🐕 Chapter 132: Animal Bite and Rabies

WHO Category I/II/III · Wound toilet (soap/water 10 min) · Rabies immunoglobulin (RIG) · HRIG 20 IU/kg · ERIG 40 IU/kg · Vaccine schedule (0,3,7,14,28) · Category III: RIG + vaccine · No suturing · 10-day observation of dog/cat

🔍 Core Concepts: Animal Bite & Rabies

📌 WHO Exposure Categories
Category I: touching/feeding, licks on intact skin → no PEP. Category II: nibbling, minor scratches/abrasions → vaccine only. Category III: transdermal bites, licks on broken skin, mucous membrane contamination → RIG + vaccine.
🧼 Wound Management (Essential)
Immediate thorough washing with soap/detergent + running water for at least 10 minutes. Povidone-iodine or alcohol. Avoid suturing (if needed, loose minimal sutures). Tetanus prophylaxis.
💉 Rabies Immunoglobulin (RIG)
HRIG (human) 20 IU/kg; ERIG (equine) 40 IU/kg. Infiltrate as much as possible into and around wound. Remainder IM at distant site. Do NOT give after day 7 (vaccine-induced antibodies present).
💊 Rabies Vaccine (Cell culture)
Day 0,3,7,14,28 (5 doses). 1 mL IM (deltoid) for HDCV/PCEC; 0.5 mL for PVRV. Do not inject into gluteal region (reduced absorption).
🐕 Observation of biting animal
Healthy dog/cat observed for 10 days. If remains healthy → rabies ruled out. PEP may be stopped if animal is vaccinated and healthy.
⚠️ Previously vaccinated
2 booster doses (days 0 and 3). No RIG needed.

🩺 Stepwise Approach: Animal Bite (Rabies PEP)

1
Immediate wound toilet (life-saving)
Wash with soap/detergent and running water for 10-15 minutes. Apply povidone-iodine or alcohol. Remove debris. Do NOT suture (if necessary, loose minimal sutures after RIG infiltration).
2
Determine WHO exposure category
Category I (touching, licks on intact skin) → no PEP. Category II (minor scratches/abrasions) → vaccine only. Category III (transdermal bites, licks on broken skin, mucous membrane) → RIG + vaccine.
3
Administer rabies immunoglobulin (RIG) for Category III
HRIG 20 IU/kg or ERIG 40 IU/kg. Infiltrate as much as possible into and around wound. Remaining dose IM at distant site (gluteal). Do NOT give after day 7.
4
Start rabies vaccine
Day 0,3,7,14,28. 1 mL IM (deltoid) for HDCV/PCEC; 0.5 mL for PVRV. Avoid gluteal region. For previously vaccinated: 2 doses (days 0 and 3), no RIG.
5
Observe biting animal (dog/cat)
If healthy, observe for 10 days. If remains healthy → rabies ruled out. If animal shows signs or is unavailable, complete PEP.
6
Additional measures
Tetanus prophylaxis (toxoid/immunoglobulin). Antibiotics if infected wound. Do NOT use herbal remedies or cauterisation.