Immediate Rabies Post-Exposure Prophylaxis Required
This child must receive rabies immunoglobulin and vaccine immediately (Option D). A cat exhibiting fever and lethargy at the time of biting represents a rabid animal until proven otherwise, and post-exposure prophylaxis should never be delayed for observation or testing results. 1, 2
Why Rabies Prophylaxis is Mandatory Here
The Symptomatic Animal Changes Everything
The standard 10-day observation period applies only to healthy cats—when a cat is febrile and lethargic at the time of the bite, observation is inappropriate and prophylaxis must begin immediately. 1, 2
Any cat that bites and exhibits signs of illness (fever, lethargy, behavioral changes) must be treated as potentially rabid, regardless of the absence of erythema at the wound site. 1
The animal should be reported to local health authorities immediately and euthanized for rabies testing, but prophylaxis must not wait for these results. 3, 1
Complete Post-Exposure Prophylaxis Protocol
Wound Management (must be done first):
Immediately wash the bite wound thoroughly with soap and water for 15 minutes—this alone markedly reduces rabies transmission risk in animal studies. 3, 4
Assess for tetanus prophylaxis needs and consider antibiotic prophylaxis based on wound characteristics. 3
Rabies Biologicals (both required for previously unvaccinated persons):
Rabies Immunoglobulin (RIG): Administer 20 IU/kg body weight, infiltrating as much as possible into and around the wound site, with any remaining volume given intramuscularly at a site distant from vaccine administration. 3, 2
Rabies Vaccine: Initiate the WHO-recommended intradermal 1-week regimen or the standard 5-dose intramuscular series over 28 days (days 0,3,7,14,28). 3, 4
RIG must be given on day 0 (can be given up to day 7 if initially missed) to provide immediate passive immunity while the vaccine induces active antibody production. 3
Why Other Options Are Incorrect
Reassurance (Option A) is contraindicated—rabies is nearly 100% fatal once symptoms develop, and this symptomatic cat represents high risk. 5
Prophylactic antibiotics alone (Option B) addresses bacterial infection risk but ignores the life-threatening rabies exposure from a symptomatic animal. 3
Wound irrigation alone (Option C), while essential as the first step, is insufficient without rabies biologicals when the biting animal shows signs of illness. 3, 4
Critical Timing Considerations
Rabies post-exposure prophylaxis is a medical urgency (not emergency), but decisions must not be delayed—administration should occur within 24 hours of exposure. 3, 2
Even if days or weeks have passed since the bite, prophylaxis should still be initiated as long as the patient shows no clinical signs of rabies (incubation periods exceeding 1 year have been documented). 3
If the animal later tests negative for rabies by direct fluorescent antibody testing, the prophylaxis series can be discontinued. 3
Common Pitfall to Avoid
The absence of erythema at the bite site is irrelevant to rabies risk assessment—rabies transmission depends on viral inoculation through the bite, not on local wound infection signs. 3 The animal's clinical status (febrile and lethargic) is the determining factor that mandates immediate prophylaxis. 1, 2