Post-exposure prophylaxis for rabies virus and other lyssavirus exposures comprises:

  • prompt wound management
  • rabies vaccine
  • HRIG (human rabies immunoglobulin)

The appropriate combination of these components depends on a detailed risk assessment, including determining the:

Post-exposure prophylaxis must include wound management

Wound management is a vital step after a potential exposure to rabies virus or other lyssaviruses. To help prevent rabies transmission:

  1. immediately and thoroughly wash all bite wounds and scratches with soap and water
  2. apply a virucidal preparation such as povidone-iodine solution

Avoid suturing a bite from a potentially rabid animal. Instead, clean, debride and infiltrate the wound well with rabies immunoglobulin. See either: 

Also consider whether the wound could be infected with pathogens such as Clostridium tetani, and take appropriate measures (see Tetanus).

Assess all potential exposures from a terrestrial animal in a rabies-enzootic area, or from a bat anywhere in the world

Assess all exposures to terrestrial mammals (in rabies-enzootic countries) and bats (in any country) for potential classical rabies virus transmission. 

There are 2 different post-exposure prophylaxis management algorithms, depending on whether the lyssavirus exposure was:

These 2 algorithms are different because:16

  • the risk from wounds from bats is often hard to determine — wounds from bat bites and scratches are usually smaller than other animal bites
  • superficial wounds from bats are more likely to result in human infection than superficial wounds from terrestrial animals 

Make every effort to have the animal tested for lyssaviruses after a potential human exposure, to avoid unnecessary post-exposure prophylaxis. For bites to the head and neck, give post-exposure prophylaxis as soon as possible and preferably less than 48 hours after exposure, even if the animal has been sent for testing. Assess the risk of rabies after exposure to both live and dead animals. A study in mice showed that rabies virus remained viable in brain tissue from decomposing carcasses for:17

  • up to 3 days in bodies kept at 25°C to 35°C
  • up to 18 days in bodies kept at lower temperatures

Give post-exposure prophylaxis that is appropriate for the category and source of exposure, even if there was a considerable delay in reporting the incident. See Table. Lyssavirus exposure categories.

However, a person does not need post-exposure prophylaxis if they present ≥15 days after being bitten or scratched by a domestic dog in a rabies-enzootic country and it is known that the animal is healthy ≥15 days after the exposure.

Contact your state or territory health authority about any potential exposures. They can help conduct a detailed risk assessment and advise on management. See also Public health management.

Table. Lyssavirus exposure categories
Exposure category

Description

Post-exposure prophylaxis management

Category I: no exposure

  • Touching or feeding animals
  • Animal licks on intact skin
  • Exposure to animal blood, urine or faeces

No prophylaxis required if contact history is reliable

Category II: exposure

  • Nibbling of uncovered skin
  • Minor scratches or abrasions without bleeding

See the following, depending on the circumstances:

Category III: severe exposure

  • Single or multiple transdermal bites or scratches
  • Contamination of mucous membrane or broken skin with saliva from animal licks
  • Exposures from direct contact with bats in situations where bites or scratches may not be apparent. Some bats have small teeth and claws, so bites or scratches may not be apparent

See the following, depending on the circumstances:

Potential exposure to terrestrial animals in rabies-enzootic countries

Most exposures that pose a risk of rabies infection are from dogs and monkeys in Asia, Africa, and Central and South America.

Potential exposure to Australian bats

The type of potential exposure to Australian bats may be difficult to categorise. This could be because a person is unaware of, or unable to communicate about, the exposure — for example:

  • a person with a developmental disability
  • an intoxicated person
  • a child
  • a person who has been sleeping in a confined space with a bat present 

If possible, and without placing others at risk of exposure, keep the bat and arrange to have it tested for ABLV (Australian bat lyssavirus).

After wound management (see Post-exposure prophylaxis must include wound management), withhold giving HRIG and rabies vaccine if the bat’s ABLV status will be available within 48 hours of the exposure. If the bat’s ABLV status will not be available within 48 hours, start the appropriate post-exposure prophylaxis as soon as possible. For bites to the head and neck, give post-exposure prophylaxis as soon as possible and preferably less than 48 hours after exposure, even if the animal has been sent for testing.

Follow the bat exposure algorithm in Figure. Rabies post-exposure prophylaxis: bat exposures.

If the bat is negative for ABLV, stop the post-exposure prophylaxis.

Page history

Last updated: 
27 September 2021
Last reviewed: 
27 September 2021

Definitions

HRIG
human rabies immunoglobulin
ABLV
Australian bat lyssavirus