Rabies Post-Exposure Prophylaxis After Cat Scratch
Direct Answer
The child does NOT need rabies post-exposure prophylaxis if the cat remains healthy and can be observed for 10 days, regardless of when the cat was vaccinated. The timing of the cat's vaccination (one week ago) is irrelevant to the decision—what matters is confining and observing the cat for the full 10-day period. 1, 2
Management Algorithm
Step 1: Immediate Wound Care
- Thoroughly wash and flush the scratch with soap and water for approximately 15 minutes immediately. 1, 3
- Apply a povidone-iodine solution or similar virucidal agent to the wound. 1
- Assess need for tetanus prophylaxis and bacterial infection control measures. 1, 4
Step 2: Confine and Observe the Cat
- Confine the cat and observe for 10 days starting from the day of the scratch. 1, 2
- The cat should be evaluated by a veterinarian at the first sign of any illness during confinement. 1
- Any illness in the cat must be reported immediately to the local public health department. 1, 2
Step 3: Decision Points During Observation
If the cat remains healthy for 10 days:
- No rabies post-exposure prophylaxis is needed for the child. 1, 2
- Cats that remain alive and healthy 10 days after exposure would not have been shedding rabies virus at the time of the scratch and would not have been infectious. 1, 4
If the cat develops signs of illness during the 10-day period:
- Immediately initiate rabies post-exposure prophylaxis for the child. 1, 3
- The cat should be euthanized and its head submitted for rabies testing. 1
If the cat cannot be confined or escapes:
- Initiate rabies post-exposure prophylaxis immediately without delay. 5, 2
- Do not wait to locate the cat before starting prophylaxis. 5
Why the Vaccination Timing Doesn't Matter
The cat's vaccination status one week ago is not the determining factor for the child's management. 1 Here's why:
- Even after an initial rabies vaccination, young or naïve animals remain at risk for rabies because of potential exposures preceding vaccination or before adequate immunity develops during the 28 days after primary vaccination. 1
- A cat with a history of continuously current vaccination (no substantial gaps) is unlikely to become infected with rabies. 1, 2
- However, the 10-day observation period is reliable for determining rabies risk regardless of vaccination status. 1, 4
Critical Considerations
Regional Epidemiology
- More cats than dogs were reported rabid in the United States during 2000-2006, with the majority associated with raccoon rabies in the eastern United States. 1, 2
- Lower vaccination rates among cats, fewer confinement laws, and nocturnal activity patterns place cats at greater risk for exposure to infected wildlife. 1
Circumstances of the Incident
- An unprovoked attack is more likely to indicate rabies than a provoked attack. 1, 2
- Scratches inflicted on a person attempting to feed or handle an apparently healthy cat should generally be regarded as provoked. 1
Rabies Post-Exposure Prophylaxis Protocol (If Needed)
If prophylaxis becomes necessary (cat develops illness or cannot be observed):
- Rabies immune globulin (RIG): 20 IU/kg body weight on day 0, with as much as possible infiltrated into and around the wound. 3, 2
- Rabies vaccine series: Days 0,3,7, and 14 (4-dose schedule for previously unvaccinated persons). 3, 6, 7
- This is a medical urgency, not a medical emergency, but should not be delayed once exposure is confirmed. 1, 5
Common Pitfalls to Avoid
- Do not delay reporting illness in the cat during observation. Prompt reporting to the local public health department is essential. 1, 4
- Do not assume the recent vaccination protects the cat. The 28-day period after primary vaccination is required for adequate immunity. 1
- Do not initiate prophylaxis prematurely if the cat can be observed. The 10-day observation period is reliable and prevents unnecessary treatment. 1, 4
- Do not fail to perform adequate wound cleansing. Thorough wound washing alone can markedly reduce rabies transmission risk. 1, 5