What should be done for a relative who got bitten by a greater bandicoot rat and didn't receive any rabies vaccine, it's been some time since the incident?

Immediate Rabies Post-Exposure Prophylaxis Required - Do Not Delay

Your relative needs immediate rabies post-exposure prophylaxis (PEP) regardless of how much time has passed since the bite, as rabies is nearly 100% fatal once symptoms develop but is preventable with prompt treatment. 1, 2

Why This Is Urgent

• Rodent bites, including greater bandicoot rats, require rabies evaluation because the animal cannot be confined for observation and wild/feral rodents may carry rabies in endemic areas 3, 1
• Rabies incubation periods are highly variable, ranging from 2 weeks to 6 years (average 2-3 months), meaning delayed treatment can still be effective 4
• Once clinical symptoms appear, rabies is virtually 100% fatal with only seven documented survivors worldwide 2, 5

Immediate Actions Required

1. Wound Management (If Not Already Done)

• Thoroughly wash the wound with soap and water for at least 15 minutes immediately - this is the single most effective measure for preventing rabies 6, 1
• Apply povidone-iodine solution after soap and water cleansing 6
• Assess tetanus immunization status and administer booster if indicated 1

2. Rabies Post-Exposure Prophylaxis Protocol

Your relative needs the complete PEP regimen started immediately: 1

• Human Rabies Immune Globulin (HRIG): 20 IU/kg body weight on Day 0

  • Infiltrate the full dose around and into the wound if anatomically feasible 1
  • Inject any remaining volume intramuscularly at a site distant from the vaccine 1

• Rabies Vaccine: 5-dose series over 28 days

  • Days 0,3,7,14, and 28 3, 1
  • Administer intramuscularly in the deltoid area (adults) or anterolateral thigh (children) 3
  • Never use the gluteal area 3

3. Do Not Wait for Animal Testing

• Wild mammals that bite humans should be considered for euthanasia and rabies examination, but prophylaxis must not be delayed waiting for results 3, 1
• The bandicoot rat cannot be observed for 10 days like domestic dogs/cats, making immediate PEP mandatory 3

Critical Pitfalls to Avoid

• Never delay PEP waiting for animal testing or observation - treatment should begin within 24 hours of recognition, but even delayed treatment can be life-saving 3, 1
• Do not exceed the recommended HRIG dose, as excess can suppress active antibody production 6
• Never administer HRIG and vaccine at the same anatomical site 6, 1
• Do not administer HRIG after day 7 of the vaccine series - it can interfere with vaccine-induced immunity 1

Geographic Considerations

• Small rodents (squirrels, rats, mice) are rarely found infected with rabies in the United States, but the local health department should be consulted before deciding to withhold prophylaxis 3
• In developing countries of Asia, Africa, and Latin America where your relative may have been bitten, rabies prevalence is higher and treatment is more urgent 6

Next Steps

1. Report the incident immediately to your local health department 1
2. Seek emergency medical care today to initiate the PEP regimen
3. Ensure completion of all 5 vaccine doses - the series must not be interrupted 1
4. If your relative has documented prior complete rabies vaccination, they need only 2 vaccine doses (days 0 and 3) without HRIG 6

The key message: Rabies PEP is nearly 100% effective when administered properly, but once symptoms develop, survival is virtually impossible. 2, 5 Time elapsed since the bite does not eliminate the need for prophylaxis given the variable incubation period. 4