What vaccine is administered following a cat bite, specifically to prevent rabies (Rabies Immunoglobulin) and tetanus (Tetanus Toxoid)?

From the Guidelines

If you've been bitten by a cat, you should receive a rabies vaccine (HDCV or PCECV) on days 0,3,7, and 14, along with rabies immune globulin (RIG) at the wound site, if you haven't been previously vaccinated against rabies. This is based on the most recent and highest quality study available, which recommends a 4-dose vaccine schedule for postexposure prophylaxis to prevent human rabies 1. The reduction in doses recommended for postexposure prophylaxis was based on evidence from rabies virus pathogenesis data, experimental animal work, clinical studies, and epidemiologic surveillance, which indicated that 4 vaccine doses in combination with RIG elicited adequate immune responses and that a fifth dose of vaccine did not contribute to more favorable outcomes 1.

Key Points to Consider

• The first dose of the 4-dose course should be administered as soon as possible after exposure (day 0) 1.
• Additional doses then should be administered on days 3,7, and 14 after the first vaccination 1.
• RIG is administered once on day 0 at the time postexposure prophylaxis is initiated, in conjunction with human rabies vaccines available for use in the United States 1.
• If anatomically feasible, the full dose of RIG is infiltrated around and into any wounds, and any remaining volume is injected intramuscularly at a site distant from vaccine administration 1.

Important Considerations

• Cat bites often cause deep puncture wounds that easily become infected, so your doctor will likely also prescribe antibiotics such as amoxicillin-clavulanate (Augmentin) for 5-7 days.
• Seek medical attention promptly after a cat bite, as these wounds have a high infection rate due to the bacteria in cats' mouths, particularly Pasteurella multocida, which can cause rapid infection within 24-48 hours.

From the FDA Drug Label

If antirabies treatment is indicated, both Rabies Immune Globulin (Human) [RIGH] and human diploid cell rabies vaccine (HDCV) should be given as soon as possible, REGARDLESS of the interval from exposure Dog and cat Healthy and available for 10 days of observation None, unless animal develops rabies Rabid or suspected rabid RIGH and HDCV

For a cat bite, the recommended vaccine is Rabies Vaccine (HDCV), and it should be given in conjunction with Rabies Immune Globulin (Human) [RIGH] if the cat is suspected of being rabid.

• The treatment should start as soon as possible after exposure.
• The vaccination status of the cat and the presence of rabies in the region should be taken into account.
• Local or state public health officials should be consulted if questions arise about the need for rabies prophylaxis 2.
• The post-exposure dosage for previously unimmunized persons is 5 intramuscular doses (1 mL each) of Imovax Rabies vaccine, one dose immediately after exposure (Day 0) and one dose 3,7,14, and 28 days later, along with Rabies immune globulin (RIG) 20 IU/kg on Day 0 3.

From the Research

Rabies Vaccine for Cat Bites

• The rabies vaccine is the primary vaccine used to prevent rabies after a cat bite, as rabies is a fatal zoonotic disease that can be transmitted through the bite of an infected animal 4, 5.
• The vaccine can prevent 99% of deaths if administered promptly after exposure, and there are two main vaccination strategies for rabies prevention: pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) 5.
• Post-exposure prophylaxis (PEP) typically includes a series of intradermal (ID) or intramuscular (IM) rabies vaccinations, as well as rabies immunoglobulin in severe cases, and can be effective in preventing rabies even after exposure has occurred 6, 7.

Types of Rabies Vaccination Schedules

• There are various rabies vaccination schedules, including abbreviated schedules with fewer doses, which can be safe and effective in preventing rabies 6, 8.
• The 1-week, 2-site ID PEP schedule has been found to be advantageous, as it is safe, immunogenic, and involves the least direct costs compared to other schedules 6.
• Both intradermal (ID) and intramuscular (IM) PrEP/PEP can produce adequate geometric mean titres (GMTs), and the selection of a schedule should take into account the patient's needs, costs, and availability to return for subsequent doses 8.

Special Considerations

• Older individuals (>50 years) may develop lower antibody responses to rabies vaccination, and therefore warrant special attention 8.
• Pregnant women can safely receive rabies vaccines, and vaccination during pregnancy is effective in preventing rabies 6.
• Special populations, such as infants and immunocompromised individuals, may require additional consideration when administering rabies vaccines, as there are gaps in understanding the safety and immunogenicity of novel PEP schedules in these groups 6.