Rabies post-exposure prophylaxis — DTM&H MCQ

Correct answer: B — Immediate wound washing, rabies vaccine and rabies immunoglobulin

The correct answer is B, immediate wound washing, rabies vaccine and rabies immunoglobulin. A deep, bleeding bite from an unvaccinated dog in a rabies-endemic country such as India is a WHO/UKHSA category III exposure (transdermal bite drawing blood), which carries the highest risk of transmission and mandates full post-exposure prophylaxis (PEP). UKHSA guidance specifies that category III exposures in a previously unvaccinated person require thorough wound washing with soap and water, a full course of rabies vaccine, and infiltration of human rabies immunoglobulin (HRIG) around the wound to neutralise virus before it reaches peripheral nerves. Rabies has essentially 100 percent case fatality once symptoms develop, so PEP must be initiated as soon as possible rather than delayed pending observation of the animal. Why the other options are wrong: D. Observation unless the dog becomes unwell: watching the dog wastes critical time and category III bites need PEP regardless of the animal's apparent health, since rabies status often cannot be confirmed in rural India. A. Rabies vaccine after symptoms develop: once clinical rabies manifests, vaccination is futile because the disease is almost invariably fatal; PEP only works before symptom onset. C. Oral amoxicillin-clavulanate without vaccination: antibiotics address secondary bacterial wound infection but have no effect on rabies virus and do not substitute for vaccine and immunoglobulin. E. Tetanus vaccine alone: tetanus prophylaxis should be reviewed alongside PEP but treating tetanus risk while ignoring rabies would leave the patient exposed to a near-universally fatal, preventable infection. Key point: any bleeding (transdermal) bite from a potentially rabid animal is category III exposure and requires wound washing plus both rabies vaccine and immunoglobulin, not vaccine alone or observation.

Reference: UKHSA, Guidelines on managing rabies post-exposure treatment (updated 2025), gov.uk/government/publications/rabies-post-exposure-prophylaxis-management-guidelines