Management of Possible Rabies Exposure in Urgent Care | Points and Pearls

Urgent Care Management of Possible Rabies Exposure (Infectious Disease CME)

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Points & Pearls Excerpt

  • Worldwide, more than 95% of cases of rabies occur in Africa and Asia, with 35% in India alone; 99% of cases are from dog bites.
  • The canine virus strain of rabies was eradicated in the United States in 2004, although dogs can rarely acquire other strains from contact with wildlife.
  • In the United States, rabies is endemic in wild mammals, including foxes, coyotes, skunks, raccoons, and bats. Small rodents are rarely infected and have never been proven to transmit rabies.
  • In the United States from 1960 to 2018, 70% of cases of rabies were attributed to bats.
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Publication Information
Editor in Chief & Update Author

Keith Pochick, MD, FACEP
Novant GoHealth Urgent Care

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


Bess Storch, MD

Peer Reviewed By

Jason Chu, MD; Edward Otten, MD, FACMT, FAWM

Publication Date

June 1, 2022

CME Expiration Date

June 1, 2025    CME Information

CME Credits

4 AMA PRA Category 1 Credits™. 4 AOA Category 2-A or 2-B Credits.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits

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Charting Tips
  • Although clinical rabies is rare in the United States, potential exposures are not uncommon, and missing an exposure could lead to a uniformly fatal outcome.
  • Ask about and document any animal exposures for patients who have returned from endemic areas (eg, India, Africa, Asia).
  • Properly refer all patients who will be traveling to endemic areas to the health department or a travel medicine clinic for PrEP.
  • For a known animal exposure, bite, or skin injury, perform and document aggressive cleansing with iodine-containing solutions.
  • Ask about and document any situation in which a bat may have been present in a closed space, or any encounter (indoors or outdoors) that involved contact with a bat.
  • Document the rabies status of the involved animal, if possible, as well as the location of the incident and notification of animal control.
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