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Table 1 Criteria for rabies risk assessment and recommended PEP prescription in case of potential exposure to “suspect or rabid animals”, extracted from the WHO adapted National Rabies Management Guidelines (2014) in Bhutan

From: Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan

Exposure typeRisk categoryRecommended PEP
Licks on intact skin, touching, feeding of animals.
1Consumption of butter, curd, cheese, whey (dachu), cooked meat.
Petting, bathing or coming in contact with utensils used on a suspected rabid animal.
None (Category 1)Not recommended, if reliable case history available.
Person consuming unboiled or unpasteurized milk, buttermilk, uncooked meat from rabid animal.
Nibbling of uncovered skin by potentially rabid animal.
Minor scratches or abrasions without bleeding.
Person who handles or prepares meat or handles carcass of rabid animals.
Moderate (Category 2)Wound management, as appropriate
Provide anti-rabies vaccine immediately
Stop vaccination if animal remains healthy throughout the observation period of 10 days or if the animal is proven to be negative for rabies by a reliable laboratory using an appropriate diagnostic technique
Single or multiple transdermal bites or scratches
Licks on broken skin
Contamination with mucous membrane with saliva (i.e. licks or splash on oral cavity, eyes, nose, external genitalia)
Severe (Category 3)Wound management
Provide anti-rabies vaccine immediately
Provide rabies immunoglobulin
Stop vaccination if animal remains healthy as described above in Category 2