Immediate Action Required: Wash the Wound Now
Even though you have already received the rabies vaccine, you must immediately and thoroughly wash the wound with soap and abundant water for approximately 15 minutes, regardless of the delay since the bite occurred. 1, 2
Why Wound Washing is Critical
- Wound cleansing is the single most important measure for preventing rabies, independent of vaccination status. 1, 2
- Animal studies demonstrate that simple local wound cleaning markedly reduces the likelihood of rabies transmission, even without vaccination. 1
- The fact that you applied "thick cotton paint" (likely an antiseptic or topical agent) does not substitute for proper mechanical washing with soap and water. 1, 2
What You Must Do Right Now
Immediate Wound Care
- Wash the wound immediately and exhaustively with abundant soap and water for 15 minutes. 2, 3
- After soap and water washing, irrigate the wound with a virucidal agent like povidone-iodine solution if available. 2
- Remove any foreign material or debris during washing. 1
Complete Your Vaccination Series
- If this was your first rabies vaccine dose after the exposure, you must complete the full post-exposure prophylaxis (PEP) series. 1, 2
- For previously unvaccinated persons, the current recommended schedule is 4 doses on days 0,3,7, and 14. 2, 4
- Each vaccine dose should be administered intramuscularly in the deltoid area (or anterolateral thigh in children). 1, 2
Assess Need for Rabies Immunoglobulin (RIG)
- If you have never been vaccinated against rabies before this exposure, you should have received rabies immunoglobulin (HRIG) at 20 IU/kg body weight infiltrated around and into the wound on day 0. 1, 2
- If you did not receive HRIG with your first vaccine dose, contact your healthcare provider immediately to determine if it can still be administered. 1
- HRIG is given only once, at the beginning of PEP, and provides immediate passive immunity while your body develops its own antibodies from the vaccine. 2
Critical Timing Considerations
- Rabies post-exposure prophylaxis is a medical urgency, not an emergency, but decisions must not be delayed. 1
- Even if significant time has passed since the bite, you should still wash the wound now and complete your vaccination series, as incubation periods of more than 1 year have been documented. 1
- The combination of proper wound care, HRIG (if indicated), and complete vaccination is nearly 100% effective when administered correctly. 5, 4
Common Pitfalls to Avoid
- Never assume that vaccination alone is sufficient—wound washing is equally essential and must be done regardless of vaccination status. 1, 2
- Do not allow the vaccine to be administered in the gluteal area, as this results in lower antibody titers and reduced protection. 1, 2
- Do not discontinue your vaccination series prematurely, even if the biting dog appears healthy or is available for observation. 1
Additional Measures
- Ensure your tetanus prophylaxis is up to date. 1, 6
- Monitor the wound for signs of bacterial infection and seek medical attention if redness, swelling, warmth, or discharge develops. 1, 6
- If possible, the biting dog should be confined and observed for 10 days to determine if it develops signs of rabies. 1