I recently had a rabies exposure and treatment question that’s worth discussing. It was from a person in India whose young child had potentially been exposed to rabies. The child had a wound on her hand and a stray dog licked the area. It wasn’t reported to the parents until a little while later. Three doses of rabies vaccine were obtained and the vaccine series was started a few days after the potential exposure.

Here are some issues:

  • Was this child actually exposed? It’s hard to say. It’s probably unlikely that rabies virus was inoculated into the child in a situation like this, with relatively minor skin lesions and fairly brief contact with the dog. However, contact of saliva from an infected animal with broken skin is a potential route of infection so, even if it’s unlikely, you have to err on the side of caution and consider the child exposed.
  • Standard recommendations for post-exposure prophylaxis are 4 doses of vaccine on days 0, 3, 7 and 14. Three doses might be effective but it’s hard to have confidence in it, especially when dealing with an almost invariably fatal disease. Trying to get ahold of a 4th dose would be best in a situation like this.
  • It doesn’t appear that rabies antibody was administered at the start. Standard protocol is to give anti-rabies antibody with the first vaccine dose. This provides an antibody boost and early protection while the vaccine is taking effect. The antibody can still be used even if it wasn’t given with the first dose of vaccine, as long as it’s within the first week. After that, it’s assumed to have limited effect because antibodies from vaccination would be increasing. It’s probably more important with serious bites and bites near the head and neck, where the onset of rabies can be earlier, but getting a dose of antibodies within the first 7 days would still be recommended.
  • Did the dog actually have rabies? That’s the big question. When someone is potentially exposed, the best thing to do is to identify and quarantine the biting dog. If the dog had rabies and was shedding rabies virus in saliva, it will show signs of rabies within 10 days. Therefore, if you quarantine the dog and it’s healthy after 10 days, it didn’t have rabies and no post-exposure treatment is necessary. In this case, it’s a stray that was known in the area, and it seems the dog was still around and healthy 15 days after the exposure.  So, as long as there is 100% confidence that the dog is actually the same one, then post-exposure treatment is not necessary. The trick is being 100% confident that it’s the same dog.