How should a woman bitten by a pet dog that was vaccinated against rabies one year ago be managed regarding wound care, tetanus prophylaxis, antibiotics, and rabies post‑exposure prophylaxis?

Management of Dog Bite from a Previously Vaccinated Dog

A dog with a current or recent rabies vaccination history (within the past year) that appears healthy should be confined and observed for 10 days; initiate immediate thorough wound care and tetanus prophylaxis now, but defer rabies post-exposure prophylaxis unless the dog develops signs of rabies during observation. 1, 2, 3

Immediate Wound Management (Perform Now)

• Wash the bite wound thoroughly with soap and water for at least 15 minutes—this single intervention is the most effective measure for reducing rabies transmission risk and should be done immediately. 1, 2, 4, 3

• Irrigate with a virucidal agent such as povidone-iodine solution if available, as this further reduces viral load at the wound site. 2, 4, 3

• Assess and provide tetanus prophylaxis according to the patient's immunization history and wound characteristics. 2, 3

• Consider antibiotic prophylaxis to prevent secondary bacterial infection, particularly for deep puncture wounds or wounds on the hands/face. 2, 3

Risk Assessment for This Specific Scenario

• A dog with a history of continuously current vaccination (vaccinated last year with no substantial gaps) is unlikely to become infected with rabies, making this a lower-risk exposure. 1

• The CDC recommends a 10-day observation period for healthy domestic dogs, cats, and ferrets that have bitten someone, regardless of vaccination status. 1, 2, 3

• Do not initiate rabies post-exposure prophylaxis immediately if the dog is available for observation and appears healthy. 2, 3

The 10-Day Observation Protocol

• Confine the dog and observe for 10 days from the date of the bite—dogs do not shed rabies virus in saliva more than 10 days before showing clinical signs. 5, 2

• If the dog remains healthy throughout the 10-day period, no rabies post-exposure prophylaxis is needed for the bite victim. 2, 3

• If the dog develops any signs suggestive of rabies during confinement (behavioral changes, aggression, paralysis, excessive salivation, difficulty swallowing), immediately initiate full post-exposure prophylaxis for the victim and euthanize the animal for laboratory testing. 1, 2

• If the dog dies or is euthanized during the observation period, submit the head under refrigeration for rabies testing by direct fluorescent antibody test; begin prophylaxis immediately pending results. 1, 3

Full Rabies Post-Exposure Prophylaxis (If Indicated)

For Previously Unvaccinated Persons

• Administer human rabies immune globulin (HRIG) at 20 IU/kg body weight on day 0, infiltrating the full calculated dose around and into the wound(s) when anatomically feasible, with any remaining volume given intramuscularly at a site distant from vaccine administration. 5, 4, 3

• Give a 4-dose rabies vaccine series (1.0 mL intramuscularly) on days 0,3,7, and 14, administered in the deltoid muscle for adults or anterolateral thigh for young children—never use the gluteal area as this produces inadequate antibody response. 5, 4, 3

• HRIG can be administered up to and including day 7 after the first vaccine dose if initially missed, but should not be given after day 7 as vaccine-induced antibodies are presumed present. 5, 4

For Previously Vaccinated Persons

• Give only 2 doses of rabies vaccine on days 0 and 3—do NOT administer HRIG as it will suppress the anamnestic immune response. 5, 4, 3

For Immunocompromised Patients

• Use a 5-dose vaccine regimen on days 0,3,7,14, and 28 plus HRIG at 20 IU/kg on day 0, even if previously vaccinated, with mandatory serologic testing 1-2 weeks after the final dose. 5, 4

Critical Considerations and Common Pitfalls

• Provoked versus unprovoked bites: An unprovoked attack is more likely to indicate rabies; bites occurring while feeding or handling an apparently healthy animal are generally considered provoked. 1, 3

• Regional rabies epidemiology matters: In the United States, rabies among dogs is most common along the US-Mexico border and in areas with enzootic wildlife rabies; consult local public health authorities about regional risk. 2, 3

• Vaccination status alone does not eliminate risk: Even vaccinated animals can occasionally develop rabies, particularly if exposed before adequate immunity developed (within 28 days of primary vaccination) or if there were gaps in vaccination coverage. 1

• Do not delay wound cleansing: Immediate washing is critical and should never be postponed while awaiting decisions about prophylaxis. 2

• When in doubt, consult local or state health departments before deciding whether to initiate prophylaxis, as they have current epidemiologic data and can facilitate animal testing. 1, 2, 3

Efficacy of Prophylaxis When Needed

• When administered promptly and correctly, rabies post-exposure prophylaxis is nearly 100% effective at preventing human rabies—no failures have been documented in the United States since current cell-culture vaccines and HRIG were licensed. 4, 6

• The typical rabies incubation period is 1-3 months but can range from days to over a year, providing a substantial window for effective prophylaxis even if treatment is delayed by days or weeks. 5, 4