When should a patient receive postexposure prophylaxis against rabies? In the case of animal bites, what if the animal cannot be found?
—Felix N. Chien, DO, Newport Beach, Calif.

According to the CDC, “administration of rabies postexposure prophylaxis (PEP) is a medical urgency, not a medical emergency” (MMWR Recomm Rep. 1999;48[RR 1]:1-21). Rabies exposure results from animal contact, mostly bites, although human-to-human transmission has occurred rarely after organ transplantation. In the United States, a healthy domestic dog, cat, or ferret that bites a person may be confined and observed for 10 days. Bites by bats, skunks, raccoons, and foxes have the highest potential for exposure to the rabies virus. In the latter setting, regardless of whether the animal can be located for follow-up testing, PEP should be initiated and public health officials should be contacted for assistance.
—Cedric W. Spak, MD, MPH