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Management of Suspected Rabies Exposure in the Emergency Department (Infectious Disease CME) -

Management of Suspected Rabies Exposure in the Emergency Department (Infectious Disease CME)
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Publication Date: April 2021 (Volume 23, Number 4)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 04/01/2024.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits, subject to your state and institutional approval.


Bess Storch, MD
Attending Physician, Mount Sinai West and Mount Sinai Morningside Hospitals, New York, NY

Peer Reviewers

Jason Chu, MD
Associate Professor of Emergency Medicine, Columbia University Medical Center, New York, NY
Edward Otten, MD, FACMT, FAWM
Professor of Emergency Medicine and Pediatrics; Director, Division of Toxicology, University of Cincinnati Medical Center, Cincinnati, OH


Rabies is a rare, yet nearly universally fatal diagnosis, responsible for over 59,000 deaths worldwide annually. Appropriate use of pre- and postexposure prophylaxis can eliminate the risk of developing rabies if administered according to the United States Centers for Disease Control and Prevention Advisory Committee on Immunization Practices guidelines. Though rabies is very rare, rapid recognition of potential exposures is vital to patient care and protection of public health. This review focuses on the challenges of managing patients who are at risk for or have had a potential rabies exposure, indications and guidelines for administering pre- or postexposure prophylaxis, and requirements for reporting, testing, and monitoring. Evidence regarding management of patients presenting with suspected clinical rabies is also reviewed.

Case Presentations

A 35-year-old woman presents to the ED for vaccinations prior to a 3-month adventure trip to Southeast Asia…
  • She said she plans on staying in remote areas and spelunking in jungle caves.
  • She asks you whether rabies vaccination is warranted…
A 2-year-old girl is brought in after her mother found a bat in the girl’s bedroom that morning...and she has the bat in a bag…
  • On your full-body exam, the child appears well, and no bite marks are evident.
  • You ask yourself: does the girl require rabies prophylaxis? What should you do with the bat?
The nurse rushes in to ask you to evaluate an elderly man, recently emigrated from rural India, who is behaving strangely, with neurological symptoms…
  • His family tells you that he developed fever and complained of pain and a tingling sensation in his right arm, and over the past 2 days has been intermittently agitated and confused. He chokes every time he tries to eat or drink. The family tells you that he is from a rural village in India and moved to the United States 2 months ago.
  • The son does not recall his father being bitten by an animal, but said there is a large population of feral dogs in his father’s village.
  • What are the next steps in diagnosing and managing this patient with possible rabies?

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