Anti-Rabies Vaccine Booster for Category II Cat Scratch (Previously Vaccinated Individual)
For a previously vaccinated individual with a Category II cat scratch exposure, administer a 2-dose rabies vaccine booster on days 0 and 3 without rabies immunoglobulin (RIG). 1
Immediate Wound Management
- Thoroughly wash and flush the scratch with soap and water for approximately 15 minutes immediately after exposure 2, 3
- Irrigate with povidone-iodine solution after soap and water cleansing, as this virucidal agent reduces rabies transmission risk 2, 1
- Assess tetanus immunization status and administer tetanus prophylaxis if indicated 2, 4
Rabies Post-Exposure Prophylaxis for Previously Vaccinated Persons
The critical distinction for previously vaccinated individuals is that they require only vaccine without RIG. 1
Definition of Previously Vaccinated Status
A person is considered previously vaccinated if they have any of the following: 1
- Prior pre-exposure vaccination with HDCV, RVA, or PCEC
- Prior post-exposure prophylaxis with HDCV, RVA, or PCEC
- Previous vaccination with any other type of rabies vaccine AND documented history of antibody response
Vaccine Regimen for Previously Vaccinated Persons
- Administer 1.0 mL rabies vaccine intramuscularly in the deltoid area on days 0 and 3 only 1
- Do NOT administer rabies immunoglobulin (RIG) to previously vaccinated persons 1
- The deltoid area is the only acceptable site for adults and older children; for younger children, use the outer aspect of the thigh 1
- Never administer vaccine in the gluteal area due to risk of sciatic nerve injury 1
Risk Assessment Considerations
- Unprovoked attacks are more likely to indicate rabies than provoked attacks (such as during feeding or handling) 5, 2, 1
- If the cat is healthy, available for 10-day observation, and properly vaccinated, confine and observe without initiating prophylaxis 2, 3
- Initiate immediate prophylaxis if the cat is stray/unwanted, cannot be confined, dies or develops illness during observation, or shows signs suggestive of rabies 2, 3
Critical Pitfall to Avoid
The most important pitfall is administering RIG to previously vaccinated persons. RIG should NOT be given to previously vaccinated individuals because it can partially suppress active antibody production and is unnecessary given their existing immune memory 1. This is a common error that wastes resources and may interfere with the anamnestic response.
Special Consideration for Category II Exposures
While Category II exposures (scratches, abrasions, or minor bites without bleeding) from cats can transmit rabies, the decision to initiate prophylaxis depends heavily on whether the cat can be observed for 10 days 2, 3, 1. A case report documented rabies transmission from a Category III cat scratch despite intradermal vaccination, though this patient did not receive RIG (which would not apply to previously vaccinated persons anyway) 6.
Timing of Administration
- Rabies post-exposure prophylaxis is a medical urgency, not an emergency, but decisions must not be delayed 5
- Prophylaxis should be administered regardless of delay length, provided the exposed person shows no clinical signs of rabies 5
- For previously vaccinated persons, the simplified 2-dose regimen on days 0 and 3 provides adequate protection through anamnestic immune response 1