Medical and veterinary care providers should combine epidemiologic data on animal rabies in the region where the exposure occurred with an assessment of the circumstances surrounding the actual patient exposure when formulating post-exposure prophylaxis recommendations. Dog and cat bites represent the most common potential exposure to rabies. Vaccination of pets remains the most sensible measure to reduce human exposure. Other important rabies-control measures include stray animal control, education of the general public regarding wild animal contact, and legislation controlling the acquisition of wild animals as pets (most notably raccoons, black footed ferrets, skunks, and foxes).
Criteria for assessing rabies exposure
The following definitions are provided to assist health care personnel in deciding on the need for post-exposure prophylaxis.
Human Exposure: Any situation in which a person experiences percutaneous or mucous membrane exposure to saliva or to central nervous system (CNS) tissue of a potentially rabid animal. Touching or handling a potentially rabid animal or another animal or inanimate object that has had contact with a rabid animal does not constitute an exposure unless wet saliva or CNS tissue entered a fresh, open wound or had contact with a mucous membrane. A physician should be consulted to assess any potential exposure.
Provoked Attack: An attack is considered "provoked" if a domestic animal is placed in a situation such that an expected reaction would be to bite or attack. This would include, but not be limited to:
the invasion of an animal's territory,
an attempt to pet or handle an unfamiliar animal,
startling an animal,
running or bicycling past an animal,
assisting an injured or sick animal,
trying to capture an animal, or
removing food, water or other objects in the animal's possession.
Unprovoked Attack: An "unprovoked" attack or bite occurs when an animal strikes for no apparent reason. The behavior should be unusual for the particular animal. A confirmation of chronic aggressive behavior can often be made by interviewing the animal's owner. This will assist in determining whether the attack was indeed "unprovoked."
State and local health department personnel are available to advise medical and veterinary providers, and the public on issues surrounding rabies.