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Urgent Care Management of Possible Rabies Exposure

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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

Author

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

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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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