Does a monkey bite require Antirabies Vaccination (ARVG)?

Monkey Bite and Rabies Post-Exposure Prophylaxis

Yes, a monkey bite requires immediate rabies post-exposure prophylaxis (PEP) with both rabies immunoglobulin (RIG) and rabies vaccine, as monkeys are mammals capable of transmitting rabies and should be treated as high-risk exposures when the animal cannot be captured and tested. 1, 2, 3

Risk Assessment for Monkey Bites

Monkeys fall into the category of mammals that require individualized assessment, but in practical terms should be treated as rabid unless proven otherwise:

• Any penetration of skin by teeth constitutes a bite exposure and represents potential rabies risk, regardless of the animal species 4
• Monkeys are not specifically listed in the "almost never require prophylaxis" category (which includes only small rodents like squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, and mice) 1, 2, 3
• Wild and exotic animals, including primates, should be regarded as potential rabies vectors when they cannot be captured and tested 1, 2

Immediate Treatment Protocol

Step 1: Wound Management (Critical First Step)

• Immediately wash and flush the bite wound thoroughly for approximately 15 minutes with soap and copious amounts of water 1
• Apply a povidone-iodine solution or other virucidal agent to the wound if available 5
• This local wound cleansing alone has been shown to markedly reduce the likelihood of rabies in experimental animals 5, 3
• Administer tetanus prophylaxis and consider antibiotic prophylaxis for bacterial infection control 5, 1

Step 2: Rabies Immunoglobulin (RIG) Administration

• Administer human rabies immunoglobulin (HRIG) at 20 IU/kg body weight as soon as possible, ideally within 24 hours of exposure 5, 6, 3
• Infiltrate up to the full dose (if anatomically feasible) thoroughly around and into the wound(s) 5, 6
• Any remaining volume should be injected intramuscularly at a site distant from vaccine administration 5, 6
• RIG can be administered up to day 7 after the first vaccine dose if not given initially, but beyond day 7 it is not indicated 5, 6
• Never administer RIG in the same syringe or anatomical site as the vaccine 5, 6

Step 3: Rabies Vaccine Schedule

For previously unvaccinated persons:

• Administer a 4-dose vaccine schedule with doses on days 0,3,7, and 14 6, 7
• Use Human Diploid Cell Vaccine (HDCV) or Purified Chick Embryo Cell Vaccine (PCECV) 6
• Inject in the deltoid area for adults and older children; use the anterolateral thigh for younger children 6
• Never administer vaccine in the gluteal area as this may result in diminished immune response 6

For previously vaccinated persons (completed pre-exposure or post-exposure series):

• Administer only a 2-dose vaccine schedule on days 0 and 3 without RIG 6

For immunocompromised patients:

• Use the extended 5-dose schedule on days 0,3,7,14, and 28 6
• Consider serologic testing to confirm adequate antibody response 6

Critical Timing Considerations

• Begin PEP immediately after exposure, regardless of the time interval between exposure and treatment initiation 5, 6, 1
• Rabies incubation periods exceeding 1 year have been documented in humans, so even delayed recognition of exposure warrants PEP 5, 6
• This is a medical urgency—do not delay treatment while attempting to locate or test the animal 6

Common Pitfalls to Avoid

• Do not wait to see if the monkey can be captured for testing before initiating PEP—in most cases with wild or escaped monkeys, this is not feasible and treatment should begin immediately 1, 2
• Do not administer less than the recommended dose of RIG, as rare failures of PEP have been reported when smaller amounts were infiltrated at exposure sites 5
• Do not use the 4-dose schedule for immunocompromised patients; they require the full 5-dose regimen 6
• Do not assume that because monkeys are not specifically mentioned in guidelines that they are low-risk—they are mammals and should be treated as potential rabies vectors 1, 2

When to Consult Public Health Officials

• Contact local or state public health officials for guidance on regional rabies prevalence in primates 1, 2, 3
• If the monkey is captured and available for testing, coordinate with public health authorities for expeditious laboratory testing 1
• If testing confirms the animal is negative for rabies, PEP can be discontinued 1, 2