Test Your Knowledge of Possible Rabies Exposure (Postscript 3 of 4)

EBUC Postscripts
Management of Possible Rabies Exposure in Urgent Care | February 2022

A 38-year-old man presents to urgent care after sustaining a bite from a squirrel he trapped outside his home. He set up the trap in hopes of catching raccoons that had been raiding his trash in the previous weeks. The bite is on the patient’s left index finger and occurred about 2 hours prior to arrival. He has the live squirrel inside the trap in the back of his truck. He is worried about rabies exposure because his “cousin’s neighbor in Kentucky got rabies from a squirrel bite and died.” The patient’s tetanus status is current, as he has documented evidence of a Tdap vaccination 3 years ago in his electronic medical record.

On examination, there are 2 small puncture-type wounds on the radial side of the left index finger midway between the MCP and PIP joints. The wounds are faintly oozing but not gaping. The affected finger has full sensation, range of motion, and capillary refill.

What is the best course of action in the management of this patient?

A. Cleanse the wound and refer the patient to the emergency department for rabies postexposure prophylaxis (PEP).

B. Cleanse and dress the wound; reassure the patient that squirrels have never been proven to transmit rabies to humans and that PEP in this scenario is not recommended. 

C. Cleanse the wound, notify county animal control so that they can acquire the squirrel, euthanize it, and test it for rabies.

D. Refer the patient for PEP; have him bring the squirrel as well so that it can be vaccinated prior to its release.

Answer:  B. There is no indication to administer PEP or rabies vaccination to either the patient or the squirrel. Small rodents such as squirrels, chipmunks, rats, and mice, as well as rabbits and hares, are rarely infected and are not known to transmit rabies to humans.

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Last Updated on June 28, 2022

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