What is the World Health Organization (WHO) exposure category for a superficial dog bite in a healthy individual with no prior medical conditions?

WHO Rabies Exposure Category for Superficial Dog Bites

A superficial dog bite without bleeding is classified as WHO Category II exposure, which requires immediate vaccination but does NOT require rabies immunoglobulin (RIG). 1

WHO Exposure Categories Framework

The World Health Organization categorizes rabies exposures into three distinct levels that determine post-exposure prophylaxis requirements:

• Category I: Touching or feeding animals, licks on intact skin (no exposure) - no prophylaxis needed 1
• Category II: Nibbling of uncovered skin, minor scratches or abrasions without bleeding, licks on broken skin - vaccine only, no RIG required 1
• Category III: Single or multiple transdermal bites or scratches with bleeding, contamination of mucous membranes with saliva from licks, exposures to bats - both vaccine AND RIG required immediately 1

Critical Distinction: Superficial vs. Penetrating Wounds

The key determinant is whether the bite penetrated the skin and caused bleeding:

• If the dog bite only abraded the superficial epidermis without drawing blood, this constitutes Category II exposure requiring the 5-dose vaccine series on days 0,3,7,14, and 28, but RIG is not indicated 2, 3
• If any penetration of the skin by teeth occurred with bleeding, regardless of how minor it appears, this automatically escalates to Category III exposure requiring both RIG (20 IU/kg infiltrated around the wound) and the complete vaccine series 1, 2

Management Algorithm for Superficial Dog Bites

Immediate wound care is the single most important intervention:

• Thoroughly wash and flush the wound with soap and water for 15 minutes, which markedly reduces rabies transmission risk even before any biologics are administered 2
• Irrigate with povidone-iodine solution after soap and water cleansing 2

Assessment of the biting dog determines prophylaxis urgency:

• If the dog is healthy, domestic, and available for observation, confine and observe for 10 days without initiating prophylaxis immediately 1, 2
• The dog must remain alive and healthy throughout the entire 10-day period to reliably exclude rabies risk at the time of the bite 1
• If the dog is stray, unwanted, unavailable, or shows any signs of illness during observation, initiate immediate rabies vaccination (Category II) or full PEP with RIG (Category III) without waiting 2

Common Pitfalls to Avoid

Never delay wound cleansing while determining exposure category - the 15-minute soap and water wash should begin immediately regardless of subsequent prophylaxis decisions 2

Never confuse "superficial" with "safe" - even minor-appearing wounds from bats or wounds in high-risk anatomic locations (head, neck, hands, fingers) warrant more aggressive prophylaxis consideration due to proximity to the central nervous system 1

Never administer RIG after day 7 of the vaccine series - if vaccination has already begun, RIG is contraindicated as it may interfere with the developing immune response 2

The observation period must be prospective, not retrospective - if the dog dies, is killed, or develops illness before completing the full 10 days, the observation approach is invalidated and prophylaxis should be initiated immediately 3