Rabies kills tens of thousands of people every year, according to WHO, mostly in Africa and Asia, and around 40% of victims are children. Almost all human cases come from dog bites. Once symptoms appear, rabies is virtually always fatal. But with prompt post-exposure prophylaxis (PEP), it is almost always preventable. Nurses in emergency departments and clinics are often the first to see bite victims, and what they do in the first hour matters.
Step 1: Wash the wound immediately
Wash the bite or scratch thoroughly with soap and running water for about 15 minutes, then apply an antiseptic such as povidone-iodine or alcohol if available. This simple step greatly reduces the risk of rabies. Avoid suturing wounds immediately if possible; if suturing is necessary, infiltrate rabies immunoglobulin first.
Step 2: Classify the exposure (WHO)
| Category | Type of contact | Action |
|---|---|---|
| I | Touching or feeding animals; licks on intact skin | No PEP needed |
| II | Nibbling of uncovered skin; minor scratches or abrasions without bleeding | Wound washing and vaccine |
| III | One or more bites or scratches that break the skin; licks on broken skin; contamination of mucous membranes with saliva; any contact with bats | Wound washing, vaccine and rabies immunoglobulin (RIG) |
Step 3: Rabies vaccine
WHO’s 2018 recommendations include shorter regimens, for example the intradermal 1-week regimen (2 sites on days 0, 3 and 7) or the intramuscular regimens (e.g. 4 doses over 2–3 weeks). Follow your national schedule. Start as soon as possible, even if the bite was days or weeks ago, because the incubation period can be long. Don’t wait to observe the dog before starting.
Step 4: Rabies immunoglobulin (for category III)
RIG provides immediate antibodies while the vaccine takes effect. As much as possible should be infiltrated into and around the wound. It is often in short supply and expensive; WHO guidance prioritises it for severe exposures. Monoclonal antibody products are available in some countries.
Other wound care
- Tetanus prophylaxis according to vaccination status. See our tetanus guide.
- Antibiotics for high-risk bites (deep, hand or face wounds, or signs of infection), as prescribed.
- Document the animal (owned or stray, vaccinated or not, behaviour) and report the bite to public health or veterinary services.
Recognising rabies
Early symptoms include fever and pain or tingling at the bite site. The “furious” form causes agitation, hallucinations, hydrophobia (fear of water, with throat spasms when trying to drink) and aerophobia (spasms with air on the face). The “paralytic” form causes gradual weakness. Death usually follows within days.
Caring for a patient with rabies
- Care focuses on comfort and dignity: a quiet, dim room; sedation and pain relief as prescribed; support for the family.
- Use standard precautions with gloves, gowns, masks and eye protection to avoid contact with saliva. Human-to-human transmission is extremely rare, but staff with exposures should be assessed for PEP.
Prevention: Zero by 30
WHO and partners aim for zero human deaths from dog-mediated rabies by 2030. The most effective strategy is vaccinating at least 70% of dogs. Nurses can teach communities, especially children, to avoid stray dogs, to wash bites immediately and to seek care the same day. Pre-exposure vaccination is recommended for people at high occupational risk, such as veterinary workers.
Based on WHO rabies fact sheets and the WHO position paper on rabies vaccines (2018). Educational content: follow national rabies PEP guidelines.