Rabies Algorithm Continued
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Dog, Cat or Ferret: Animal is NOT Available for Testing
Considering searching for animal (1,2)
If animal cannot be found, post-exposure prophylaxis is generally indicated. (3)
However, if the animal was not exhibiting signs of rabies at the time of the attack, and is known to have been current on rabies vx. (especially if it had been vaccinated more than once during its lifetime), and the bite was provoked, and the wound was promptly cleansed with soap and water, then the risk of rabies transmission is probably low enough to forego prophylaxis, although the the clinician and the patient should realize that the risk is not absolutely zero. Consult with physician and public health officials to discuss circumstances in more detail.
(1) Confirm that bite victim will be able to definitely identify the biting animal before initiating search.
(2) The question of how long prophylaxis can be delayed while searching for the animal is a judgment call. There is no unequivocally "safe" period to wait. In general, if the animal showed no clinical signs of rabies, and the bite was provoked and did not involve wounds to the head/neck or to highly innervated areas, and if the wound was washed promptly and thoroughly with soap and water, it is usually reasonable to delay prophylaxis for 48-72 hours after the bite incident if there is a realistic chance of capturing the biting animal.