A considered approach should be taken by a person who has been bitten by a cat or any other animal when getting a post-bite rabies shot – what the medical profession call: Rabies Post-exposure Prophylaxis (RPEP). Prophylaxis means: treatment! This page concerns the USA. I was prompted to write this because the press quite often report “rabid cat” stories. I hate that terminology. Being bitten by a strange cat does not mean being bitten by a rabid cat although common sense dictates that playing safe is wise considering the severity of the disease.
Obviously, not every cat bite results in the need to rush to a medical centre for rabies shots. And I am referring here to people who have not had a preventative rabies vaccination. The rabies vaccine is typically administered after a bite. Only people who work in high risk environments are advised (or it is obligatory) to have the preventative vaccination.
The vaccine to prevent the progress of the disease is given in four shots in the shoulder (called: pre-exposure prophylaxis). The first is given immediately after the possible exposure to rabies and then 3, 7 and 14 days later3.
Note: If the wound caused by a suspected rabid animal is cleaned and immunisation is carried out within a few hours after contact the onset of rabies and death can be prevented.
In the USA the CDC sets out the protocol (the steps that are taken in the process called RPEP).
There are two types of exposure:
- Infectious material entering body via wound
The guidelines for when to be given a post-exposure vaccine (RPEP) is as follows (shortened version):
Exposure by a domestic animal that has no signs of rabies and is healthy etc. do not undertake RPEP until the animal has been observed for 10 days.
If exposed by a dog, cat, ferret that cannot be observed (because they have disappeared, for example) the person is recommended to initiate PREP if animal control has decided that the bite was unprovoked and the animal was behaving strangely. This means taking a clear, objective approach to reporting and consulting with the health district. You might like to read this story.
If exposed by a wild animal such as a fox or coyote the person should go down the PREP route if the animal has not been captured and tested or if brain testing of the animal can’t be completed with 24 hours or the brain specimen shows up rabies. If a test is done and proves negative RPEP should be stopped.
If exposed by a bat the person should initiate RPEP under the same criteria as for wild animals such as foxes etc.. Additional advice for bat exposure is that if a person was in the same room as a bat but unaware of possible exposure to rabies, RPEP should be considered.
Exposure to a small animal (rabbit, rat, mouse, squirrel) RPEP is not recommended because these animals are rarely infected and rodents are not reservoirs for rabies.