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October 15, 2026
Rabies Post-Exposure Prophylaxis
Summary
Rabies exposures include bites, scratches, and fresh wound or mucous membranes contaminated with a mammal’s saliva or neural tissue.
- Bat exposures deserve special attention, including if a bat is found in the same room with a person who cannot say exposure did not occur (e.g., child, sleeping person). Bat bites may not leave visible marks.
- Touching animal fur, blood, urine, or feces is not a rabies exposure.
Report only animal bites or encounters with suspicion for rabies exposure to Public Health.
Consult Public Health for guidance on rabies exposure assessment and administration of rabies post-exposure prophylaxis (PEP) for patients
Actions requested
-
Identify
- Conduct thorough rabies risk assessment. Consider:
- Type of animal
- Circumstances leading to exposure
- If the animal had any clinical signs consistent with rabies
- Geographic location where the exposure occurred
- Type and severity of the wound
- If animal is available for testing or observation, if indicated
- Understand situations that warrant treatment with rabies PEP
- CDC rabies post-exposure prophylaxis guidance
- WA state rabies assessment algorithm
- CDC tool to evaluate risk of rabies in animals if unable to test or observe animals
- Ask patients about prior rabies vaccination in the US and outside the country
- Use CDC's rabies PEP calculator to determine PEP schedules and deviations
- Conduct thorough rabies risk assessment. Consider:
-
Manage
Provide immediate wound care and ensure appropriate PEP administration
- Consult your hospital pharmacist for PEP administration questions for a patient
- Understand common errors for administering rabies PEP and how to correct
Common errors for HRIG or rabies vaccine administration include:
- Administration technique
- Incorrectly administering rabies vaccine in the gluteal area
- Not infiltrating HRIG into and around wounds to the extent anatomically feasible
- Incorrectly administering HRIG and vaccine in same anatomical site or syringe
- Immunity and administration
- Forgetting to give HRIG to someone who needs it
- Incorrectly administering HRIG to a person previously vaccinated against rabies
- Misclassifying vaccination history, resulting in missed or unnecessary treatment
- Schedule and administration
- Using an incorrect rabies vaccine schedule (e.g. pre-exposure vs PEP)
- Unnecessarily restarting the vaccine series after a schedule deviation
-
Notify
Report suspected rabies exposure to Public Health to 206-296-4774.
Resources
- Prevention of Human Rabies: Assessment of Rabies Exposures from Animal Contact and Guidance on Rabies Post-Exposure Prophylaxis, WA State Dept. of Health
- Bats in Bedrooms – Assessing Risk, WA State Dept. of Health
- Clinical Overview of Rabies | Rabies, CDC
- Clinical Screening for Rabies PEP | Rabies, CDC
- Rabies Post-exposure Prophylaxis Guidance | Rabies, CDC
- Rabies Biologics | Rabies, CDC
- Rabies PEP Calculator | Rabies, CDC
- Rabies PEP training modules, CDC
- Rabies is Still Here: Epidemiology, Outbreaks, and Costs of Prevention in the United States | COCA Call, CDC
- Nationwide Increase in Reported Human Rabies Exposures: Rabies Post-exposure Prophylaxis Administration, Sept 10, 2026, CDC HAN