Urgent Care Management of Possible Rabies Exposure -
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Publication Date: June 2022 (Volume 1, Number 3)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 06/01/2025.

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

Editor-in-Chief & Update Author

Keith A. Pochick, MD, FACEP

Attending Physician, Novant GoHealth Urgent Care, Charlotte, NC

Urgent Care Peer Reviewer

Claude Shackelford, MD

Assistant Professor of Clinical Medicine, Vanderbilt University Medical Center; Assistant Medical Director, Walk-In Clinics, Vanderbilt University Medical Center, Nashville, TN

Charting Commentator

Patrick O’Malley, MD

Attending Physician, Emergency Department, Newberry County Memorial Hospital, Newberry, SC

Original Author

Bess Storch, MD

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

Original Peer Reviewers

Jason Chu, MD

Associate Professor 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

Case Presentations

CASE 1: A 35-year-old woman presents to UC requesting malaria prophylaxis for an upcoming 3-month adventure trip to Southeast Asia…

She plans on staying in remote areas and spelunking in jungle caves.
She asks you whether rabies vaccination is also warranted...

CASE 2: A 2-year-old girl is brought in after her mother found a bat in the girl’s bedroom that morning…

On your full body exam, the child appears well, and no bite marks are evident.
You ask yourself whether this patient requires rabies post-exposure prophylaxis…

CASE 3: A 58-year-old man returned to the United States from India yesterday. He sustained a dog bite to his lower leg the day prior to his return trip. He states that the dog was “medium sized” and wearing a collar, but that there was no obvious owner nearby…

He requests antibiotics and a tetanus booster.
In addition to administering proper wound care, you wonder if there are other steps you should take in the management of this patient…

Introduction

Rabies is a rare diagnosis, but with a fatality rate of over 99%, it is one of the world’s most deadly infectious diseases.¹ Once symptoms begin, no treatment is available, and death is almost inevitable within weeks of symptom onset.¹ As above, rabies is responsible for approximately 59,000 annual deaths worldwide; this figure is likely a gross underestimate due to poor surveillance and underreporting.² Rabies is a scourge of the developing world, with more than 95% of cases arising in resource-limited countries in Africa and Asia; 35% of cases are found in India alone.² Children account for nearly half of human rabies cases.³ The estimated annual economic burden of rabies worldwide is $8.6 billion.²

Worldwide, 99% of human rabies deaths are attributed to bites from infected dogs.^1,3 In North America, Europe, and some countries in Latin America, rabies has been eliminated in domestic dogs due to widespread vaccination programs beginning in the early 1950s.³ (See Figure 1.) This successful public health effort has reduced the number of human rabies cases in the United States from more than 100 per year in the early 20th century to no more than 6 per year since 1960.^4,5 The canine rabies virus strain was eradicated from the United States in 2004, but dogs can occasionally acquire other strains from encounters with wildlife.¹

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.