Rabies

You may have been exposed to rabies if you were:

• Bitten by a type of animal that is known to transmit rabies virus and the animal cannot be tested. In NYC this includes raccoons and bats. In other areas of the U.S. it includes skunks, foxes, coyotes, and mongooses.
• Bitten by any animal that tests positive for rabies.
• Bitten by an animal suspected of being rabid but the animal cannot be tested.
• Bitten by a dog, cat, or ferret that is unavailable for testing or observation.
• In contact with a bat, found a bat in the room of a previously unattended child, or woke up to find a bat in the room.

Petting a rabid animal, or having contact with the blood, urine, or feces of a rabid animal, is not considered an exposure.

Rabbits and small rodents — including squirrels, hamsters, mice and rats — are not normally found to be infected with rabies, nor have there been any human rabies cases associated with them. Bites by these animals are usually not considered a rabies risk unless the animal was showing signs of rabies.

If you think you were exposed to rabies, follow these steps:

1. Immediately wash the wound with soap and water for 10 to 15 minutes. This will help kill and remove any virus that may have entered the wound.
2. If the exposure was from a dog or cat, try to get the pet owner's name, address, and phone number or get information for any person that may be able to identify the animal.
3. Report it through 311 or to your health care provider. This will help the Health Department follow up with the pet owner.
4. Contact your health care provider and ask if you need to be vaccinated.
5. If it is a wild animal, call 311 to report the bite, so that steps can be taken to capture and test the animal for rabies, if necessary. If you were exposed to a bat found in your home, close all windows and doors so it cannot escape until it can be captured. If the animal is tested, you will only need to be vaccinated if the animal tests positive.

It can be difficult to tell if a rabies exposure occurred. You should tell your health care provider about any injury from an animal or exposure to a bat within the household.

Human Rabies Vaccine

If your health care provider thinks you may have been exposed to rabies, they will recommend a preventive treatment called rabies postexposure prophylaxis (rPEP).

• For people who have never been vaccinated against rabies, rPEP includes:
  • Injection of rabies immune globulin and a dose of rabies vaccine (this is counted as day zero), followed by three additional doses of rabies vaccine on days three, seven and 14.
  • If you have a weakened immune system, your provider may recommend a fifth dose of vaccine on day 28, followed by a blood test to make sure your body responded to vaccination.
• For people who have been previously vaccinated against rabies, rPEP includes:
  • Two doses of rabies vaccine, one on day zero and a second on day three.

If administered appropriately after an exposure, rPEP can prevent infection.

Symptoms of rabies usually start to appear one to three months after exposure. In rare cases, symptoms have not shown up for several years.

Where to Get Rabies Postexposure Prophylaxis

People who are exposed and have never been vaccinated against rabies should always start the rPEP series in a hospital emergency room to ensure they receive both rabies immune globulin and their first dose of rabies vaccine. Emergency rooms are the only healthcare facilities in NYC that reliably have rabies immune globulin.

For the additional three recommended vaccine doses, people can do one of the following:

1. Return to the emergency room or any other emergency room.
2. Visit an urgent care clinic. Many CityMD sites and some hospital-based urgent care clinics have rabies vaccine available; call the location of your choice to ensure they have the vaccine on site. Most other urgent care sites do not offer rabies vaccine.
3. Arrange with your health care provider. Your provider may be able to order and administer rabies vaccine, though most providers do not do so.

You may want to check with your health insurance regarding vaccination coverage at different sites.

People who have previously completed a rabies preexposure or postexposure prophylaxis vaccine series and only need two booster doses of rabies vaccine can receive vaccine at an emergency room or anywhere that rabies vaccine is offered, as outlined above.

NYC Health + Hospitals provides emergency room care, regardless of anyone’s ability to pay. If you do not have health insurance, or need a discounted fee program based on your income and ability to pay, NYC Health + Hospitals makes health care services affordable for all New Yorkers through its financial assistance programs.