What To Do After a Bite: Post-Exposure Prophylaxis (PEP)
If you've been bitten or scratched by a potentially rabid animal, immediate action is critical. This medically reviewed checklist explains wound care, rabies immune globulin, and vaccine timing so you can begin PEP without delay.
Author
Dr. Emily Rodriguez, MD, Emergency Medicine
Emergency Physician & PEP Protocol Lead
Dr. Rodriguez manages rabies exposure cases in a Level I trauma center and teaches evidence-based PEP workflows.
Medical review
Reviewed by Dr. Huma Ashraf, MBBS, FCPS — January 20, 2025
Key Steps
Wash the wound immediately with soap and water for 15 minutes
Seek medical attention right away
Contact your local health department
Start PEP if recommended by healthcare provider
Report the bite to animal control so the animal can be observed or tested
Detailed Steps
Immediate Wound Care
Clean the wound thoroughly as soon as possible. This is the most important step to reduce viral load.
- Wash the wound with soap and running water for at least 15 minutes
- If available, irrigate the wound with povidone-iodine solution
- Avoid closing the wound with sutures if possible (wait until after rabies immune globulin is infiltrated)
- Apply a clean bandage to prevent infection
Seek Medical Attention Immediately
Go to an emergency room or urgent care center right away. Do not wait for symptoms to appear.
- Bring information about the animal if available (vaccination status, owner contact, capture details)
- Tell healthcare providers about the bite/scratch immediately
- Request evaluation for rabies PEP
- Ask about tetanus prophylaxis and antibiotic prophylaxis if needed
Contact Local Health Department
Your local health department can help assess the risk and coordinate with animal control.
- Report the bite to your local health department
- Provide details about the animal and circumstances
- Follow their guidance on observation or testing of the animal
- Coordinate PEP administration if recommended
Assess the Animal
If the animal is available, it can be observed or tested to determine if PEP is needed.
- If it's a healthy dog, cat, or ferret: observe for 10 days (if it stays healthy, PEP may not be needed)
- If the animal can be tested: rapid testing can determine if PEP is necessary
- If it's wildlife or unknown: PEP is usually recommended immediately
- If the animal cannot be found: PEP is typically recommended
Start PEP if Recommended
Post-exposure prophylaxis includes rabies immune globulin (RIG) and a series of vaccines.
- If previously unvaccinated: Receive HRIG (20 IU/kg) infiltrated into the wound on Day 0 (up to Day 7) and vaccine on Days 0, 3, 7, 14 (add Day 28 if immunocompromised).
- If previously vaccinated: Receive vaccine only on Days 0 and 3 (no HRIG).
- Do not inject HRIG and vaccine in the same anatomical site; avoid gluteal injections for vaccine.
- Follow up for all scheduled doses and report any side effects to your healthcare provider.
Follow Up Care
Complete the full PEP series and monitor for any complications.
- Attend all scheduled vaccine appointments
- Monitor the wound for signs of infection
- Watch for any side effects from PEP
- Contact your healthcare provider with any concerns
When PEP Is Needed
PEP is needed if:
- You were bitten or scratched by a wild animal (bats, raccoons, skunks, foxes, etc.)
- You were bitten or scratched by an unvaccinated or unknown-status domestic animal
- You had contact with a bat (even without a visible bite)
- The animal cannot be observed for 10 days or tested
- The animal shows signs of rabies or tests positive
- You had contact with an animal's saliva on broken skin or mucous membranes
Category III exposures (bites, scratches, or mucous membrane contact) require both HRIG and vaccine as soon as possible (CDC).
When PEP Is Not Needed
PEP may not be needed if:
- A healthy dog, cat, or ferret can be observed for 10 days and remains healthy
- The animal tests negative for rabies
- You were only exposed to a vaccinated animal with current vaccination status
- Public health determines the risk is negligible (for example, contact with intact skin)
Important: Always follow the guidance of your healthcare provider and local health department. When in doubt, err on the side of caution and start PEP while officials assess the animal.
Side Effects & Safety
Common side effects of PEP vaccines:
- Pain, redness, or swelling at the injection site
- Headache
- Nausea
- Muscle aches
- Dizziness
Serious side effects are rare:
- Severe allergic reactions (anaphylaxis) - very rare
- Guillain-Barré syndrome - extremely rare
Safety: PEP is safe for pregnant women and children. Pregnancy and pediatric age are NOT contraindications to PEP.
Source: CDC Rabies Medical Care
Costs & Insurance
Cost considerations:
- PEP can be expensive, ranging from $1,000 to $6,000 or more in the United States
- Most health insurance plans cover PEP when medically necessary
- Some states have programs to help cover costs for uninsured individuals
- Contact your local health department for information about financial assistance and find clinics that offer PEP
- Some hospitals offer payment plans
Note: The cost of PEP is far less than the cost of treating rabies once symptoms appear (which is almost always fatal). Do not delay PEP due to cost concerns - discuss payment options with your healthcare provider.
Tip: Ask your health department about vaccine assistance programs if you are uninsured.
Find PEP Clinics
Locate a clinic near you that provides post-exposure prophylaxis (PEP) treatment.
Find a Clinic Near YouRabies Laws by State
Legal requirements can influence observation periods, reporting, and vaccination documentation after an exposure.
Compare Texas, Florida, and New York, then review our prevention blog category, find treatment at clinic finder, and check urgency with the risk assessment tool.
Frequently Asked Questions
How long do I have to start PEP after a bite?
PEP should be started as soon as possible after exposure. The sooner you start, the more effective it is. However, PEP can still be effective if started days or even weeks after exposure, as long as symptoms have not appeared. Do not delay seeking care.
What if I can't find the animal?
If the animal cannot be found, observed, or tested, PEP is typically recommended. Your healthcare provider and local health department will help determine the best course of action based on the circumstances.
Can I skip a dose of the PEP vaccine?
No. It is important to complete the full PEP series as scheduled. Missing doses can reduce effectiveness. If you miss a dose, contact your healthcare provider immediately to reschedule.
Is PEP safe during pregnancy?
Yes. PEP is safe and recommended during pregnancy. The risk of rabies far outweighs any theoretical risk from PEP. Pregnant women should receive the same PEP protocol as non-pregnant individuals.
What if the animal was vaccinated?
If you can confirm the animal is currently vaccinated against rabies, PEP may not be needed. However, the animal should still be observed for 10 days if possible. Always consult with your healthcare provider and local health department.
How effective is PEP?
PEP is nearly 100% effective when started promptly after exposure and before symptoms appear. This is why immediate medical attention is critical.
What is rabies immune globulin (RIG)?
RIG is a medication that provides immediate, temporary protection against rabies. It contains antibodies that neutralize the virus at the site of exposure. It is given once, ideally on Day 0, and infiltrated into and around the wound.
Can I get PEP at any hospital?
Not all hospitals stock rabies vaccines and RIG. Emergency departments and urgent care centers are most likely to have them. Your local health department can help you locate a facility that provides PEP.
What if the animal is located later and tests negative?
If the animal tests negative for rabies by an approved laboratory, public health officials may advise discontinuing PEP even if doses have started.
Do I need PEP after touching a bat without a visible bite?
Yes—if a bat was in direct contact with you or was found in a room with a sleeping person, infant, or impaired individual, PEP is recommended because bat bites can be difficult to detect.