If the cat is healthy, available for 10-day observation, and properly vaccinated, confine and observe the cat for 10 days without initiating prophylaxis 1, 4, 2
• If the cat remains healthy for the full 10 days, no rabies prophylaxis is needed 4
• A fully vaccinated cat is unlikely to become infected with rabies, though rare cases have been reported 1, 4

When Rabies Prophylaxis IS Required:

Initiate immediate rabies post-exposure prophylaxis if: 1, 4, 2

• The cat is stray or unwanted
• The cat cannot be confined for observation
• The cat dies or develops illness before completing the 10-day observation period
• The cat shows signs suggestive of rabies during observation (euthanize immediately and test)
• The cat's vaccination status is unknown or inadequate 3

Rabies Post-Exposure Prophylaxis Regimen:

For previously unvaccinated persons: 1, 4, 2, 5

• Rabies Immune Globulin (RIG): 20 IU/kg body weight given once on day 0 (infiltrate as much as possible around the wound site, with remainder given intramuscularly at a site distant from vaccine administration) 4, 2
• Rabies vaccine series: 5 doses on days 0,3,7,14, and 28 (administered intramuscularly in the deltoid muscle for adults and older children, or anterolateral thigh for infants and small children) 1, 4, 5

For previously vaccinated persons (those with documented rabies antibody titers or completed pre-exposure/post-exposure vaccination with cell culture vaccine):

• Administer vaccine only (no RIG) - 2 doses on days 0 and 3 2, 5

Critical Timing Considerations:

• Begin post-exposure prophylaxis as soon as possible, ideally within 24 hours 1
• However, prophylaxis should be initiated regardless of delay, as incubation periods greater than 1 year have been reported 1
• If RIG was not given when vaccination began (day 0), it can still be administered up to and including day 7 of the vaccine series 2

Antibiotic Prophylaxis

• Cat bites have the highest infection risk (20-80%) compared to dog bites (3-18%), primarily due to Pasteurella multocida, which is isolated in over 50% of cat bite wounds 6, 7
• Amoxicillin-clavulanate is the first-line prophylactic antibiotic for cat bite wounds, particularly for hand wounds, puncture wounds, wounds over tendons or bones, and immunocompromised patients 3, 4, 6, 8
• For penicillin-allergic patients, alternatives include doxycycline, fluoroquinolone plus an agent active against anaerobes, or clindamycin plus a fluoroquinolone 3, 4
• Approximately 90% of domestic cats carry P. multocida in their oral cavity, making prophylactic antibiotics appropriate for most cat bites 7

Risk Assessment Factors

• Unprovoked attacks are more likely to indicate rabies than provoked attacks (bites inflicted while attempting to feed or handle an apparently healthy animal are generally regarded as provoked) 1, 4, 2
• More cats than dogs are reported rabid in the United States, with the majority associated with raccoon rabies epizootics in the eastern US 1
• This high rabies rate in cats is attributed to fewer cat vaccination laws, fewer leash laws, and roaming habits 1

Common Pitfalls to Avoid

• Never delay wound cleansing - this is the first and most important intervention, as thorough wound cleansing alone has been shown to markedly reduce rabies likelihood in animal studies 1, 4
• Do not exceed the recommended RIG dose (20 IU/kg), as excess RIG can suppress active antibody production 4
• Do not initiate unnecessary post-exposure prophylaxis for healthy domestic cats that can be observed for 10 days 4
• Do not fail to establish a 10-day observation plan for the cat and document its vaccination status 3
• Monitor the wound for signs of infection including increasing redness, swelling, warmth, pain, purulent discharge, fever, or systemic symptoms 3

Potential Complications

• Infectious complications include septic arthritis, osteomyelitis, subcutaneous abscess, tendonitis, and bacteremia caused by Pasteurella species, Staphylococci, and anaerobes 4, 9
• Capnocytophaga canimorsus can cause fatal sepsis, particularly in patients with asplenia or underlying hepatic disease 4, 9
• Disseminated infections from P. multocida can lead to septic shock, meningitis, endocarditis, and other severe sequelae 9