On World Rabies Day, When to Seek Treatment, Clinical Considerations for Post Exposure Prophylaxis

Earlier this month, the Centers for Disease Control and Prevention (CDC) issued a health advisory through its Health Alert Network (HAN) after it was reported there was a 17% increase in calls this summer to the federal agency regarding potential human rabies exposures.

Rodney E Rohde, PhD, SV/SM/MB(ASCP)CM, FACSc is a university distinguished and regents’ professor and chair for the Medical Laboratory Science (MLS) Program in the College of Health Professions (CHP) at Texas State University, says it is important to point out the differences between exposures and confirmed cases.

“What we're actually seeing is more reported human exposures, not necessarily yet evidence of a sustained increase in human rabies disease, and that's a pretty important distinction,” Rohde said. “But, what they are seeing is primarily an increase in rabies exposure and the use of post-exposure prophylaxis (PEP).”

Seeking Medical Attention After an Animal Interaction

Rabies can be contracted by an animal bite, or less commonly through a scratch. People who have had an encounter with an animal can be given PEP, which is a series of shots to prevent the infection from taking hold into the central nervous system and subsequently the brain.

If not treated with PEP, when the virus enters the brain, rabies is fatal. There has been only one recorded case in history in which a person who developed rabies, was not treated with PEP, and survived.

Therefore, Rohde says it is absolutely vital for people who have an animal exposure to seek medical attention immediately. “Never ever wait for symptoms to develop. Rabies is a medical emergency.”

“If you are bitten or scratched by a potentially rabid mammal, or even if you think you have a possible bad exposure, you really want to wash that wound thoroughly with soap and water, and then contact a healthcare provider...You really don’t want to try to decide on your own whether the animal looked rabid. I've had so many people in the public say, ‘Oh, you know, the animal looked fine’…You really don't know because animal rabies is cyclical.”

PEP Treatment Considerations

PEP is a series of shots depending on vaccination status. Unvaccinated individuals receive a 4-dose series of PEP (on days 0, 3, 7, and 14), while previously vaccinated individuals or are receiving pre-exposure prophylaxis (PrEP) for rabies receive just 2 doses given 3 days apart without human rabies immune globulin (HRIG).¹

HRIG is administered only once at the beginning of the PEP course. HRIG provides immediate antibodies until rabies vaccination provides immunogenicity. HRIG should never be administered in the same syringe or in the same anatomical site as the first vaccine dose, says the CDC.

Rohde offers additional clinical considerations:

• Recognize the exposure and assess risk quickly. Rabies exposure goes well beyond aggressive dog bites. In the US, bats are the top concern because contact often goes unnoticed. Raccoons, skunks, foxes, and feral cats also count. Clinicians should check local epidemiology with public health, take a travel history, and find out whether saliva reached broken skin or mucous membranes through a bite or scratch. When in doubt, lean conservative and start the vaccine series.
• Wound care matters. Wash and irrigate bites or scratches right away and thoroughly with soap and water. This reduces the amount of virus at the wound site.
• Adjust for special populations. Immunocompromised patients may need a fifth dose on day 28, followed by a check of their antibody response.

World Rabies Day, Success of Public Health

Today is World Rabies Day marked every September 28, and Rohde points to the success and peril of the medical advances made in this area.

“World Rabies Day represents really one of public health's great paradoxes…it's one of the deadliest infections we know, yet it's almost entirely preventable,” Rohde said.

He points out that approximately 3 Americans die annually from human rabies, compared to 59,000 deaths globally. And although the success of reducing cases and subsequent deaths has been very successful in the US, there can be a lack of understanding about the severity of the disease exhibited amongst the general public.

“Rabies is a classic example of why we cannot allow successful disease programs to really create complacency…It's almost like we have done so well in some examples of vaccination that people have forgotten where we came from. So surveillance, laboratory testing, animal vaccination, public education, access to vaccines really must remain strong, even when disease in humans is rare, because it's a deadly disease.”

This is a 2-part interview, and in the second episode, Rohde discusses his work in Texas in eliminating canine rabies through a mass animal vaccination program.

Reference
1.Rabies Post-exposure Prophylaxis Guidance. CDC. September 17, 2026. Accessed September 28, 2026.
https://www.cdc.gov/rabies/hcp/clinical-care/post-exposure-prophylaxis.html