What is the recommended number of rabies vaccinations for a patient bitten by a Greater Bandicoot Rat?

Rabies Post-Exposure Prophylaxis for Greater Bandicoot Rat Bite

For a Greater Bandicoot Rat bite in a previously unvaccinated person, administer 4 doses of rabies vaccine on days 0,3,7, and 14, plus rabies immune globulin (RIG) at 20 IU/kg on day 0. 1

Critical Context: Rodent Bites and Rabies Risk

While the guidelines provided focus on rabies post-exposure prophylaxis protocols, it's essential to recognize that rodent bites (including rats) are generally NOT considered rabies exposures in the United States and most developed countries. Small rodents like rats are almost never found to be infected with rabies and have not been known to transmit rabies to humans. 1

However, if rabies exposure is suspected or confirmed based on local epidemiology or specific circumstances, the standard protocol applies:

Standard Post-Exposure Prophylaxis Regimen

For Previously Unvaccinated Persons:

• Immediate wound care: Thoroughly wash all wounds with soap and water for 15 minutes, followed by irrigation with a virucidal agent such as povidone-iodine solution if available 1, 2

• Rabies Immune Globulin (RIG): Administer 20 IU/kg body weight on day 0, ideally at the same time as the first vaccine dose 1, 2, 3

  • Infiltrate the full calculated dose around and into the wound(s) if anatomically feasible 1, 3
  • Any remaining volume should be administered intramuscularly at a site distant from vaccine administration 1, 3
  • Never administer RIG in the same syringe or anatomical site as the vaccine 1, 3
  • RIG can be given up to and including day 7 after the first vaccine dose if not initially administered 2, 3

• Vaccine regimen: 4 doses of HDCV or PCECV, 1.0 mL intramuscularly on days 0,3,7, and 14 1, 2, 4

  • Day 0 is defined as the day the first dose is administered 1, 2
  • Inject in the deltoid muscle for adults and older children 1, 2
  • Use the anterolateral thigh for young children 1, 2
  • Never use the gluteal area as this produces inadequate antibody response 1, 2, 3

For Previously Vaccinated Persons:

• Only 2 doses of vaccine (on days 0 and 3) are required 1, 2, 5
• No RIG is needed for previously vaccinated individuals 1, 2, 5

For Immunocompromised Patients:

• 5-dose vaccine regimen on days 0,3,7,14, and 28, plus RIG at 20 IU/kg on day 0 2, 5, 6
• This applies even if previously vaccinated 2, 5
• Serologic testing should be performed 1-2 weeks after the final dose to confirm adequate antibody response 2

Critical Pitfalls to Avoid

• Do not exceed 20 IU/kg of RIG, as higher doses suppress active antibody production 1, 2, 3
• Do not give RIG to previously vaccinated persons (unless immunocompromised), as it inhibits the anamnestic response 2, 5
• Do not delay initiation of PEP - begin as soon as possible after exposure, ideally within 24 hours 2, 7
• Do not use the gluteal area for vaccine administration - this is associated with vaccine failure 1, 2, 3

Efficacy

When administered promptly and appropriately, this PEP regimen is nearly 100% effective in preventing human rabies. 2, 4, 7