Rabies Risk Assessment: Test Your Knowledge

Erin R. Whitehouse, PhD, MPH, RN


August 08, 2019

Editorial Collaboration

Medscape &

Rabies Exposure Risk Assessment

Although not the primary reservoirs of rabies in the United States, other mammals and wildlife, including opossums, can occasionally contract rabies virus. Furthermore, rabies virus is transmitted via contact with saliva, tears, or nervous tissue, primarily via a bite or scratch. In this instance, given that the two children only had contact with the tail of the animal and did not sustain any bites or scratches, this would not be considered a possible exposure.[1]

Administration of PEP is a critical and life-saving intervention for a known or potential rabies exposure. However, it is a limited resource with potential side effects, and can be costly (upward of $3600 for biologics alone).[3] PEP is safe, but severe adverse events, such as anaphylaxis, can occur. Common side effects of rabies vaccine are mild and include headache, fever, nausea, dizziness, and pain at the injection site.[9,10] Human rabies immunoglobulin is generally only available in emergency departments, and four doses of rabies vaccine are given over 2 weeks. Administration should always be based on a risk assessment.

Although this scenario did not require PEP, some parents may request vaccination for their child "just to be on the safe side." Healthcare providers should avoid unnecessary vaccination and consult with local or state public health departments if they have questions about rabies risk in their area or individual potential exposures. ACIP guidelines also provide recommendations for rabies exposure and administration of rabies pre- and postexposure prophylaxis.[1,2]

Follow Medscape on Facebook, Twitter, Instagram, and YouTube


ACIP Recommendations: Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies


Rabies and Kids