Mongoose Bite Rabies Post-Exposure Prophylaxis
Yes, a mongoose bite requires immediate rabies post-exposure prophylaxis with both rabies immune globulin (RIG) and vaccine, as mongooses are wild terrestrial carnivores that cannot be observed for rabies and represent a high-risk exposure. 1
Why Mongooses Require Full Prophylaxis
Mongooses are classified as wild terrestrial carnivores, not domestic animals, and therefore cannot be confined for the standard 10-day observation period that applies only to dogs, cats, and ferrets. 1
Wild animals and wild animal hybrids should not be kept as pets, and any bite from these animals warrants immediate rabies prophylaxis regardless of the animal's apparent health status. 1
The CDC recommends rabies prophylaxis for all feral and wild animal bites, particularly in geographic areas with high rabies prevalence, and consultation with local health departments is essential to assess regional risk. 1
Immediate Treatment Protocol
Step 1: Wound Management (Critical First Step)
Immediately wash the wound thoroughly with soap and water for at least 15 minutes, as this single intervention markedly reduces rabies transmission risk more than any vaccine or immunoglobulin. 2, 3
Apply a virucidal agent such as povidone-iodine solution to the wound site after washing. 1, 3
Avoid suturing the wound when possible, as closure may increase rabies risk by trapping virus in the wound. 1, 3
Update tetanus prophylaxis (0.5 mL intramuscularly if status is outdated or unknown). 1, 3
Step 2: Passive Immunization (Day 0)
Administer rabies immune globulin (RIG) at 20 IU/kg body weight on day 0, infiltrating the full dose around and into the wound(s) if anatomically feasible, with any remaining volume given intramuscularly at a site distant from vaccine administration. 2, 3
RIG must be given within 7 days of starting vaccine; beyond day 7, it is contraindicated as antibody response to vaccine is presumed to have occurred. 2, 3
Never administer RIG in the same syringe or anatomical site as vaccine, as this can interfere with vaccine efficacy. 1, 2
Step 3: Active Immunization (Vaccine Series)
For previously unvaccinated persons, administer a 4-dose intramuscular vaccine regimen on days 0,3,7, and 14 in the deltoid muscle (or anterolateral thigh in children), never in the gluteal area. 2, 3
Use tissue culture vaccines (HDCV, RVA, or PCEC), which are the standard of care globally and have demonstrated equivalent immunogenicity. 1, 2
For previously vaccinated persons with documented prior complete rabies vaccination, administer vaccine ONLY on days 0 and 3 without RIG, as RIG may suppress the anamnestic antibody response. 2, 3
Critical Timing Considerations
Begin treatment immediately after exposure (within 24 hours ideally), though even delayed treatment is indicated as rabies incubation periods can exceed 1 year. 1, 3
Post-exposure prophylaxis should be initiated regardless of time elapsed since exposure, as incubation periods of more than 1 year have been documented in humans. 1, 2
Once clinical signs of rabies appear, treatment is essentially futile, as rabies is nearly 100% fatal after symptom onset despite intensive supportive care. 4, 5
Common Pitfalls to Avoid
Do not delay treatment waiting to capture or test the mongoose, as wild animals cannot be reliably observed and testing may take days. 1
Do not omit RIG thinking vaccine alone is sufficient – the combination of both passive and active immunization is essential for previously unvaccinated persons. 1
Do not administer more than the recommended 20 IU/kg dose of RIG, as excess RIG can partially suppress active antibody production from the vaccine. 1
Do not inject vaccine in the gluteal area, as this has been associated with treatment failures due to poor immunogenicity. 2