categories of contact and recommended post rabies exposure prophylaxis

Last reviewed 01/2018

categories of contact and recommended post exposure prophylaxis

WHO has described three categories according to the type of exposure and the recommended post exposure prophylaxis (PEP) for each category:


category of exposure

type of exposure to domestic or wild animal suspected or confirmed to be rabid, or animal unavailable for testing

recommended post-exposure prophylaxis

I

touching or feeding animals; licks on intact skin; contact of intact skin with secretions or excretions of rabid animal or human case
  • none, if reliable case history is available

II

nibbling of uncovered skin; minor scratches or abrasions without bleeding
  • immediate vaccination and local treatment of wound
  • stop treatment if animal remains healthy throughout an observation period of 10 days or is proved to be negative for rabies by reliable laboratory using appropriate diagnostic techniques

III

single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva (that is, licks) exposure to bats
  • immediate vaccination and administration of rabies immunoglobulin, preferably as soon as possible after initiation of post-exposure prophylaxis; local treatment of the wound
  • rabies immunoglobulin can be injected up to seven days after first vaccine dose has been administered
  • stop treatment if animal remains healthy throughout an observation period of 10 days (does not apply to bats) or is proved to be negative for rabies by a reliable laboratory using appropriate diagnostic techniques

Five dose post exposure vaccination regimen is popular in most of the countries, but several countries have now adopted a WHO recommended four dose schedule, with vaccine administered intramuscularly at 0.1 mL on days 0, 3, 7, and 14

  • immunoglobulin is recommended for category II as well as category III exposures if the four dose schedule is used
  • a fifth dose at day 28 is still recommended for immunocompromised patients

For people who are already vaccinated, only two boosters are required, intramuscularly on days 0 and 3, or intradermally in four doses at a single visit; no rabies immunoglobulin is required

Note:

  • PEP is not routinely required for exposure to rodents, rabbits, or hares
  • bites especially on the head, neck, face, hands, and genitals are category III exposures because of the rich innervation of these areas.
  • PEP should be considered when contact between a human and a bat has occurred, unless the exposed person can rule out a bite or scratch or exposure of a mucous membrane.

Reference:

Related pages:

rabies