The likelihood of rabies in a domestic animal varies regionally, and the need for postexposure prophylaxis also varies on the basis of regional epidemiology. Because rabies biologics are valuable resources that are periodically in short supply, a risk assessment weighing potential adverse consequences associated with administering postexposure prophylaxis along with their severity and likelihood versus the actual risk for the person acquiring rabies should be conducted in each situation involving a possible rabies exposure. All bites by such wildlife should be considered possible exposures to rabies virus. Nonbite exposures other than organ or tissue transplants have almost never been proven to cause rabies, and postexposure prophylaxis is not indicated unless the nonbite exposure met the definition of saliva or other potentially infectious material being introduced into fresh, open cuts in skin or onto mucous membranes. Administration of rabies postexposure prophylaxis is a medical urgency, not a medical emergency. Because the period of rabies virus shedding in wild animal hybrids is unknown, when such animals bite humans euthanasia and rabies testing of the hybrid animal is the safest course of action.



Under all three cost-effectiveness scenarios, the analysis determined that it is always cost saving to administer postexposure prophylaxis if a patient is bitten by a rabid animal that has tested positive for rabies or if a patient is bitten by a reservoir or vector species (e.g. skunk, raccoon, bat, or fox bite in the United States or dog bite in countries with dog variant rabies), even if the animal is not available for testing. Other factors that might influence the urgency of decision-making regarding the initiation of postexposure prophylaxis before diagnostic results are known include the species of the animal, the general appearance and behavior of the animal protection league, whether the encounter was provoked by the presence of a human, and the severity and location of bites. In six cases, a bite was reported; in two cases, contact with a bat and a probable bite were reported; in 15 cases, physical contact was reported (e.g., the removal of a bat from the home or workplace or the presence of a bat in the room where the person had been