Injection Anti rabies vaccine required in bites of which organisms?

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Anti-Rabies Vaccine (Post-Exposure Prophylaxis) - Indications by Animal

Rabies post-exposure prophylaxis (PEP) - which includes the anti-rabies vaccine (HDRV/Human Diploid Cell Rabies Vaccine) and often Rabies Immunoglobulin (RIG) - is required after bites/exposures from the following organisms:

HIGH RISK - Vaccine + RIG Required Immediately

1. Wild Carnivores (treat ALL as rabid unless lab-proven negative)

Bats (can harbor virus for many months even without symptoms)
Raccoons
Skunks
Foxes (red and gray)
Coyotes
Jackals / Wolves
Bobcats and other wild carnivores
Groundhogs

2. Domestic Animals (dogs, cats) - conditionally

If the animal is unavailable for observation, known to be rabid, or without up-to-date vaccination records - start full PEP immediately
If the animal is healthy and available for 10-day observation, treatment can be deferred - but start immediately if it develops any signs of rabies

MEDIUM RISK - Consult Public Health Authorities

These should be considered individually in consultation with local/state public health officials:

Livestock (cattle, horses, etc.) - cases of rabies in cattle are increasing
Ferrets
Lagomorphs (rabbits and hares)

LOW / NO RISK - Vaccine Generally NOT Required

Small rodents: squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice - "almost never call for anti-rabies prophylaxis" and have not been known to transmit rabies to humans
Cold-blooded animals: reptiles (snakes, lizards), fish, amphibians, birds - cannot transmit rabies
Insects - cannot transmit rabies

Key Decision-Making Questions (from Fitzpatrick's Dermatology)

Before initiating PEP, consider:

What is the rabies status in the geographic area of exposure?
Was the attack provoked or unprovoked? (Unprovoked = higher suspicion)
Species and size of the animal?
Health and vaccination record of the animal?
Can the animal's brain be examined within 48 hours?
Can the animal be quarantined for observation?

PEP Regimen (for reference)

Situation	Treatment
Previously unvaccinated	RIG (20 IU/kg) + HDRV on days 0, 3, 7, 14, 28
Previously vaccinated with documented immunity	HDRV only on day 0 and day 3 (no RIG)

First and most important step: Immediately and thoroughly wash the wound with soap and water, then scrub with green soap or 70% alcohol (rabicidal).

Summary Table

Animal Category	Vaccine Needed?
Dogs/cats (healthy, observable 10 days)	Defer; treat if animal develops signs
Dogs/cats (rabid, unavailable, unvaccinated)	YES - immediate PEP
Bats	YES - always
Wild carnivores (skunks, foxes, raccoons, coyotes, bobcats)	YES - always
Livestock, ferrets, rabbits	Consult public health
Small rodents (rats, mice, squirrels, hamsters)	Generally NO
Reptiles, fish, birds, insects	NO

Sources: Fitzpatrick's Dermatology, Vol. 1-2; Rosen's Emergency Medicine, 9e; Pye's Surgical Handicraft, 22nd Edition

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