Rabies Post-Exposure Prophylaxis (PEP) Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Exposure category (WHO)
   WHO exposure category? (Immediately and thoroughly wash all wounds (soapy water and running water ≥15 min + povidone-iodine). Category I = touching/feeding animals, licks on intact skin (non-exposure); category II = minor bites without bleeding, minor scratches; category III = transdermal bites/scratches, licks on broken skin, mucosa contaminated by saliva, bat contact.)
   • Category I (intact-skin contact) → Category I
   • Category II (minor injury without bleeding) → Category II
   • Category III (transdermal/mucosa/bat) → Category III
2. [End] Category I
   Intact-skin contact, non-exposure — no vaccine or immunoglobulin needed; if uncertain, wash the contact site and assess the animal.
3. [End] Category II
   Thoroughly wash and disinfect the wound + vaccinate as soon as possible (full course of cell-culture vaccine, by the 5-dose Essen or 2-1-1 schedule). Immunocompromised patients are treated as category III with added immunoglobulin. A 10-day observation of the suspect animal can be done (where applicable).
4. [End] Category III
   Thoroughly wash and disinfect + vaccinate as soon as possible + rabies immunoglobulin (human HRIG 20 IU/kg or equine ERIG 40 IU/kg), infiltrating around the wound as much as possible, remainder IM away from the vaccine site; never use the same syringe/site as the vaccine. Those already fully immunized need only 2 booster doses (days 0 and 3), no immunoglobulin.

Source guidelines & references

• WHO rabies vaccine position paper and post-exposure prophylaxis (category I/II/III)
• China rabies exposure prophylaxis technical guideline

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways