Diagnostic Criteria for Rabies PEP

Overview

Rabies, caused by rabies virus, is fatal but preventable. The virus can spread to people and animals through the bites and scratches of an infected animal. Rabies can cause severe disease and death if patients don't receive appropriate and urgent post-exposure prophylaxis (PEP) after a rabies exposure, before symptoms start.

Thanks to rabies control programs and PEP, rabies is rare in people in the United States, with less than 10 cases reported annually. However, about 100,000 Americans receive PEP following an exposure each year.

Exposure risks

In the U.S., rabies is mostly found in wild animals like bats, raccoons, skunks, and foxes. But in many other countries, dogs are still the main carriers of rabies. People and pets can be exposed to rabies through bites and scratches from infected animals.

Rabies virus can also be transmitted through direct contact between broken skin or mucus membranes and infectious tissue or fluids, including saliva. However, there have been no confirmed instances of human-to-human transmission of rabies virus aside from those attributable to organ and tissue transplantation. Rabies virus is not transmitted through contaminated objects or materials such as clothes or bedding.

Healthcare workers

If you're a healthcare worker providing care to patients with suspected or confirmed rabies, protect yourself by using standard precautions. Healthcare workers caring for patients with rabies do not pose a risk to their families or community.

Patient risk assessment for PEP

Most rabies exposures require medical attention quickly, but they do not require an immediate trip to the emergency room unless the wound needs urgent medical attention. A patient should be immediately assessed for rabies-related care in the following cases:

• They had direct contact with bats unless a bite or scratch can be definitively ruled out.
• They had exposure to certain high-risk animals, which typically include bats, raccoons, skunks, foxes, and mongoose.
• They had severe exposures, such as multiple bite wounds or exposures to the head and neck.
• They are a young child.

When assessing the need for PEP in a patient with a suspected exposure, consider the following:

• Geographic location: Bats are a risk for rabies in every state besides Hawaii. Other high-risk animals are found in specific geographic areas of the U.S. In many countries outside of the U.S., dogs present the highest rabies risk. Consult your health department for more information on geographic rabies risk.
• Type of animal: All mammals are susceptible to rabies, but certain species are at greater risk of transmitting the virus to people. These include bats, raccoons, skunks, foxes, and mongoose.
• Behavior of the animal: Rabies causes behavioral changes in animals that may not be obvious until several days after they become infectious. Unprovoked bite or scratches, and signs of apparent illness are often associated with rabid animals.

A health official familiar with rabies should always conduct the risk assessment. If you need assistance in conducting a rabies risk assessment, contact your state or local health department.