What are the Indian rabies guidelines for a patient bitten by a rat?

Indian Rabies Guidelines for Rat Bites

Direct Recommendation

Rat bites in India generally do NOT require rabies post-exposure prophylaxis (PEP) unless the rat was acting abnormally or local epidemiology indicates rabies in rodents, but immediate wound care is mandatory and local health authorities must be consulted for case-specific guidance. 1

Risk Assessment for Rodent Bites

Low-Risk Classification

• Rodents (including rats, mice, squirrels, hamsters, guinea pigs, gerbils, and chipmunks) are almost never found to be infected with rabies and have not been known to cause rabies among humans in the United States. 1
• Small rodents are considered negligible risk for rabies transmission globally 1

Important Exception - Bandicoot Rats

• If the bite is from a bandicoot rat (greater bandicoot rat, Bandicota indica), which is larger and found in India, treat this as a HIGH-RISK exposure requiring full rabies PEP. 2
• Bandicoot rats and other large rodents have been documented to carry rabies in endemic areas 2, 3

When to Initiate PEP for Rat Bites

Administer full rabies prophylaxis if ANY of the following apply:

• The rat was acting abnormally or aggressively (unprovoked attack) 1
• The rat cannot be captured for observation or testing 3
• Local health department confirms rabies in rodents in your area 1, 3
• The rat is a large species like bandicoot rat 2
• The rat is a non-traditional rodent species (Gambian pouch rats, etc.) 3

Immediate Wound Management (ALWAYS Required)

Regardless of whether PEP is indicated, perform thorough wound care immediately: 1, 4

1. Wash the wound with soap and copious water for at least 15 minutes - this is the single most important step to reduce rabies transmission risk 1, 2, 4, 5
2. Apply dilute povidone-iodine solution to the wound after washing 1, 4
3. Avoid suturing the wound when possible to allow drainage 4
4. Assess for nerve or tendon injury 1, 4

Full Rabies Post-Exposure Prophylaxis Protocol (If Indicated)

For Previously Unvaccinated Patients

Administer BOTH rabies immunoglobulin AND vaccine simultaneously on Day 0: 2, 3, 4

Human Rabies Immunoglobulin (HRIG)

• Dose: 20 IU/kg body weight 1, 2, 3
• Infiltrate the full dose around and into the wound if anatomically feasible 1, 2, 3
• Inject any remaining volume intramuscularly at a site distant from the vaccine 2, 4
• HRIG can be given up to Day 7 if not initially administered, but NEVER after Day 7 as it suppresses active antibody production 1, 4

Rabies Vaccine Series

• 5-dose regimen: Days 0,3,7,14, and 28 1, 4
• Administer at a different anatomical site from HRIG 2, 3
• Use cell culture vaccines (HDCV or PCECV) 1, 3

For Previously Vaccinated Patients

• Vaccine ONLY (no HRIG) - 2 doses on Days 0 and 3 1

Additional Essential Measures

1. Tetanus prophylaxis: Assess immunization status and administer booster if indicated 1, 2, 4
2. Antibiotic prophylaxis: Consider if presentation is delayed >8-12 hours or wound is high-risk 2, 4
3. Report to local health department immediately for guidance on local rabies epidemiology 1, 2, 3

Critical Pitfalls to Avoid

• Never delay rabies prophylaxis waiting for animal testing if the animal is high-risk, unavailable, or confirmed rabid 2, 4
• Never administer HRIG after Day 7 of the vaccine series 2, 4
• Never exceed the recommended HRIG dose of 20 IU/kg as excess suppresses vaccine response 1, 4
• Do not assume all rodents are low-risk - large rodents like bandicoot rats require full PEP 2, 3
• Do not withhold prophylaxis based on time elapsed since exposure unless clinical rabies is already present 4

Algorithm for Decision-Making

Step 1: Identify the rodent species

• Small rat (common house rat) → Likely low-risk
• Bandicoot rat or large rodent → HIGH-RISK, proceed with PEP

Step 2: Assess animal behavior and availability

• Normal behavior + available for observation → Low-risk
• Abnormal/aggressive behavior OR unavailable → HIGH-RISK, proceed with PEP

Step 3: Contact local health department

• Confirm local rabies epidemiology in rodents
• Follow their specific guidance for your region

Step 4: When in doubt, TREAT

• Rabies is 100% fatal once symptoms appear but nearly 100% preventable with proper prophylaxis 6
• The risk of PEP is minimal compared to the risk of rabies death 5, 6