Should I receive rabies post‑exposure prophylaxis (including rabies immune globulin and vaccine series) after being bitten by a monkey, given I have no prior rabies vaccination?

Rabies Post-Exposure Prophylaxis After Monkey Bite

Yes, you absolutely need rabies post-exposure prophylaxis immediately after a monkey bite if you have no prior rabies vaccination. Monkeys are high-risk animals for rabies transmission, and the disease is nearly 100% fatal once symptoms develop, making immediate prophylaxis essential. 1, 2

Immediate Wound Management (First Priority)

• Wash the wound thoroughly with soap and water for 15 minutes immediately—this single intervention is perhaps the most effective measure for preventing rabies infection and markedly reduces viral load in animal studies. 1, 3, 2
• Follow wound washing with irrigation using a virucidal agent such as povidone-iodine solution if available. 3, 2, 4
• Assess tetanus immunization status and administer tetanus prophylaxis as indicated. 1, 3

Complete Post-Exposure Prophylaxis Protocol

Human Rabies Immune Globulin (HRIG)

• Administer HRIG at exactly 20 IU/kg body weight on day 0 (the day you seek treatment), ideally simultaneously with the first vaccine dose. 1, 2, 5
• Infiltrate the full calculated dose around and into the bite wound(s) if anatomically feasible; inject any remaining volume intramuscularly at a site distant from vaccine administration. 1, 2, 5
• HRIG can still be administered up to and including day 7 if not given initially, but never beyond day 7 as vaccine-induced antibodies are presumed to have developed by then. 1, 2
• Never exceed 20 IU/kg—higher doses suppress active antibody production from the vaccine. 1, 2
• Do not administer HRIG in the same syringe or at the same anatomical site as the vaccine. 2, 5

Rabies Vaccine Series

• Administer 4 doses of rabies vaccine (HDCV or PCECV), 1.0 mL intramuscularly on days 0,3,7, and 14. 1, 2, 4
• Inject in the deltoid muscle for adults and older children, or the anterolateral thigh for young children. 1, 2, 4
• Never use the gluteal area—this produces inadequate antibody response and is associated with vaccine failure. 2, 4

Critical Timing Considerations

• Initiate prophylaxis as soon as possible after exposure, ideally within 24 hours, though treatment remains indicated even if weeks or months have elapsed since the bite. 3, 2
• There is no absolute cutoff for starting prophylaxis—delays of even hours matter significantly given rabies is uniformly fatal once symptoms appear. 2
• When administered promptly and appropriately, this regimen is nearly 100% effective in preventing human rabies. 2

Special Circumstances

If You Are Immunocompromised

• You require a 5-dose vaccine regimen (days 0,3,7,14, and 28) plus HRIG at 20 IU/kg on day 0, even if previously vaccinated. 2, 5
• Conditions requiring this extended regimen include corticosteroid use, other immunosuppressive agents, HIV infection, or chronic lymphoproliferative disorders. 2
• Mandatory serologic testing 1-2 weeks after the final dose is required to confirm adequate antibody response. 2

If You Were Previously Vaccinated

• You would need only 2 vaccine doses (days 0 and 3) and no HRIG—but this does not apply to you since you stated no prior vaccination. 2, 5, 4

Common Pitfalls to Avoid

• Do not wait for the monkey to be observed or tested before starting prophylaxis if the animal is unavailable, shows any signs of rabies, or the exposure was severe. 3
• Do not withhold prophylaxis while waiting for animal testing results in areas where rabies is endemic in primates. 3
• Do not give HRIG to previously vaccinated persons (not applicable to you, but critical error if it were). 3, 5
• Do not delay treatment for serologic testing—routine post-vaccination antibody testing is unnecessary in immunocompetent individuals. 2

Why Monkeys Are High-Risk

Monkeys are considered high-risk animals for rabies transmission, similar to wild terrestrial carnivores and bats, requiring immediate post-exposure prophylaxis when the animal is unavailable for observation or testing. 3 The rabies virus is transmitted when saliva or neural tissue from a rabid animal is introduced into bite wounds, open cuts, or mucous membranes. 2

Efficacy and Reassurance

No failures of rabies prophylaxis have been documented in the United States since current cell culture vaccines and HRIG have been licensed, when the regimen is administered properly. 1 All immunocompetent individuals completing the 4-dose schedule achieve protective neutralizing antibody titers by day 14. 2