What should be done if someone is bitten or scratched by a rabid bandicoot rat?

Management of Rabid Bandicoot Rat Bite or Scratch

If someone is bitten or scratched by a rabid bandicoot rat, immediately initiate post-exposure prophylaxis with both rabies immune globulin and rabies vaccine, as wild mammals that bite or otherwise expose persons should be considered for rabies examination and any person bitten by a wild mammal should immediately report to a physician for antirabies treatment evaluation. 1

Immediate Wound Management (First 15 Minutes)

• Thoroughly wash and flush the wound with soap and copious amounts of water for at least 15 minutes - this is the single most critical step to reduce rabies transmission risk 2, 3, 4
• Apply an iodine-containing or similarly viricidal topical preparation to the wound where available 3
• Avoid suturing puncture wounds, hand wounds, or high-risk bites to allow drainage and reduce infection risk 2
• Explore the wound for nerve or tendon laceration and foreign bodies 2

Rabies Post-Exposure Prophylaxis (Initiate Immediately)

For Previously Unvaccinated Persons

Administer both human rabies immune globulin (HRIG) AND rabies vaccine simultaneously on day 0 at different anatomical sites 2, 3, 5

Human Rabies Immune Globulin (HRIG)

• Dose: 20 IU/kg body weight 2, 3
• Infiltrate the full dose around and into the wound if anatomically feasible - any remaining volume should be injected intramuscularly at a distant site from the vaccine 2, 3
• HRIG can be administered up to day 7 if not given initially, but NEVER after day 7 as it interferes with active immunity 2
• Never exceed the 20 IU/kg dose as excess suppresses vaccine response 2

Rabies Vaccine Regimen

• 5-dose series over 28 days: days 0,3,7,14, and 28 2, 5
• Administer at a site anatomically separate from HRIG 3, 5
• Do not delay prophylaxis waiting for animal testing results - wild mammals like bandicoot rats should be presumed rabid until proven otherwise 1, 2

For Previously Vaccinated Persons

• Administer rabies vaccine alone (no HRIG needed) if the person has previously received complete pre-exposure or post-exposure vaccination with documented antibody titers 3, 5
• Use 2-dose regimen on days 0 and 3 5

Rationale for Immediate Treatment in Wild Rodent Bites

• Wild mammals that bite or otherwise expose persons should be considered for euthanasia and rabies examination 1
• Small rodents are rarely infected with rabies, but bandicoot rats are wild mammals and the local health department should be consulted before deciding whether to initiate prophylaxis 1, 3, 5
• However, if the animal is confirmed or suspected to be rabid, immediate prophylaxis is mandatory - the question specifically states "rabid bandicoot rat," making prophylaxis non-negotiable 1
• Management of animals other than dogs, cats, and ferrets depends on species, circumstances, local epidemiology, and the animal's potential for rabies exposure 1

Additional Essential Measures

• Assess tetanus immunization status and administer booster if indicated 2, 3
• Consider antibiotic prophylaxis, particularly if presentation is delayed >8-12 hours 2
• Report the incident immediately to local health department 1

Critical Pitfalls to Avoid

• Never delay rabies prophylaxis waiting for animal testing if the animal is confirmed rabid, high-risk, or unavailable 2
• Never administer HRIG after day 7 of the vaccine series 2
• Never withhold prophylaxis based on time elapsed since exposure unless clinical rabies is already present 2
• Do not suture high-risk wounds (puncture wounds, hand bites) as this increases infection risk 2
• Prophylaxis can only be discontinued if laboratory testing (direct fluorescent antibody test) confirms the animal was not rabid 2

Prognosis Without Treatment

• Rabies is nearly 100% fatal once clinical symptoms develop 6, 7, 8
• Post-exposure prophylaxis is nearly 100% effective when administered correctly and promptly 8
• Only seven individuals have survived rabies virus infection to date 8