Rabies Post Exposure Prophylaxis (RPEP)1 Algorithm

Person exposed Person sustained

Person bitten Person bitten
Person bitten to a bat and an open wound
by a by a
by a a bite cannot be or mucous membrane
domesticated3 small rodent
wild2 animal definitively exposure5 to a wild2 or
animal or rabbit
ruled out4 domesticated3 animal

CALL COUNTY HEALTH DEPARTMENT

Discuss indications RPEP

Animal available? Animal available? Animal available? for RPEP on a generally not
case-by-case basis indicated6
Yes

Yes

Yes
No

No

No

Submit Submit
Begin animal
Begin Animal Begin animal 1. RPEP: For persons never vaccinated for rabies,
RPEP RPEP status? RPEP treatment includes (1) human rabies immune
for testing7 for testing7
globulin (HRIG), 20 IU/kg body weight, infiltrated into
and around the wound(s) AND (2) 4 doses of vaccine
e

e
Pos
Pos
ativ

ativ

administered IM in the deltoid (or anterolateral thigh

it
it
Neg

Neg

ive
ive

for small children) on days 0, 3, 7 and 14.

Immunocompromised persons should receive a 5th
No No dose of vaccine on day 28. Never give rabies vaccine
indication Begin indication Begin
RPEP in the gluteal area. If unable to infiltrate the full dose
for RPEP for RPEP RPEP
of HRIG into the wound, the remainder should be
al Nor given IM at a site distant from the vaccine site. For
norm ma
l persons previously vaccinated, treatment includes
Ab
only 2 doses of vaccine on days 0 and 3 (no HRIG).
2. Wild animals with the highest rabies incidence
Submit 10-day
include raccoons, bats, skunks and foxes. For small
animal confinement
for testing7 observation rodents and rabbits, see footnote 6.
3. Domesticated animals: dogs, cats, ferrets, horses,
Animal healthy for Animal appears sick donkeys, mules, cattle, sheep, goats and pigs.
e
Pos
ativ

entire 10 days or develops signs of rabies

itiv

4. This includes situations where a bat is found in the

Neg

during 10 days
e

same room as a sleeping person, unattended child,

intoxicated or mentally compromised person.
No No Submit
indication Begin indication animal 5. Open wound/mucous membrane exposure:
for RPEP RPEP for RPEP for testing7 introduction of saliva or other potentially infectious
material (cerebrospinal fluid, spinal cord or brain
tissue) from a rabid or potentially rabid animal into
ee
PPooss
aattiivv

an open wound or mucous membrane (eyes, nose,

iittiivv
NNeegg

ee

mouth).
6. For bite exposures from outdoor-caged rodents or
No rabbits, or for other unusual circumstances, contact
indication Begin
RPEP the county health department.
for RPEP
7. If an animal specimen is submitted but found to be
untestable, it should be assumed to be positive for
rabies treatment decision making purposes.

3028 Last Revised 11/10