Anti-Rabies Prophylaxis for Human Bites
Anti-rabies post-exposure prophylaxis (PEP) is NOT necessary after a human bite. 1
Evidence for No Rabies PEP After Human Bites
No documented laboratory-confirmed cases of human-to-human rabies transmission have ever occurred from a bite or non-bite exposure (excluding organ/tissue transplantation cases). 1
The only documented human-to-human rabies transmissions have occurred through transplanted corneas (8 cases), solid organs (7 cases), and vascular tissue (1 case) from donors who died of rabies. 1
Two suggested cases of human-to-human transmission in Ethiopia (one bite, one kiss) were never laboratory-confirmed, making them unreliable evidence. 1
When Healthcare Workers Should Consider PEP
Healthcare workers providing routine care to a patient with rabies do not need PEP unless they are reasonably certain they were bitten or their mucous membranes/non-intact skin was directly exposed to the patient's saliva or neural tissue. 1
Standard precautions (gowns, goggles, masks, gloves) during patient care—particularly during intubation and suctioning—will minimize any theoretical risk and eliminate the need for PEP. 1
Critical Distinction: Animal vs. Human Bites
All bites from high-risk animals (bats, raccoons, skunks, foxes, coyotes) require immediate PEP with both rabies vaccine and immunoglobulin unless the animal tests negative. 2, 3, 4
Any penetration of skin by animal teeth constitutes a bite exposure requiring evaluation, but this does not apply to human bites. 1, 2
The median risk of rabies transmission from a bat bite is estimated at 0.001 (1 in 1,000), while non-bite exposures have less than 1 in 1,000 risk. 5