22 month old male presents to the ED with a CC of right forearm wound after being bitten by an unknown dog the previous day.
On physical exam the puncture wounds are non-draining and non-erythematous with no obvious bony deformity.
In addition to antibiotic and tetanus prophylaxis, should we vaccinate him against rabies?
CDC epidemiological survey published in 2010
92.1% of all rabid animals were wild animals
Raccoons, skunks, bats, foxes, and other mammals
7.9% of all rabid animals were domestic
Cats > dogs
Map of rabid dogs and cats reported in 2010
All wild animals listed above are considered rabid unless they test negative in laboratory.
Give RIG and vaccine and if negative discontinue
-> normal behavior for 10 days -> no prophylaxis
->abnormal behavior when captured or after -> animal brain testing
-> epidemiological absence of rabies in species -> no prophylaxis
-> epidemiological existence of rabies in species or data lacking -> prophylaxis
Submitted by Matthew Kongkatong.
References: Blanton, J. D., Palmer, D., Dyer, J., & Rupprecht, C. E. Rabies surveillance in the United States during 2010. Journal of the American Veterinary Medical Association, 773-783.; Tintinalli, J. E. (2012). 152. Rabies. Tintinalli’s emergency medicine manual (7th ed., ). New York: McGraw-Hill Medical.; picture